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  • Review Article
  • Published:

Critical comparison of elastography methods to assess chronic liver disease

Nature Reviews Gastroenterology & Hepatology volume 13, pages 402–411 (2016)Cite this article

Subjects

Key Points

  • Ultrasound-based shear wave elastography methods enabling liver stiffness measurements have been implemented for noninvasive assessment of liver fibrosis, with biopsy reserved for uncertain aetiologies

  • Transient elastography is currently the most widely used technique

  • A combination of ultrasound-based shear wave elastography methods with serum biomarkers improves the diagnostic utility for clinically significant fibrosis

  • The results of magnetic resonance elastography are promising, but accessibility and cost will determine the extent of its use

  • Noninvasive imaging using transient elastography can be used for prognosis in patients with chronic liver disease

Abstract

Staging of liver fibrosis and diagnosis, or exclusion, of early compensated liver cirrhosis are important in the treatment decisions and surveillance of patients with chronic liver disease. Good diagnostic accuracy, increased availability and the possibility to perform follow-up examinations led to the implementation of noninvasive methods into clinical practice. Noninvasive tests are increasingly included in national and international guidelines, leaving liver biopsy reserved for patients with unexplained discordance or suspected additional aetiologies of liver disease. In addition to staging of liver fibrosis, data on the prognostic value of these methods have increased in the past few years and are of great importance for patient care. This Review focuses on elastography methods for noninvasive assessment of liver fibrosis, disease severity and prognosis. Although liver elastography started with transient elastography, at present all large ultrasonography companies offer an elastography technique integrated in their machines. The goal of this Review is to summarize the methodological problems of noninvasive tests in general, in addition to providing an overview on currently available techniques and latest developments in liver elastography.

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Figure 1: Example of a diagnostic algorithm for interpreting transient elastography measurement results in liver disease.

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Authors and Affiliations

  1. Department of Internal Medicine, J.W. Goethe-University Hospital, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany

    Mireen Friedrich-Rust

  2. Hepatology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, 47–83 Boulevard de l'Hôpital, Paris, 75013, France

    Thierry Poynard

  3. Université Pierre et Marie Curie, INSERM, UMR-S 938, 57 Boulevard de l'Hôpital, Paris, 75013, France

    Thierry Poynard

  4. Department of Hepatology, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, 100 Boulevard du General Leclerc, Clichy, 92110, France

    Laurent Castera

  5. Université Paris VII, INSERM UMR 1149, Centre de Recherche sur l'Inflammation, 16 Rue Huchard, Paris, 75018, France

    Laurent Castera

Authors
  1. Mireen Friedrich-Rust
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  2. Thierry Poynard
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  3. Laurent Castera
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All authors made equal contributions to all aspects of this manuscript.

Corresponding author

Correspondence to Mireen Friedrich-Rust.

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Competing interests

M.F.-R. has received equipment funding support from Echosens (Paris, France), Siemens (Munich, Germany) and Supersonic Imagine (Aix-en-Provence, France). L.C. has received some lecture fees from Echosens and BioPredictive. T.P. is the inventor of FibroTest and SteatoTest, and is the founder of BioPredictive, the company that markets these tests. Patents belong to the French Public Organization Assistance Publique-Hôpitaux de Paris (APHP).

Supplementary information

Supplementary Table 1

Diagnostic performance of transient elastography for the detection of clinically significant portal hypertension (PDF 136 kb)

Supplementary Table 2

Performance of baseline liver stiffness values obtained using transient elastography for predicting development of HCC in patients with chronic liver disease during longitudinal prospective studies (PDF 157 kb)

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Friedrich-Rust, M., Poynard, T. & Castera, L. Critical comparison of elastography methods to assess chronic liver disease. Nat Rev Gastroenterol Hepatol 13, 402–411 (2016). https://doi.org/10.1038/nrgastro.2016.86

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