Clinical Application of Transient Elastography in the Diagnosis of Liver Fibrosis: an Expert Panel Review and Opinion

Abstract

Liver fibrosis evaluation is pivotal for treatment decisions and prognosis assessment in patients with chronic liver disease. Liver transient elastography (TE) is a newly developed non-invasive technique for diagnosis of liver fibrosis. It can assess the state of liver fibrosis by liver stiffness measurements, and offers better performance for the diagnosis of liver cirrhosis than serum biological markers. It has now been approved for clinical use in China. The aim of this review is to provide a guide for clinicians to apply this technique appropriately. The recommendations are made under the auspices of China Foundation for Hepatitis Prevention and Control, and have been prepared by a panel experts, who have reviewed and summarized the clinical studies on TE in order to develop these recommendations.

Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

“…The optimum cut-off value for F ≥2 was 6.6 kPa in the present study, which was slightly lower than the values for NAFLD (6.9 kPa) and CHB patients (7.2 kPa). However, the optimum cut-off values for F ≥3 and F=4 were 8.7 kPa and 10.9 kPa, which were intermediate values between those for NAFLD (8.4 kPa and 10.3 kPa) and CHB patients (9.4 kPa and 12.2 kPa) [24, 26, 29]. This variation may be explained by the degree of hepatic steatosis.…”

“…A previous study indicated that hepatic steatosis could influence the architectural structure of the liver, potentially changing the propagation time of the vibratory wave through the liver [30]. Statistical analysis indicated that cut-off values with a PLR >10.0 offer sufficient confidence to confirm the diagnosis, while an NLR <0.1 provides enough confidence to exclude the diagnosis [29]. In our study, the cut-off value of 10.9 kPa for assessing cirrhosis had a PLR of 14.9 and an NLR of 0.08.…”

Clinical spectrum of non-alcoholic fatty liver disease in patients with diabetes mellitus

“…Nevertheless, TE has been endorsed as an alternative to liver biopsy by international guidelines in guiding clinical management of chronic liver disease, including NAFLD [ 11 , 32 ]. The diagnostic performance for NAFLD fibrosis was excellent using a cut-off value of 9.6kPa, with a positive likelihood ratio (PLR) of 8.9 and the AUROC of 0.93 for ≥F3 fibrosis [ 18 ]. Therefore, TE may be a valid and accurate modality in assessing NAFLD fibrosis in a real-world community-based setting where liver biopsy is not practical for all subjects.…”

“…Fibroscan examination was performed at the same study visit. We used increased controlled attenuated parameter (CAP) value of more than 248 dB/m to define the presence of �S1 hepatic steatosis and Liver Stiffness Measurement (LSM) of 9.6 kPa or more for � F3 liver fibrosis [18,19]. Performance of Fibroscan was based on manufacturer's recommendations.…”

“…The Fibroscan result was considered reliable if 10 or more valid measurements were acquired. A success rate of more than 60% and the ratio of the interquartile range to the median of 10 measurements (IQR/M) being 0.3 or less defined successful readings [18]. All subjects provided written informed consent prior to study participation.…”