Skip to main content
SpringerLink
Log in

Liver Stiffness by Ultrasound Elastography

  • Chapter
  • First Online:
Book cover Diagnostic Methods for Cirrhosis and Portal Hypertension

Abstract

Over the past decade, non-invasive methods have been increasingly validated and used for staging liver fibrosis. Among these methods, transient elastography (TE) (FibroScan™, Echosens, Paris, France), an ultrasound-based technique allowing to measure liver stiffness (LS), has reached an established role in clinical practice, and is now routinely used worldwide, particularly in viral hepatitis [1]. Given its excellent performance for diagnosing cirrhosis (with mean AUROC values above 0.90), TE use has been recommended as first line tool for prioritizing patients for HCV therapy, based on disease stage, by several international guidelines [2–4]. With the wide availability of TE, most patients are currently diagnosed at a very initial stage of cirrhosis, in which clinically significant portal hypertension (CSPH, defined by an hepatic venous gradient pressure (HVPG) ≥10 mmHg) or eosophageal varices (OV) are often absent. In order to better reflect the fact that the spectrum of severe fibrosis and cirrhosis is a continuum in asymptomatic patients, and that distinguishing between the two is often not possible on clinical grounds, the alternative term “compensated advanced chronic liver disease (cACLD)”, defined by LS >10 kPa using TE, has been proposed by the Baveno VI consensus on PH [5]. In this new scenario, a large proportion of HVPG measurements and screening endoscopy may be unnecessary. Therefore, efforts should be directed at limiting these procedures to those patients at higher risk of CSPH and varices, so as to reducing healthcare cost and lessen patients’ discomfort [6]. Alternative ultrasound-based elastography techniques, such as point shear wave elastography (pSWE), also known as acoustic radiation force impulse imaging (ARFI) and 2D-shearwave elastography (2D-SWE) have also been proposed [7]. This chapter is aimed at reviewing the role of LS measurement, using the different available ultrasound elastography techniques (TE, pSWE and 2D SWE), for the prediction and the follow-up of patients with portal hypertension (PH).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology. 2012;142:1293–302. e1294

    Article  PubMed  Google Scholar 

  2. EASL-ALEH Clinical Practice Guidelines. Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63:237–64.

    Article  Google Scholar 

  3. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (short version). Ultraschall Med. 2017;38(4):377–94.

    Article  PubMed  Google Scholar 

  4. Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, Cosgrove D, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3. Liver. Ultrasound Med Biol. 2015;41:1161–79.

    Article  PubMed  Google Scholar 

  5. de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63:743–52.

    Article  PubMed  Google Scholar 

  6. Berzigotti A, Bosch J, Boyer TD. Use of noninvasive markers of portal hypertension and timing of screening endoscopy for gastroesophageal varices in patients with chronic liver disease. Hepatology. 2014;59:729–31.

    Article  PubMed  Google Scholar 

  7. Berzigotti A, Castera L. Update on ultrasound imaging of liver fibrosis. J Hepatol. 2013;58:180–2.

    Article  Google Scholar 

  8. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705–13.

    Article  PubMed  Google Scholar 

  9. Roulot D, Czernichow S, Le Clesiau H, Costes JL, Vergnaud AC, Beaugrand M. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol. 2008;48:606–13.

    Article  PubMed  Google Scholar 

  10. Friedrich-Rust M, Poynard T, Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat Rev Gastroenterol Hepatol. 2016;13:402–11.

    Article  PubMed  Google Scholar 

  11. Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48:835–47.

    Article  PubMed  Google Scholar 

  12. Boursier J, Zarski JP, de Ledinghen V, Rousselet MC, Sturm N, Lebail B, Fouchard-Hubert I, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57:1182–91.

    Article  PubMed  Google Scholar 

  13. Castera L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, Couzigou P, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51:828–35.

    PubMed  Google Scholar 

  14. Myers RP, Pomier-Layrargues G, Kirsch R, Pollett A, Duarte-Rojo A, Wong D, Beaton M, et al. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology. 2012;55:199–208.

    Article  PubMed  Google Scholar 

  15. Arena U, Lupsor Platon M, Stasi C, Moscarella S, Assarat A, Bedogni G, Piazzolla V, et al. Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution. Hepatology. 2013;58:65–72.

    Article  CAS  PubMed  Google Scholar 

  16. Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, Darriet M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128:343–50.

    Article  PubMed  Google Scholar 

  17. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Ledinghen V, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48–54.

    Article  PubMed  Google Scholar 

  18. Corpechot C, El Naggar A, Poujol-Robert A, Ziol M, Wendum D, Chazouilleres O, de Ledinghen V, et al. Assessment of biliary fibrosis by transient elastography in patients with PBC and PSC. Hepatology. 2006;43:1118–24.

    Article  PubMed  Google Scholar 

  19. Ganne-Carrie N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L, Dhumeaux D, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases. Hepatology. 2006;44:1511–7.

    Article  PubMed  Google Scholar 

  20. Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, Bertet J, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006;55:403–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Fraquelli M, Rigamonti C, Casazza G, Conte D, Donato MF, Ronchi G, Colombo M. Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease. Gut. 2007;56:968–73.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Coco B, Oliveri F, Maina AM, Ciccorossi P, Sacco R, Colombatto P, Bonino F, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat. 2007;14:360–9.

    Article  CAS  PubMed  Google Scholar 

  23. Arena U, Vizzutti F, Abraldes JG, Corti G, Stasi C, Moscarella S, Milani S, et al. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C. Gut. 2008;57:1288–93.

    Article  CAS  PubMed  Google Scholar 

  24. Yoneda M, Yoneda M, Mawatari H, Fujita K, Endo H, Iida H, Nozaki Y, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis. 2008;40:371–8.

    Article  CAS  PubMed  Google Scholar 

  25. Nobili V, Vizzutti F, Arena U, Abraldes JG, Marra F, Pietrobattista A, Fruhwirth R, et al. Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis. Hepatology. 2008;48:442–8.

    Article  CAS  PubMed  Google Scholar 

  26. Nahon P, Kettaneh A, Tengher-Barna I, Ziol M, de Ledinghen V, Douvin C, Marcellin P, et al. Assessment of liver fibrosis using transient elastography in patients with alcoholic liver disease. J Hepatol. 2008;49:1062–8.

    Article  PubMed  Google Scholar 

  27. Nguyen-Khac E, Chatelain D, Tramier B, Decrombecque C, Robert B, Joly JP, Brevet M, et al. Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with 7 non-invasive laboratory tests. Aliment Pharmacol Ther. 2008;28:1188–98.

    Article  CAS  PubMed  Google Scholar 

  28. Marcellin P, Ziol M, Bedossa P, Douvin C, Poupon R, de Ledinghen V, Beaugrand M. Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int. 2009;29:242–7.

    Article  PubMed  Google Scholar 

  29. Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, Chan FK, et al. Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009;16:36–44.

    Article  PubMed  Google Scholar 

  30. Wong VW, Vergniol J, Wong GL, Foucher J, Chan HL, Le Bail B, Choi PC, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51:454–62.

    Article  CAS  PubMed  Google Scholar 

  31. Degos F, Perez P, Roche B, Mahmoudi A, Asselineau J, Voitot H, Bedossa P. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010;53:1013–21.

    Article  PubMed  Google Scholar 

  32. Zarski JP, Sturm N, Guechot J, Paris A, Zafrani ES, Asselah T, Boisson RC, et al. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study. J Hepatol. 2012;56:55–62.

    Article  PubMed  Google Scholar 

  33. Chon YE, Choi EH, Song KJ, Park JY, Kim do Y, Han KH, Chon CY, et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS One. 2012;7:e44930.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960–74.

    Article  PubMed  Google Scholar 

  35. Stebbing J, Farouk L, Panos G, Anderson M, Jiao LR, Mandalia S, Bower M, et al. A meta-analysis of transient elastography for the detection of hepatic fibrosis. J Clin Gastroenterol. 2010;44:214–9.

    Article  PubMed  Google Scholar 

  36. Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2007;5:1214–20.

    Article  PubMed  Google Scholar 

  37. Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol. 2011;54:650–9.

    Article  CAS  PubMed  Google Scholar 

  38. Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat. 2012;19:e212–9.

    Article  CAS  PubMed  Google Scholar 

  39. Nierhoff J, Chavez Ortiz AA, Herrmann E, Zeuzem S, Friedrich-Rust M. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol. 2013;23:3040–53.

    Article  PubMed  Google Scholar 

  40. Hu X, Qiu L, Liu D, Qian L. Acoustic Radiation Force Impulse (ARFI) elastography for noninvasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis. Med Ultrason. 2017;19:23–31.

    Article  PubMed  Google Scholar 

  41. Bota S, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM, Peck-Radosavljevic M. Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 2013;33:1138–47.

    Google Scholar 

  42. Herrmann E, de Lédinghen V, Cassinotto C, Chu WC, Leung VY, Ferraioli G, et al. ​Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology. 2018;67(1):260–72.

    Google Scholar 

  43. Cassinotto C, Lapuyade B, Mouries A, Hiriart JB, Vergniol J, Gaye D, Castain C, et al. Non-invasive assessment of liver fibrosis with impulse elastography: comparison of supersonic shear imaging with ARFI and FibroScan(R). J Hepatol. 2014;61:550–7.

    Article  PubMed  Google Scholar 

  44. Gerber L, Kasper D, Fitting D, Knop V, Vermehren A, Sprinzl K, Hansmann ML, et al. Assessment of liver fibrosis with 2-D shear wave elastography in comparison to transient elastography and acoustic radiation force impulse imaging in patients with chronic liver disease. Ultrasound Med Biol. 2015;41:2350–9.

    Article  PubMed  Google Scholar 

  45. Carrion JA, Navasa M, Bosch J, Bruguera M, Gilabert R, Forns X. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12:1791–8.

    Article  PubMed  Google Scholar 

  46. Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, Petrarca A, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45:1290–7.

    Article  PubMed  Google Scholar 

  47. Bureau C, Metivier S, Peron JM, Selves J, Robic MA, Gourraud PA, Rouquet O, et al. Transient elastography accurately predicts presence of significant portal hypertension in patients with chronic liver disease. Aliment Pharmacol Ther. 2008;27:1261–8.

    Article  CAS  PubMed  Google Scholar 

  48. Lemoine M, Katsahian S, Ziol M, Nahon P, Ganne-Carrie N, Kazemi F, Grando-Lemaire V, et al. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment Pharmacol Ther. 2008;28:1102–10.

    Article  CAS  PubMed  Google Scholar 

  49. Sanchez-Conde M, Montes-Ramirez ML, Miralles P, Alvarez JM, Bellon JM, Ramirez M, Arribas JR, et al. Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers. J Viral Hepat. 2010;17:280–6.

    Article  CAS  PubMed  Google Scholar 

  50. Llop E, Berzigotti A, Reig M, Erice E, Reverter E, Seijo S, Abraldes JG, et al. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol. 2012;56:103–8.

    Article  PubMed  Google Scholar 

  51. Colecchia A, Montrone L, Scaioli E, Bacchi-Reggiani ML, Colli A, Casazza G, Schiumerini R, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology. 2012;143:646–54.

    Article  PubMed  Google Scholar 

  52. Reiberger T, Ferlitsch A, Payer BA, Pinter M, Schwabl P, Stift J, Trauner M, et al. Noninvasive screening for liver fibrosis and portal hypertension by transient elastography—a large single center experience. Wien Klin Wochenschr. 2012;124:395–402.

    Article  PubMed  Google Scholar 

  53. Kitson MT, Roberts SK, Colman JC, Paul E, Button P, Kemp W. Liver stiffness and the prediction of clinically significant portal hypertension and portal hypertensive complications. Scand J Gastroenterol. 2015;50:462–9.

    Article  PubMed  Google Scholar 

  54. Augustin S, Millan L, Gonzalez A, Martell M, Gelabert A, Segarra A, Serres X, et al. Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study. J Hepatol. 2014;60:561–9.

    Article  PubMed  Google Scholar 

  55. Hong WK, Kim MY, Baik SK, Shin SY, Kim JM, Kang YS, Lim YL, et al. The usefulness of non-invasive liver stiffness measurements in predicting clinically significant portal hypertension in cirrhotic patients: Korean data. Clin Mol Hepatol. 2013;19:370–5.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Zykus R, Jonaitis L, Petrenkiene V, Pranculis A, Kupcinskas L. Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: a prospective cohort study. BMC Gastroenterol. 2015;15:183.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Schwabl P, Bota S, Salzl P, Mandorfer M, Payer BA, Ferlitsch A, Stift J, et al. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 2015;35:381–90.

    Article  PubMed  Google Scholar 

  58. Cho EJ, Kim MY, Lee JH, Lee IY, Lim YL, Choi DH, Kim YJ, et al. Diagnostic and prognostic values of noninvasive predictors of portal hypertension in patients with alcoholic cirrhosis. PLoS One. 2015;10:e0133935.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kumar A, Khan NM, Anikhindi SA, Sharma P, Bansal N, Singla V, Arora A. Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: a study of 326 patients from India. World J Gastroenterol. 2017;23:687–96.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Lee CM, Jeong WK, Lim S, Kim Y, Kim J, Kim TY, Sohn JH. Diagnosis of clinically significant portal hypertension in patients with cirrhosis: splenic arterial resistive index versus liver stiffness measurement. Ultrasound Med Biol. 2016;42:1312–20.

    Article  PubMed  Google Scholar 

  61. Berzigotti A, Seijo S, Arena U, Abraldes JG, Vizzutti F, Garcia-Pagan JC, Pinzani M, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology. 2013;144:102–11. e101

    Article  PubMed  Google Scholar 

  62. You MW, Kim KW, Pyo J, Huh J, Kim HJ, Lee SJ, Park SH. A meta-analysis for the diagnostic performance of transient elastography for clinically significant portal hypertension. Ultrasound Med Biol. 2017;43:59–68.

    Article  PubMed  Google Scholar 

  63. Reiberger T, Ferlitsch A, Payer BA, Pinter M, Homoncik M, Peck-Radosavljevic M. Non-selective beta-blockers improve the correlation of liver stiffness and portal pressure in advanced cirrhosis. J Gastroenterol. 2012;47:561–8.

    Article  CAS  PubMed  Google Scholar 

  64. Kim BK, Han KH, Park JY, Ahn SH, Kim JK, Paik YH, Lee KS, et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. Am J Gastroenterol. 2010;105:1382–90.

    Article  PubMed  Google Scholar 

  65. Abraldes JG, Bureau C, Stefanescu H, Augustin S, Ney M, Blasco H, Procopet B, et al. Noninvasive tools and risk of clinically significant portal hypertension and varices in compensated cirrhosis: the “anticipate” study. Hepatology. 2016;64:2173–84.

    Article  CAS  PubMed  Google Scholar 

  66. Salzl P, Reiberger T, Ferlitsch M, Payer BA, Schwengerer B, Trauner M, Peck-Radosavljevic M, et al. Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index. Ultraschall Med. 2014;35:528–33.

    Article  CAS  PubMed  Google Scholar 

  67. Attia D, Schoenemeier B, Rodt T, Negm AA, Lenzen H, TO L, Manns M, et al. Evaluation of liver and spleen stiffness with acoustic radiation force impulse quantification elastography for diagnosing clinically significant portal hypertension. Ultraschall Med. 2015;36:603–10.

    Article  CAS  PubMed  Google Scholar 

  68. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Takabatake H, Matsueda K, et al. Portal hypertension in patients with liver cirrhosis: diagnostic accuracy of spleen stiffness. Radiology. 2016;279:609–19.

    Article  PubMed  Google Scholar 

  69. Procopet B, Berzigotti A, Abraldes JG, Turon F, Hernandez-Gea V, Garcia-Pagan JC, Bosch J. Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension. J Hepatol. 2015;62:1068–75.

    Article  PubMed  Google Scholar 

  70. Elkrief L, Rautou PE, Ronot M, Lambert S, Dioguardi Burgio M, Francoz C, Plessier A, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology. 2015;275:589–98.

    Article  PubMed  Google Scholar 

  71. Kim TY, Jeong WK, Sohn JH, Kim J, Kim MY, Kim Y. Evaluation of portal hypertension by real-time shear wave elastography in cirrhotic patients. Liver Int. 2015;35:2416–24.

    Article  PubMed  Google Scholar 

  72. Jansen C, Bogs C, Verlinden W, Thiele M, Moller P, Gortzen J, Lehmann J, et al. Algorithm to rule out clinically significant portal hypertension combining shear-wave elastography of liver and spleen: a prospective multicentre study. Gut. 2016;65:1057–8.

    Article  PubMed  Google Scholar 

  73. Berzigotti A. Non-invasive evaluation of portal hypertension using ultrasound elastography. J Hepatol. 2017;67(2):399–411.

    Article  PubMed  Google Scholar 

  74. Castera L, Pinzani M, Bosch J. Non invasive evaluation of portal hypertension using transient elastography. J Hepatol. 2012;56:696–703.

    Article  PubMed  Google Scholar 

  75. Shi KQ, Fan YC, Pan ZZ, Lin XF, Liu WY, Chen YP, Zheng MH. Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int. 2013;33:62–71.

    Article  PubMed  Google Scholar 

  76. Takuma Y, Nouso K, Morimoto Y, Tomokuni J, Sahara A, Toshikuni N, Takabatake H, et al. Measurement of spleen stiffness by acoustic radiation force impulse imaging identifies cirrhotic patients with esophageal varices. Gastroenterology. 2012;144:92–101.e2.

    Article  PubMed  Google Scholar 

  77. Ding NS, Nguyen T, Iser DM, Hong T, Flanagan E, Wong A, Luiz L, et al. Liver stiffness plus platelet count can be used to exclude high-risk oesophageal varices. Liver Int. 2016;36:240–5.

    Article  PubMed  Google Scholar 

  78. Marot A, Trepo E, Doerig C, Schoepfer A, Moreno C, Deltenre P. Liver stiffness and platelet count for identifying patients with compensated liver disease at low risk of variceal bleeding. Liver Int. 2017;37:707–16.

    Article  PubMed  Google Scholar 

  79. Jangouk P, Turco L, De Oliveira A, Schepis F, Villa E, Garcia-Tsao G. Validating, deconstructing and refining Baveno criteria for ruling out high-risk varices in patients with compensated cirrhosis. Liver Int. 2017;37:1177–83.

    Article  PubMed  Google Scholar 

  80. Maurice JB, Brodkin E, Arnold F, Navaratnam A, Paine H, Khawar S, Dhar A, et al. Validation of the Baveno VI criteria to identify low risk cirrhotic patients not requiring endoscopic surveillance for varices. J Hepatol. 2016;65:899–905.

    Article  PubMed  Google Scholar 

  81. Llop E, Lopez M, de la Revilla J, Fernandez N, Trapero M, Hernandez M, Fernandez C, et al. Validation of non invasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease. J Gastroenterol Hepatol. 2017;32(11):1867–72.

    Article  PubMed  Google Scholar 

  82. Augustin S, Pons M, Maurice JB, Bureau C, Stefanescu H, Ney M, Blasco H, et al. Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology. 2017;66(6):1980–8.

    Article  PubMed  Google Scholar 

  83. Kim TY, Kim TY, Kim Y, Lim S, Jeong WK, Sohn JH. Diagnostic performance of shear wave elastography for predicting esophageal varices in patients with compensated liver cirrhosis. J Ultrasound Med. 2016;35:1373–81.

    Article  PubMed  Google Scholar 

  84. Stefanescu H, Allegretti G, Salvatore V, Piscaglia F. Bidimensional shear wave ultrasound elastography with supersonic imaging to predict presence of oesophageal varices in cirrhosis. Liver Int. 2017;37(9):1405.

    Article  PubMed  Google Scholar 

  85. Robic MA, Procopet B, Metivier S, Peron JM, Selves J, Vinel JP, Bureau C. Liver stiffness accurately predicts portal hypertension related complications in patients with chronic liver disease: a prospective study. J Hepatol. 2011;55:1017–24.

    Article  PubMed  Google Scholar 

  86. Merchante N, Rivero-Juarez A, Tellez F, Merino D, Jose Rios-Villegas M, Marquez-Solero M, Omar M, et al. Liver stiffness predicts clinical outcome in human immunodeficiency virus/hepatitis C virus-coinfected patients with compensated liver cirrhosis. Hepatology. 2012;56:228–38.

    Article  PubMed  Google Scholar 

  87. Wang JH, Chuah SK, Lu SN, Hung CH, Kuo CM, Tai WC, Chiou SS. Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis. Liver Int. 2014;34:1340–8.

    Article  PubMed  Google Scholar 

  88. Kim BK, Kim do Y, Han KH, Park JY, Kim JK, Paik YH, Lee KS, et al. Risk assessment of esophageal variceal bleeding in B-viral liver cirrhosis by a liver stiffness measurement-based model. Am J Gastroenterol. 2011;106:1654–62. 1730

    Article  PubMed  Google Scholar 

  89. Merchante N, Rivero-Juarez A, Tellez F, Merino D, Rios-Villegas MJ, Ojeda-Burgos G, Omar M, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis. AIDS. 2017;31:493–500.

    Article  PubMed  Google Scholar 

  90. Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, et al. Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1573–1584.e1–2. quiz e1588–9

    Article  PubMed  PubMed Central  Google Scholar 

  91. Corpechot C, Gaouar F, El Naggar A, Kemgang A, Wendum D, Poupon R, Carrat F, et al. Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis. Gastroenterology. 2014;146:970–9. quiz e915–6

    Article  PubMed  Google Scholar 

  92. Hezode C, Castera L, Roudot-Thoraval F, Bouvier-Alias M, Rosa I, Roulot D, Leroy V, et al. Liver stiffness diminishes with antiviral response in chronic hepatitis C. Aliment Pharmacol Ther. 2011;34:656–63.

    Article  CAS  PubMed  Google Scholar 

  93. Singh S, Facciorusso A, Loomba R, Falck-Ytter YT. Magnitude and kinetics of decrease in liver stiffness after antiviral therapy in patients with chronic hepatitis C: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017. https://doi.org/10.1016/j.cgh.2017.04.038.

  94. Lens S, Alvarado E, Marino Z, Londono MC, LLop E, Martinez J, Fortea JI, et al. Effects of all-oral anti-viral therapy on HVPG and systemic hemodynamics in patients with hepatitis C virus-associated cirrhosis. Gastroenterology. 2017;153(5):1273–1283.e1.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepatology, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, INSERM UMR 1149, CRI, University of Paris-VII, Clichy, France

    Laurent Castera M.D., Ph.D.

Authors
  1. Laurent Castera M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurent Castera M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Inselspital, University of Bern, UVCM, DMLL, Hepatology Inselspital, University of Bern, Berne, Switzerland

    Annalisa Berzigotti

  2. Hospital Clinic, Hepatic Hemodynamic Laboratory Hospital Clinic, Barcelona, Spain

    Jaime Bosch

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Castera, L. (2018). Liver Stiffness by Ultrasound Elastography. In: Berzigotti, A., Bosch, J. (eds) Diagnostic Methods for Cirrhosis and Portal Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-72628-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-72628-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72627-4

  • Online ISBN: 978-3-319-72628-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation