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Liver Stiffness by Ultrasound Elastography

  • Laurent Castera
Chapter

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).

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hepatology, Hôpital Beaujon, Assistance Publique—Hôpitaux de Paris, INSERM UMR 1149, CRIUniversity of Paris-VIIClichyFrance

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