Ultrasound-based liver elastography: current results and future perspectives
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REVIEW PAPER: DIFFUSE LIVER DISEASE
Ultrasound‑based liver elastography: current results and future perspectives Cheng Fang1 · Paul S. Sidhu1 Received: 3 June 2020 / Revised: 3 June 2020 / Accepted: 21 August 2020 © The Author(s) 2020
Abstract Chronic liver disease affects 185 million population worldwide. It encompasses a heterogenous disease spectrum, but all can lead to the development of liver fibrosis. The degree of liver fibrosis is not only a prognosticator, but has also been used to guide the treatment strategy and to evaluate treatment response. Traditionally, staging of liver fibrosis is determined on histological analysis using samples obtained from an invasive liver biopsy. Ultrasound-based liver elastography is a noninvasive method of assessing diffuse liver disease in patients with known chronic liver disease. The use of liver elastography has led to a significant reduction in the number of liver biopsies performed to assess the severity of liver fibrosis and a liver biopsy is now reserved for only select sub-groups of patients. The aim of this review article is to discuss the key findings and current evidence for ultrasound-based elastography in diffuse liver disease as well as the technical challenges and to evaluate the potential research direction. Keywords Liver elastography · Transient elastography · Fibrosis · Hepatitis · Cirrhosis · Chronic liver disease
Introduction Chronic liver disease affects 185 million people worldwide [1]. It encompasses many disease aetiologies with the vast majority of cases secondary to viral hepatitis, alcohol induced, non-alcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), autoimmune hepatitis (AIH). The common pathological consequence for all these different aetiologies involves the development of liver fibrosis; a result of chronic inflammation. Untreated, liver fibrosis can lead to end stage liver disease and cirrhosis both of which are associated with a high morbidity and mortality. Assessment of the degree of liver fibrosis is clinically relevant in guiding treatment, evaluating response and predicting associated complications. Ultrasound-based elastography is an adjunctive tool to traditional B-mode ultrasound for assessing patients with chronic liver disease. It is inexpensive, quick to perform and has a short period of training for the operator.
Liver elastography guidelines are available from European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [2], World Federation for Ultrasound in Medicine and Biology (WFUMB) [3, 4] and Society of Radiologists in Ultrasound Consensus [5]. The aim of this review article is to discuss the key findings and current evidence for ultrasound-based elastography in diffuse liver disease as well as technical challenges and potential further research.
Types of elastography Elastography is a method of studying tissue stiffness. The differences in tissue stiffness between healthy and pathological tissue allows for the inference of the presence and severity of disease. There
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