The use of transient elastography in the management of chronic hepatitis B

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http://www.springerlink.com/content/t2570g7451642670/

Hepatology International

DOI: 10.1007/s12072-011-9288-5Online First™Open Access

Review Article

The use of transient elastography in the management of chronic hepatitis B

Fung, Ching-Lung Lai, Wai-Kay Seto and Man-Fung Yuen

Abstract

There has been increasing interest in noninvasive methods of assessing liver

fibrosis over the last decade. The use of transient elastography in measuring

liver stiffness has become the forefront of a wide range of noninvasive tools.

Most of the other methods are based on measurements of biomarkers associated

with fibrosis. There are several reasons for its wide acceptance, including the

ease of performing a scan, the short procedure time, the results being

immediately available on completion of the examination, and its reproducibility.

For chronic hepatitis B (CHB), the cut-off values for F3 and F4 fibrosis range

between 7.5–12.0 and 11.0–13.4 kPa, respectively, although the cut-offs may be

slightly lower in those with normal ALT. In addition to measuring liver

fibrosis, recent studies have demonstrated several other roles for transient

elastography, including selecting patients who will benefit from antiviral

therapy, monitoring response to antiviral therapy, and predicting long-term

outcomes. However, there are limitations associated with transient elastography,

including the confounding effects of inflammatory activity, and to a lesser

extent, steatosis, on liver stiffness. There is also reduced accuracy observed

in lower fibrosis stages (F0–F2). Furthermore, the incidences of failed and

unreliable scan have been reported to be ~ 3 and 16%, respectively. Although

liver biopsy can be avoided in an estimated 50–60% using transient elastography,

in situations where liver stiffness measurement is nondiagnostic or inconsistent

with the clinical picture, a biopsy is still recommended. Further studies are

needed to consolidate the role of transient elastography in the management of

CHB, and for incorporation of this method into current treatment guidelines.