Hepatic Elastography Using Ultrasound Waves

Indexed in: EBSCO.

Some time ago, Schiano raised the question "To B or not to B", which means "To Biopsy or not to Biopsy" the liver for the evaluation of chronic hepatopathies. For a long period, liver biopsy (LB) was ...
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Combined Methods for Liver Fibrosis Evaluation

Pp. 103-106 (4)

Ioan Sporea and Simona Bota


Biological tests, elastographic methods alone or in combination can be used for the non-invasive evaluation of chronic liver diseases, in order to increase their value.

The combination of TE and serological tests offered a good diagnostic performance, both for significant fibrosis (F≥2) and for severe fibrosis/cirrhosis (F3–F4) diagnosis. A clinical management algorithm, using the combination of FibroScan and FibroTest as part of the first-line work-up was developed for liver fibrosis assessment in HCV patients. By using this algorithm, liver biopsy would have been avoided in the majority (77%) of patients. In HBV inactive carriers, the combination of TE and FibroTest allowed the exclusion of significant fibrosis (F≥2) in nearly 80% of cases.

Another useful combination is the one between two elastographic methods (TE and ARFI), being highly specific for predicting significant fibrosis (F≥2 Metavir). For predicting F≥2, when LS by means of both TE and ARFI were higher than the proposed cut-offs, the sensitivity was 93.3%, the positive predictive value was 96.8%, so that in those patients, liver biopsy could be avoided (60.5% of cases). For predicting cirrhosis (F4) the results were also very good, with 94.4% specificity, 94.4% negative predictive value and 91.8% accuracy, so the combined methods are not only able to confirm, but also to exclude the presence of cirrhosis.


Serological tests, elastography, liver fibrosis, combination methods.


Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 10, Iosif Bulbuca Bv, 300736, Timișoara, Romania