Hepatic Elastography Using Ultrasound Waves Revised Edition of Volume 1

Hepatic Elastography Using Ultrasound Waves Revised Edition of Volume 1

Liver biopsy (LB) is sometimes considered to be the "gold standard" for the evaluation of liver morphology in the diagnosis of chronic hepatopathies. A major disadvantage of LB is its invasiveness: ...
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Combined Methods for Liver Fibrosis Evaluation

Pp. 124-129 (6)

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.

Combinations of non-invasive tests were searched for in order to improve the diagnostic performance of significant fibrosis (F≥2) and severe fibrosis/cirrhosis (F3–F4) the most promising being TE and serologic tests. In chronic hepatitis C a clinical management algorithm was proposed, using the combination of TE (FibroScan®) and FibroTest as the first-line tests in the work-up strategy, thus avoiding liver biopsy in most patients (77%). 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 of two elastographic methods [TE and VTQ (ARFI)], which proved to be highly specific for predicting significant fibrosis (F≥2 Metavir). When both TE and VTQ (ARFI) values were higher than the proposed cut-offs, their combination had 93.3% Sp and 96.8% PPV for predicting F≥2, so that liver biopsy could be avoided in 60.5% of cases. For predicting cirrhosis (F4), the results were also very good, with 94.4% Sp, 94.4% NPV and 91.8% accuracy, so that the combination of TE and VTQ was able to confirm, and also to exclude the presence of liver cirrhosis.


Combination methods, Elastography, Liver fibrosis, Serological tests.


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