Role of Elastography in the Evaluation of Liver Fibrosis

Publication Date: May 4, 2020
Last Updated: November 8, 2022

Diagnosis

In patients with chronic hepatitis C, the AGA recommends VCTE, if available, rather than other nonproprietary, noninvasive serum tests (APRI, FIB-4) to detect cirrhosis. ( Moderate , Strong )
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In patients with chronic hepatitis C, the AGA suggests a VCTE cutoff of 12.5 kPa to detect cirrhosis. ( Low , Conditional (weak) )
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In noncirrhotic patients with HCV who have achieved A sustained viral response (SVR) after antiviral therapy, the AGA suggests a post-treatment VCTE cutoff of 9.5 kPa to rule out advanced liver fibrosis. ( Very Low , Conditional (weak) )
Comment: Noncirrhotic patients with VCTE <9.5 kPa who place a low value on the inconvenience and risks of continued laboratory and fibrosis testing, and a high value on avoiding the small risk of developing HCC, may reasonably select to continue specialty care rather than being discharged from the specialty clinic.
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In patients with chronic hepatitis B, the AGA suggests VCTE rather than other nonproprietary noninvasive serum tests (ie, APRI and FIB-4) to detect cirrhosis. ( Low , Conditional (weak) )
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In patients with chronic hepatitis B, the AGA suggests a VCTE cutoff of 11.0 kPa to detect cirrhosis. ( Low , Conditional (weak) )
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The AGA makes no recommendation regarding the role of VCTE in the diagnosis of cirrhosis in adults with NAFLD. ( Evidence Gap , No recommendation )
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In patients with chronic alcoholic liver disease, the AGA suggests a VCTE cutoff of 12.5 kPa to detect cirrhosis. ( Low , Conditional (weak) )
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In patients with suspected compensated cirrhosis, the AGA suggests a VCTE cutoff of 19.5 kPa to assess the need for esophagogastroduodenoscopy to identify high risk esophageal varices. ( Low , Conditional (weak) )

Comment: Patients, particularly those at higher risk, with VCTE <19.5 kPa who place a low value on the inconvenience and risks of endoscopy, and a high value on avoiding the small risk of acute variceal hemorrhage associated with VCTE values of <19.5 kPa, may reasonably select to undergo screening endoscopy.

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In patients with suspected chronic liver disease undergoing elective nonhepatic surgery, the AGA suggests a VCTE cutoff of 17.0 kPa to detect clinically significant portal hypertension to inform preoperative care. ( Low , Conditional (weak) )
Comment: Patients, particularly those at higher risk, with VCTE <17.0 kPa who place a low value on the inconvenience and risks of interventions (endoscopy, hepatic venous pressure gradient measurement) to detect clinically significant portal hypertension, and a high value on avoiding the small risk of operative morbidity and mortality associated with elective nonhepatic surgery, may reasonably select to undergo screening endoscopy.
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In adult patients with chronic hepatitis C, the AGA suggests using VCTE rather than magnetic resonance elastography (MRE) for detection of cirrhosis. ( Very Low , Conditional (weak) )
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In adults with NAFLD and a higher risk of cirrhosis, AGA suggests using MRE, rather than VCTE, for detection of cirrhosis. ( Low , Conditional (weak) )
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In adults with NAFLD and a lower risk of cirrhosis, AGA makes no recommendation regarding the role of MRE or VCTE for detection of cirrhosis. ( Evidence Gap , No recommendation )
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Comment: High-risk populations are NAFLD with advanced age, obesity, particularly central adiposity, diabetes, alanine elevated >2× upper limit of normal with an estimated cirrhosis prevalence of 30% (typically seen in a referral setting). Low-risk population are those with NAFLD and signs of fatty liver on imaging only and an estimated cirrhosis prevalence of ≤5% (typically seen in a primary care setting).

Recommendation Grading

Overview

Title

Role of Elastography in the Evaluation of Liver Fibrosis

Authoring Organization

American Gastroenterological Association

Publication Month/Year

May 4, 2020

Last Updated Month/Year

October 3, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To provide clinicians with evidence-based guidance on the specific role of vibration-controlled transient elastography (VCTE) in clinical practice.

Target Patient Population

Patients with chronic liver disease

PICO Questions

  1. In adults with HCV who have achieved sustained virologic response (SVR) with antiviral therapy undergoing VCTE, at what liver stiffness cutoff can we accurately rule out advanced fibrosis and consider discharging patients from a dedicated liver clinic?

  2. Should magnetic resonance elastography (MRE) vs vibration-controlled transient elastography (VCTE) be used to diagnose cirrhosis in adults with NAFLD?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening

Diseases/Conditions (MeSH)

D008107 - Liver Diseases

Keywords

elastography, vibration-controlled transient elastography, VCTE, liver fibrosis, liver disease

Supplemental Methodology Resources

Technical Review