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 )
612
In patients with chronic hepatitis C, the AGA suggests a VCTE cutoff of 12.5 kPa to detect cirrhosis. ( Low , Conditional (weak) )
612
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.
612
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) )
612
In patients with chronic hepatitis B, the AGA suggests a VCTE cutoff of 11.0 kPa to detect cirrhosis. ( Low , Conditional (weak) )
612
The AGA makes no recommendation regarding the role of VCTE in the diagnosis of cirrhosis in adults with NAFLD. ( Evidence Gap , No recommendation )
612
In patients with chronic alcoholic liver disease, the AGA suggests a VCTE cutoff of 12.5 kPa to detect cirrhosis. ( Low , Conditional (weak) )
612
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.
612
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.
612
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) )
612
In adults with NAFLD and a higher risk of cirrhosis, AGA suggests using MRE, rather than VCTE, for detection of cirrhosis. ( Low , Conditional (weak) )
612
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 )
612
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).
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
February 15, 2024
External Publication Status
Published
Country of Publication
US
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