Abstract
Transient elastography (TE) based on liver stiffness measurement (LSM) is one of the most validated noninvasive methods for liver fibrosis staging in patients with chronic liver diseases. This method is painless, has no potential complications, is rapid (<10 min), and can be performed at the patient's bedside. However, several points should be considered when interpreting TE results. This review aims to discuss the critical points that might influence liver stiffness and TE results. Spectrum bias and the impact of the prevalence of fibrosis stages should be taken into account when interpreting the studies that validated this method using liver biopsy as a gold-standard. LSM might be influenced by nonfasting status, flare of transaminases, heart failure, extrahepatic cholestasis, presence of steatosis, aetiology of liver disease, type and position of probe, and operator's experience. In addition, interobserver variability can impact on the management of patients with chronic liver diseases. TE should be performed by an experienced operator (>100 exams), in a 3-hour fasting status, and its results should be handled by specialist clinicians that are aware of the limitations of this method.
Highlights
Transient elastography (TE) by Fibroscan (EchoSens, Paris, France) is one of the most widely used and validated noninvasive methods for liver fibrosis staging [1]
Similar results were observed in patients with chronic hepatitis C (CHC): amongst patients within the same fibrosis stages (F0–F2 and F3-F4; F0–F3 and F4), mean liver stiffness values were significantly higher in subjects with moderate-severe steatosis (≥20% at liver biopsy) compared to those without [31]
An operator effect in TE was validated in a study that used FibroTest as the reference: the diagnostic performance of TE was significantly better when examinations performed by the nonexperimented operator were excluded (AUROC = 0.80 versus 0.70; p = 0.009) [7]
Summary
Transient elastography (TE) by Fibroscan (EchoSens, Paris, France) is one of the most widely used and validated noninvasive methods for liver fibrosis staging [1]. This method is painless, is not associated with potential complications, and is well accepted by patients, especially for repeated examinations [2]. TE is accurate for staging liver fibrosis [1] and can be used for prediction of mortality and severe outcome in patients with chronic liver diseases [3, 4]. Several points should be considered when using TE for liver fibrosis staging to avoid misclassification of patients [5]. The type and position of probe and operator experience can impact on TE results
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