Review
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World J Gastroenterol. Mar 28, 2013; 19(12): 1890-1900
Published online Mar 28, 2013. doi: 10.3748/wjg.v19.i12.1890
Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives
Beom Kyung Kim, James Fung, Man-Fung Yuen, Seung Up Kim
Beom Kyung Kim, Seung Up Kim, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-740, South Korea
Beom Kyung Kim, Seung Up Kim, Liver Cirrhosis Clinical Research Center, Seoul 120-740, South Korea
James Fung, Man-Fung Yuen, Department of Medicine, State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Author contributions: Kim BK and Kim SU contributed to the study idea, study design, literature search, manuscript writing and final revision of the article; Fung J and Yuen MF contributed to manuscript writing and final revision of the article.
Supported by Liver Cirrhosis Clinical Research Center, in part by a grant from the Korea Healthcare technology R and D project, Ministry of Health and Welfare, Republic of Korea, No A102065; and by the Yonsei Liver Blood Bank, in part by a grant from sanofi-aventis Korea
Correspondence to: Seung Up Kim, MD, Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea. ksukorea@yuhs.ac
Telephone: +82-2-22281982 Fax: +82-2-3936884
Received: August 10, 2012
Revised: August 29, 2012
Accepted: September 28, 2012
Published online: March 28, 2013
Processing time: 242 Days and 2.2 Hours
Abstract

Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the “gold standard” for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.

Keywords: Liver stiffness; Transient elastography; Fibroscan; Fibrosis; Longitudinal; Outcome