Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11542
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: July 11, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: November 7, 2015
Processing time: 189 Days and 12.2 Hours
Progressive fibrosis is encountered in almost all chronic liver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks (inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis (serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasound-based elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography (TE) and acoustic radiation force impulse (ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shear-wave elastography, the ElastPQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.
Core tip: Ultrasound-based elastographic methods are being used more and more for the non-invasive assessment of liver fibrosis, with very good accuracy in diagnosing cirrhosis. Transient elastography is a promising method for predicting portal hypertension in cirrhotics, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of employing acoustic radiation force impulse elastography in the liver to predict portal hypertension is debatable. It may be significantly increased if spleen stiffness is assessed, whether alone or in combination with liver stiffness and other parameters. Two-dimensional shear-wave elastography, the ElastPQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.