NICE - transient elastography in the diagnosis of liver cirrhosis

Transient elastography is a non-invasive, rapid, and reproducible method allowing evaluation of liver fibrosis by measurement of liver stiffness

• this system is equipped with a probe consisting of an ultrasonic transducer mounted on the axis of a vibrator
  • a vibration of mild amplitude and low frequency is transmitted from the vibrator to the tissue by the transducer itself
  • vibration induces an elastic shear wave which propagates through the tissue
  • in the meantime, pulse-echo ultrasonic acquisitions are performed to follow the propagation of the shear wave and measure its velocity, which is directly related to tissue stiffness (or elastic modulus). The harder the tissue, the faster the shear wave propagates

Transient elastography should be offered to diagnose cirrhosis for:

• people with hepatitis C virus infection
• men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
• people diagnosed with alcohol-related liver disease

Transient elastography or acoustic radiation force impulse imaging should be offered (whichever is available) to diagnose cirrhosis for people with NAFLD and advanced liver fibrosis (as diagnosed by a score of 10.51 or above using the enhanced liver fibrosis [ELF] test).

Adults with chronic hepatitis B - offer transient elastography as the initial test for liver disease in adults newly referred for assessment

Consider liver biopsy to diagnose cirrhosis in people for whom transient elastography is not suitable.

Retesting for cirrhosis every 2 years is indicated for:

• people diagnosed with alcohol-related liver disease
• people with hepatitis C virus infection who have not shown a sustained virological response to antiviral therapy
• people with NAFLD and advanced liver fibrosis

Reference:

• NICE (July 2016). Cirrhosis in over 16s: assessment and management