REAL TIME TISSUE ELASTOGRAPHY AS A NEW TOOL IN POSTHEPATITIS CHRONIC LIVER DISEASE: ROLE, LIMITATIONS AND PITFALLS

Abstract

Liver biopsy remains the reference method in detecting hepatic fibrosis, however, based on the abundant literature regarding biopsy alternatives in CHC patients, it is now the time that non-invasive methods can be used instead of LB. US elastography is a new non-invasive tool which measures tissue elasticity, and can be used for diagnosing hepatic fibrosis in patients with CHC. RTE showed a high performance using LFI for detecting the degree of liver fibrosis in CHC patients, and proved to be especially valuable for diagnosis of advanced hepatitis and early cirrhosis that are concerns in clinical practice. It also compared favorably to the published pooled TE performance. So we suggest that RTE could also be used as an initial imaging method to evaluate the degree of liver fibrosis in patients with CHC, to minimize unnecessary liver biopsies and for patients in whom LB cannot be performed. RTE imaging is easy to use, cost-effective and painless. It is readily available with US machines as an additional mode, it takes only 5–10 minutes to perform, results are instantaneous and the clinician can use them to make decisions during patients’ visits, besides, it can be used to examine cases for which fibroscan is difficult or unreliable. Once RTE is approved, it will most likely be used as a screening tool in all patients. However, RTE may have limitations related to being operator dependent. Training is needed to avoid artifacts related to obesity, to set the ROI not to include