George Sebastian Gherlan and Petre Iacob Calistru

ABSTRACT

Assessing liver fibrosis is essential for the management of chronic viral hepatitis. Over the last ten years we have been witnessing the emergence of many noninvasive methods tending to replace liver biopsy for the purpose of staging the fibrosis. There are two main classes of noninvasive methods that have demonstrated a fair ability to classify fibrosis compared to liver biopsy: the biochemical/hematological markers (also known as serologic markers) and the imaging techniques. Among the imaging techniques, ultrasound elastography has had an explosive development, with many different approaches, based on different physical principles, trying to achieve the same goal: the measurement of the stiffness of a tissue or organ. Transient elastography (TE), acoustic radiation force impulse imaging (ARFI) and shear-wave elastography (SWE) are the major players of the moment. Transient elastography is the oldest of the methods; it is validated by numerous independent studies and is already recommended by some of the main professional hepatology associations as a possible replacement for liver biopsy for the assessment of the fibrosis in chronic C hepatitis. ARFI and SWE have also been analyzed in many studies that showed their value as noninvasive liver fibrosis evaluation methods. Data abounds in the literature; the techniques are evolving so fast that even experienced ultrasonographers have trouble integrating all the information. This review is an attempt to summarize the most important data on the subject of ultrasound elastography in chronic viral hepatitis.

Keywords: liver elastography, chronic hepatitis, liver fibrosis, noninvasive, transient elastography, ARFI, shear wave elastography

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