Vibration-controlled Transient Elastography

A Practical Approach to the Noninvasive Assessment of Liver Fibrosis

Elliot B. Tapper; Nezam H. Afdhal


Curr Opin Gastroenterol. 2015;31(3):192-198. 

In This Article

Vibration-controlled Transient Elastography for the Patient With Chronic Hepatitis B Virus

Just as for patients with chronic HCV, VCTE is an effective tool to aid in decision making and risk stratification for patients with chronic hepatitis B virus (HBV). VCTE has test characteristics very similar to that seen in the HCV population and can be included in clinical practice in a similar fashion.[39] Indeed, VCTE accurately predicts advanced fibrosis and its complications.[30,39–47] In a meta-analysis of 18 studies comprising 2772 subjects, VCTE predicted cirrhosis with an AUROC of 0.929 using an optimal LSM cutoff of 11.7 kPa; the cutoff for F3-F4 fibrosis was 8.8 kPa with an AUROC of 0.887.[41] VCTE also nicely categorizes patients with HBV into different risk strata. In their study of 128 Koreans with advanced fibrosis, an LSM cutoff of 19 kPa predicted hepatic decompensation and hepatocellular carcinoma with a hazard ratio of 7.176.[43] Similar to their study of patients with HCV, Poynard et al.[45] found that baseline LSM predicted the 10 year rate of severe liver-related morbidity in a cohort of 1434 subjects with an AUROC of 0.88 overall and 0.95 for the development of varices.

The decision to pursue HBV treatment is guided in a large part by the recommendations of the specialty societies.[48,49] These recommendations include periodic assessment of inflammation (ALT), viral load and often histology. VCTE could potentially replace histological assessment. However, the confounding effect of inflammation on liver stiffness can be a significant issue for patients with chronic HBV.[39,42,44]

Accordingly, Chan et al. suggest an ALT-based algorithm for the use of VCTE in HBV, using different cutoffs for patients with normal and abnormal ALT. For patients with normal ALT, biopsy was reserved for patients with a kPa of 6–9, with 5 or less being negative and 9 or greater indicating a positive result deserving of treatment. For patients with an ALT greater than the upper limit of normal, biopsy was utilized for those with 7–12 kPa, with treatment for those with an LSM greater than 12 kPa (suggestive of advanced fibrosis). For this reason and given the nature of treatment decisions for patients with HBV, one-size-fits-all cutoffs are likely too inflexible especially for those with intermediate results.