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 in Cholestatic Liver Diseases

Experience with VCTE in the cholestatic diseases is steadily increasing. The central limitation for VCTE in this setting is that cholestasis is a known confounder of LSM.[18,46] Despite this, however, VCTE is a powerful tool for patients with primary biliary cirrhosis and primary sclerosing cholangitis. Corpechot et al.[50] were the first group to examine the role of VCTE in a group of 73 patients with both diseases. In this study, optimal LSM cutoffs were 9.8 and 17.3 kPa for advanced fibrosis and cirrhosis, respectively. This group has followed up with two studies examining these conditions separately. In their study of 103 patients with primary biliary cirrhosis,[51] using internal validation measures, F3-F4 and F4 were discriminated best with the respective cutoffs of 10.9 and 16.1 kPa (AUROC of 0.95 and 0.99). Meanwhile, in a separate study of 59 patients with primary sclerosing cholangitis (excluding patients with autoimmune hepatitis and small-duct disease), 9.6 and 14.4 kPa were the optimal cutoffs for F3-F4 and F4, respectively.[52] This study then followed the patients for several years and discovered two important findings. First, they found that baseline VCTE cutoffs as low as 6.5 kPa (NPV 0.95) to 18.5 kPa (PPV 0.57) predicted overall survival. Second, annual rates of VCTE increase as low as 1.3 kPa (NPV 0.97) to 4 kPa (PPV 0.57) predicted survival. Taken together, even in the presence of a known confounder, VCTE is a powerful ally in the initial and follow-up examination of patients with cholestatic liver disease.