Liver Fibrosis Assessment in Chronic Liver Diseases Using Elastography: A Comprehensive Review of Vibration-Controlled Transient Elastography and Shear Wave Elastography

초록

Chronic liver diseases (CLD) are a major global health issue, with liver fibrosis progression and cirrhosis as critical determinants of prognosis and treatment strategy. Historically, liver biopsy has been the gold standard for assessing fibrosis, but limitations such as invasiveness, variability in results, and cost have spurred the development of non-invasive tests. Elastography techniques measure liver stiffness, providing important insights into fibrosis severity across various CLDs, including hepatitis B and C and metabolic dysfunction-associated steatotic liver disease (MASLD). Ultrasound-based elastography techniques include vibration-controlled transient elastography (VCTE), point shear wave elastography, and 2D shear wave elastography. Most studies report high accuracy for diagnosing significant fibrosis and cirrhosis. While VCTE is the most widely used elastography method, each technique has strengths and limitations in different patient populations, affected by factors like alanine aminotransaminase levels, obesity, and presence of hepatic inflammation. Elastography proves valuable informations in treatment decisions for hepatitis B patients in the "gray zone" and helps identify high-risk groups requiring post-hepatitis C eradication surveillance. Recent studies emphasize the potential of elastography-based scores, such as the FibroScan-AST and AGILE scores, in improving diagnostic accuracy for patients with MASLD. However, diagnostic performance may vary by setting, requiring validation in primary care. Emerging precision medicine approaches, integrating genomics and novel biomarkers, promise to further enhance risk stratification in CLD management. Despite substantial advances, broader clinical application of elastography and related biomarkers necessitates further validation, particularly in diverse care settings, to ensure their optimal utility in routine clinical practice.

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