Stages of Chronic Liver Disease
1. Healthy Liver
2. Fibrosis is an abnormal increase in collagen deposition in response to chronic injury. The stage of liver fibrosis is important to determine prognosis and surveillance and to prioritize for treatment and potential for reversibility. The process of fibrosis is dynamic, and studies have shown that a regression of fibrosis is possible with treatment of the underlying condition.
3. Cirrhosis is a diffuse process, characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.
4. Hepatocellular carcinoma (HCC).
1. Fatty Liver on routine Ultrasound
2. Elevated SGOT (AST) & SGPT (ALT)
3. Metabolic disorder (Obesity, Hypothyroidism & Insulin resistance)
4. Infections with HBV & HCV
5. Alcohol abuse
Types of Liver Elastography
Transient Elastography: used by a company called Echosens which manufactures the machine Fibroscan, the technique is without image guidance hence it has a higher technical failure rate.
Shear Wave Elastography: is with image guidance & hence allows adequate sampling site selection.
Both these technologies are equivalent.
Findings Diagnosis Fibrosis Stage
0 – 7 kPa Normal F0 & F1
7 – 14 kPa fibrosis F2 & F3
> 14.0 kPa cirrhosis F4
Median kPa --
Inter-Quartile Range < 0.4
IQR: Median < 0.3
After quantification with the above technique, patients can be grouped into 3 categories:
1. Those with normal elastography values who have a low likelihood of cirrhosis (stage F0 of F1) and may not require additional follow-up.
2. Those in between who have moderate to severe fibrosis (stage F2 and F3) and are at risk for progression of the fibrosis, additional lab investigations / biopsy would be indicated.
3. Those with high elastography values who have a high likelihood of cirrhosis & require different management & prioritization for therapy.