Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-740, South Korea.
World J Gastroenterol. 2013 Mar 28;19(12):1890-900. doi: 10.3748/wjg.v19.i12.1890.
Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the "gold standard" for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
准确评估肝脏纤维化的存在和程度非常重要，因为慢性肝病的预后和管理策略主要取决于这些因素。迄今为止，肝活检（LB）仍然是评估肝纤维化严重程度的“金标准”；然而，LB 常常受到其侵袭性、采样误差以及组织学解释的观察者内和观察者间变异性的限制。此外，在短时间内重复进行 LB 检查在实际临床实践中确实是不合适的。因此，由于迫切需要肝纤维化的非侵入性替代物，瞬时弹性成像（TE）作为一种新的超声技术，已经能够实现对肝硬度的非侵入性测量，并在近年来得到了普及。在过去的几年中，除了作为 LB 的非侵入性替代物的最初目的之外，瞬态 TE 的额外作用还包括预测纤维化进展的两个最关键后果：门静脉高压相关并发症和肝细胞癌的发展。这表明瞬态 TE 的作用不仅仅局限于减少对 LB 的需求，瞬态 TE 可以通过提供更详细的预后信息来制定量身定制的管理策略。特别是在肝纤维化的临床过程是动态和双向的概念下，特别是在开始适当干预时，瞬态 TE 可以用于跟踪抗病毒或抗纤维化治疗期间纤维负担的动态变化。本综述从纵向角度讨论了瞬态 TE 在预测真实临床终点发展方面的扩展应用。
