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World J Gastroenterol. Jun 28, 2020; 26(24): 3413-3420
Published online Jun 28, 2020. doi: 10.3748/wjg.v26.i24.3413
Ultrasound liver elastography beyond liver fibrosis assessment
Giovanna Ferraioli, Richard G Barr
Giovanna Ferraioli, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Medical School University of Pavia, Pavia 27100, Italy
Giovanna Ferraioli, Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Pavia 27100, Italy
Richard G Barr, Northeastern Ohio Medical University, Rootstown, OH 44272, United States
Author contributions: Ferraioli G designed the review outline, performed the literature research, extracted the data from the literature search, and wrote the paper; Barr RG performed the literature research and extracted the data; Both authors approved the final version of the manuscript.
Conflict-of-interest statement: Dr. Ferraioli reports personal fees and non-financial support from Canon Medical Systems, non-financial support from Hitachi Ltd, non-financial support from Mindray Bie.Medical Electronics Co, personal fees and non-financial support from Philips Healthcare, personal fees from Siemens Healthineers, outside the submitted work; Dr. Barr reports grants and personal fees from Philips Ultrasound, grants and personal fees from Siemens Ultrasound, grants and personal fees from Mindray, grants and personal fees from Samsung Ultrasound, grants from SuperSonic lmagine, grants and personal fees from Cannon Ultrasound, outside the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Giovanna Ferraioli, MD, Academic Research, Doctor, Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico S Matteo, University of Pavia, Viale Camillo Golgi 19, Pavia 27100, Italy. giovanna.ferraioli@unipv.it
Received: March 3, 2020
Peer-review started: March 4, 2020
First decision: March 31, 2020
Revised: April 8, 2020
Accepted: June 9, 2020
Article in press: June 9, 2020
Published online: June 28, 2020
Processing time: 117 Days and 3 Hours
Abstract

Several guidelines have indicated that liver stiffness (LS) assessed by means of shear wave elastography (SWE) can safely replace liver biopsy in several clinical scenarios, particularly in patients with chronic viral hepatitis. However, an increase of LS may be due to some other clinical conditions not related to fibrosis, such as liver inflammation, acute hepatitis, obstructive cholestasis, liver congestion, infiltrative liver diseases. This review analyzes the role that SWE can play in cases of liver congestion due to right-sided heart failure, congenital heart diseases or valvular diseases. In patients with heart failure LS seems directly influenced by central venous pressure and can be used as a prognostic marker to predict cardiac events. The potential role of LS in evaluating liver disease beyond the stage of liver fibrosis has been investigated also in the hepatic sinusoidal obstruction syndrome (SOS) and in the Budd-Chiari syndrome. In the hepatic SOS, an increase of LS is observed some days before the clinical manifestations; therefore, it could allow an early diagnosis to timely start an effective treatment. Moreover, it has been reported that patients that were successfully treated showed a LS decrease, that reached pre-transplantation value within two to four weeks. It has been reported that, in patients with Budd-Chiari syndrome, LS values can be used to monitor short and long-term outcome after angioplasty.

Keywords: Liver stiffness; Shear wave elastography; Heart failure; Liver congestion; Hepatic sinusoidal obstruction syndrome; Fontan circulation; Budd Chiari syndrome; Valvular diseases

Core tip: An increase of liver stiffness (LS) has been reported in patients with liver congestion. It is a “confounding factor” for the evaluation of liver fibrosis. However, in the setting of right-sided heart failure LS seems directly influenced by central venous pressure and can be used as a prognostic marker to predict cardiac events. It should be emphasized that heart failure “per se” may lead to irreversible liver disease. The potential role of LS in evaluating liver disease beyond the stage of liver fibrosis has been investigated also in the hepatic sinusoidal obstruction syndrome and in the Budd-Chiari syndrome.