Clinical and Molecular Hepatology

"Elastography"

Reply to Correspondence

Reply to correspondence on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”: Mathias Jachs, Mattias Mandorfer; Clin Mol Hepatol 2026;32(1):e106-e108.
Published online April 16, 2025; DOI: https://doi.org/10.3350/cmh.2025.0391

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Original Article

Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease: Hye Won Lee, Jae Seung Lee, Mi Na Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim; Clin Mol Hepatol 2025;31(3):1018-1031.
Published online April 4, 2025; DOI: https://doi.org/10.3350/cmh.2024.1183

Background/Aims
Recently, the Korean Association for the Study of the Liver (KASL) introduced a noninvasive test-based approach that uses the fibrosis-4 (FIB-4) index followed by vibration-controlled transient elastography (VCTE) to identify high-risk patients with metabolic-associated steatotic liver disease (MASLD). In this study, the KASL two-step approach was validated by assessing the risk of liver-related event (LRE) development.
Methods
We retrospectively analyzed 8,131 patients with MASLD who underwent VCTE between 2012 and 2020. The index date was defined as the date of the VCTE measurement. Using the KASL two-step approach (FIB-4 index and subsequent VCTE), patients were stratified into four groups (low-, intermediate-low-, intermediate-high-, and high-risk groups). Outcomes, including LREs such as decompensation (DCC) or hepatocellular carcinoma (HCC) were evaluated.
Results
During the follow-up (median 46.6 months), 86 (1.1%) patients developed LREs (39 [0.5%] with DCC and 47 [0.6%] with HCC). The KASL two-step approach classified 67.6%, 17.7%, 5.7% and 9.0% of patients in the low-, intermediate-low-, intermediate-high-, and high-risk groups, respectively. The cumulative incidences of LREs increased proportionally according to risk stratification (0.07%, 0.10%, 0.29%, and 1.51% at 3 years and 0.35%, 0.26%, 1.94% and 5.46% at 5 years). The overall accuracy in predicting LREs ranged from 67.7–99.8%. The FIB-4 index and subsequent Agile3+, Agile 4, or FibroScan aspartate aminotransferase scores showed similar predictive abilities compared to the KASL approach.
Conclusions
The KASL two-step approach is an effective and practical method for risk stratification in patients with MASLD, optimizing patient care through early identification of high-risk individuals.

Citations

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Correspondence to editorial on “Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease”
Hye Won Lee, Seung Up Kim
Clinical and Molecular Hepatology.2026; 32(1): e87. CrossRef
Risk stratification of metabolic dysfunction-associated steatotic liver disease: The KASL pathway: Editorial on “Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease”
May Xuan Goh, Xin En Goh, Jarell Jie-Rae Tan, Vincent L Chen, Yu Jun Wong
Clinical and Molecular Hepatology.2026; 32(1): 429. CrossRef
Validation of combo ichroma as a reliable concentration-based alternative for AST and ALT measurement in liver disease monitoring
Minsoo Kim, Su A Kim, Jeong Min Kim, Hee Young Kim, Ho Yeong Yoon, Sung Won Park, Daegyun Park, Ji Sook Han, Ki Tae Suk
Methods.2025; 243: 66. CrossRef

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Correspondence

Steatotic liver disease

Addressing the burden of steatotic liver disease: The role of transient elastography: Correspondence to editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023”: Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, George Cholankeril, Rohit Loomba, Aijaz Ahmed; Clin Mol Hepatol 2025;31(2):e180-e182.
Published online February 13, 2025; DOI: https://doi.org/10.3350/cmh.2025.0125

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Reply to Correspondence

Viral hepatitis

Reply to correspondence on “Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis”: Mirko Zoncapè, Emmanuel A. Tsochatzis; Clin Mol Hepatol 2025;31(1):e117-e118.
Published online November 11, 2024; DOI: https://doi.org/10.3350/cmh.2024.0994

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Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence to editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis”: Young Eun Chon, Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2025;31(1):e61-e63.
Published online October 15, 2024; DOI: https://doi.org/10.3350/cmh.2024.0878

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Editorials

Autoimmune liver disease

Transient elastography for assessing liver fibrosis in autoimmune liver diseases: Excellent performance but limited details: Editorial on “Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis”: Kyung-Ah Kim; Clin Mol Hepatol 2025;31(1):275-276.
Published online October 8, 2024; DOI: https://doi.org/10.3350/cmh.2024.0827

Citations

Citations to this article as recorded by

Metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus in Tanzania: prevalence and predictors
Evangelista Malindisa, Illuminata Kafumu, Allen Rweyendera, Elisha Mkemangwa, David Majinge, Igembe Nkandala, Paulina Manyiri, Semvua Kilonzo
BMC Endocrine Disorders.2026;[Epub] CrossRef

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Viral hepatitis

The use of transient elastography for predicting hepatocellular carcinoma in chronic hepatitis B patients: Editorial on “Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis”: Mirko Zoncapè, Emmanuel A. Tsochatzis; Clin Mol Hepatol 2025;31(1):268-274.
Published online September 24, 2024; DOI: https://doi.org/10.3350/cmh.2024.0817

Citations

Citations to this article as recorded by

Reply to correspondence on “Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis”
Mirko Zoncapè, Emmanuel A. Tsochatzis
Clinical and Molecular Hepatology.2025; 31(1): e117. CrossRef
Correspondence to editorial on “Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis”
Young-Joo Jin, Seung Up Kim
Clinical and Molecular Hepatology.2025; 31(1): e55. CrossRef
Aspirin Use and Risk of HCC and Gastrointestinal Bleeding in Patients With HBV‐Related Cirrhosis: A Landmark Analysis
Mi Na Kim, Geun U. Park, Seng Chan You, Jae Seung Lee, Hye Won Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn
Journal of Gastroenterology and Hepatology.2025; 40(11): 2750. CrossRef

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Correspondence

Steatotic liver disease

Correspondence to editorial on “Optimal cutoffs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis”: Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2025;31(1):e52-e54.
Published online September 24, 2024; DOI: https://doi.org/10.3350/cmh.2024.0815

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Editorials

Steatotic liver disease

Towards unification of liver stiffness measurement cutoffs: Editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis”: Yangyue Zhang, Vincent Wai-Sun Wong; Clin Mol Hepatol 2025;31(1):264-267.
Published online September 20, 2024; DOI: https://doi.org/10.3350/cmh.2024.0766

Citations

Citations to this article as recorded by

Correspondence to editorial on “Optimal cutoffs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analys
Jung Hwan Yu, Seung Up Kim
Clinical and Molecular Hepatology.2025; 31(1): e52. CrossRef
Liver disease in people with latent autoimmune diabetes in adults (LADA): A cross-sectional study using magnetic resonance elastography
Ernesto Maddaloni, Marta Zerunian, Vincenzo Cardinale, Annalisa Zurru, Rocco Amendolara, Daniela Luverà, Renata Risi, Luca D’Onofrio, Benedetta Masci, Francesco Covotta, Damiano Caruso, Domenico Alvaro, Andrea Laghi, Raffaella Buzzetti
Diabetes Research and Clinical Practice.2025; 229: 112465. CrossRef
Mistakes in the utilization of vibration-controlled transient elastography in the evaluation of liver fibrosis: a narrative review
Madunil Anuk Niriella, Uditha Bandara Dassanayake, Charith Priyanga Madurapperuma, Indeewari Prathibha Wijesingha, Arjuna Priyadarshin De Silva, Hithnadura Janaka de Silva
Expert Review of Gastroenterology & Hepatology.2025; 19(12): 1299. CrossRef

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Liver fibrosis, cirrhosis, and portal hypertension

Spotting undiagnosed significant liver fibrosis in the general population: impact on subsequent clinical care: Editorial on “Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis”: Nana Peng, Mary Yue Wang, Sherlot Juan Song, Terry Cheuk-Fung Yip; Clin Mol Hepatol 2025;31(1):256-260.
Published online September 3, 2024; DOI: https://doi.org/10.3350/cmh.2024.0737

Citations

Citations to this article as recorded by

Correspondence to editorial on “Prevalence of clinically significant liver fibrosis in the general population: A systematic review and meta-analysis”
Hee Yeon Kim, Miyoung Choi, Dae Won Jun
Clinical and Molecular Hepatology.2025; 31(1): e48. CrossRef

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Original Articles

Autoimmune liver disease

Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver diseases: A systematic review and meta-analysis: Jihyun An, Young Eun Chon, Gunho Kim, Mi Na Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Miyoung Choi, Dae Won Jun, Seung Up Kim, Ji Won Han, Young-Joo Jin; Clin Mol Hepatol 2024;30(Suppl):S134-S146.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0586

Background/Aims
The assessment of liver fibrosis is crucial for managing autoimmune liver diseases such as primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). However, data on the efficacy of noninvasive tests for these diseases are limited. This meta-analysis evaluated the diagnostic accuracy of vibration-controlled transient elastography (VCTE) for staging fibrosis in patients with autoimmune liver disease.
Methods
Searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases to assess the diagnostic accuracy of VCTE against histology as the reference standard in adult patients with autoimmune liver disease. The summary area under the curve (sAUC) and diagnostic odds ratio were calculated for significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis, according to liver biopsy.
Results
Fourteen articles were included, comprising 559 PBC patients from six studies, 388 AIH patients from five studies, and 151 PSC patients from three studies. VCTE demonstrated good performance for fibrosis staging in PBC, AIH, and PSC. In PBC, sAUCs of VCTE were 0.87, 0.89, and 0.99 for staging SF, AF, and cirrhosis, respectively. In AIH, the sAUCs were 0.88, 0.88, and 0.92, respectively, while in PSC, they were 0.88, 0.95, and 0.92, respectively. The cutoff values for AF were 7.5–17.9 kPa in PBC, 8.18–12.1 kPa in AIH, and 9.6 kPa in PSC.
Conclusions
VCTE shows high diagnostic accuracy for staging liver fibrosis in patients with autoimmune liver diseases. This non-invasive method serves as a valuable tool for the evaluation and monitoring of fibrosis in these lifelong diseases.

Citations

Citations to this article as recorded by

Critical considerations in evaluating the therapeutic potential of HK-660S for primary sclerosing cholangitis: Letter to the editor on “Safety and efficacy of HK-660S in patients with primary sclerosing cholangitis: a randomized double-blind phase 2a tria
Yizi He, Haifeng He, Qi Liang, Yongzhi Xie
Clinical and Molecular Hepatology.2026; 32(1): e1. CrossRef
Transient elastography for assessing liver fibrosis in autoimmune liver diseases: Excellent performance but limited details: Editorial on “Diagnostic accuracy of vibration-controlled transient elastography for staging liver fibrosis in autoimmune liver di
Kyung-Ah Kim
Clinical and Molecular Hepatology.2025; 31(1): 275. CrossRef
Diagnostic value of serum Golgi protein 73 in liver fibrosis and inflammation in patients with autoimmune hepatitis
Yazhen Zhang, Aifang Xu, Yujiao Jin, Jing Gao, Jiahui He
Medicine.2025; 104(26): e43064. CrossRef
Targeting endoplasmic reticulum proteostasis in liver fibrosis: From signaling mechanisms to therapeutic opportunities
Yawei Kong, Zhengyang Chen, Zhentian Nie, Wei Chen
Pharmacological Research.2025; 217: 107823. CrossRef
Diagnostic Performance of SWE and Predictive Models Based on SWE for Post-Hepatectomy Liver Failure: A Systematic Review and Meta-analysis
Jiaxu Liang, Fukun Shi, Lan Zhang, Suo Yin, Yong Chen
Current Medical Imaging Formerly Current Medical Imaging Reviews.2025;[Epub] CrossRef
Hidden weaknesses and biological insights in machine learning models of fibrosis in autoimmune hepatitis
Shiuan-Chih Chen, Chun-Chieh Chen
QJM: An International Journal of Medicine.2025;[Epub] CrossRef
Transient Elastography and Fibroscan: Stethoscope of a Hepatologist in Today’s World
Sajid Jalil, Mangesh Pagadala, Nicholas Dunn, Hanna Blaney, Mohamed Elfeki, Nimish Thakral, Ashwani K. Singal
Current Hepatology Reports.2025;[Epub] CrossRef

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Steatotic liver disease

Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: Young Eun Chon, Young-Joo Jin, Jihyun An, Hee Yeon Kim, Miyoung Choi, Dae Won Jun, Mi Na Kim, Ji Won Han, Han Ah Lee, Jung Hwan Yu, Seung Up Kim; Clin Mol Hepatol 2024;30(Suppl):S117-S133.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0392

Background/aims
Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.
Methods
Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.
Results
A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80–0.86), 0.83 (0.80–0.86), 0.87 (0.84–0.90), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86–0.92), 0.92 (0.89–0.94), 0.89 (0.86–0.92), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1–7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62–3.8 kPa.
Conclusions
VCTE (7.1–7.9 kPa) and MRE (3.62–3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF.

Citations

Citations to this article as recorded by

Non-invasive Risk-based Surveillance Strategy for Hepatocellular Carcinoma in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease
Ji Won Han
The Korean Journal of Gastroenterology.2026; 86(1): 62. CrossRef
Correspondence to editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analy
Young Eun Chon, Jung Hwan Yu, Seung Up Kim
Clinical and Molecular Hepatology.2025; 31(1): e61. CrossRef
Essential tools for assessing advanced fibrosis in metabolic dysfunction-associated steatotic liver disease: Editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fib
Won Sohn
Clinical and Molecular Hepatology.2025; 31(1): 277. CrossRef
Correspondence to editorial on “Optimal cutoffs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analys
Jung Hwan Yu, Seung Up Kim
Clinical and Molecular Hepatology.2025; 31(1): e52. CrossRef
Towards unification of liver stiffness measurement cutoffs: Editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver d
Yangyue Zhang, Vincent Wai-Sun Wong
Clinical and Molecular Hepatology.2025; 31(1): 264. CrossRef
Sustainability of General Population Screening for Steatotic Liver Disease: A Proof-of-Concept Study
Laura De Rosa, Gabriele Ricco, Maurizia Rossana Brunetto, Ferruccio Bonino, Francesco Faita
Healthcare.2025; 13(7): 759. CrossRef
Therapeutic Efficacy of Silymarin, Vitamin E, and Essential Phospholipid Combination Therapy on Hepatic Steatosis, Fibrosis, and Metabolic Parameters in MASLD Patients: A Prospective Clinical Study
Dan-Ionuț Gheonea, Cristina Tocia, Victor-Mihai Sacerdoțianu, Alexandra-Georgiana Bocioagă, Irina-Paula Doica, Nicolae Cătălin Manea, Adina Turcu-Știolică, Carmen-Nicoleta Oancea, Eugen Dumitru
International Journal of Molecular Sciences.2025; 26(12): 5427. CrossRef
Deep learning radiomics of elastography for diagnosing compensated advanced chronic liver disease: an international multicenter study
Xue Lu, Haoyan Zhang, Hidekatsu Kuroda, Matteo Garcovich, Victor de Ledinghen, Ivica Grgurević, Runze Linghu, Hong Ding, Jiandong Chang, Min Wu, Cheng Feng, Xinping Ren, Changzhu Liu, Tao Song, Fankun Meng, Yao Zhang, Ye Fang, Sumei Ma, Jinfen Wang, Xiaol
Visual Computing for Industry, Biomedicine, and Art.2025;[Epub] CrossRef
Liver disease in people with latent autoimmune diabetes in adults (LADA): A cross-sectional study using magnetic resonance elastography
Ernesto Maddaloni, Marta Zerunian, Vincenzo Cardinale, Annalisa Zurru, Rocco Amendolara, Daniela Luverà, Renata Risi, Luca D’Onofrio, Benedetta Masci, Francesco Covotta, Damiano Caruso, Domenico Alvaro, Andrea Laghi, Raffaella Buzzetti
Diabetes Research and Clinical Practice.2025; 229: 112465. CrossRef
Paired snRNA-seq and scRNA-seq analysis of MASLD patients to identify early-stage markers for disease progression
Suebin Park, Su-Hyeon Lee, Se-eun Han, Beom Kyung Kim, Byungjin Hwang
Hepatology Communications.2025;[Epub] CrossRef
Even Lower Alcohol Intake Might Be Harmful for East Asian Males With MASLD Spectrum
Byungyoon Yun, Juyeon Oh, Heejoo Park, Jian Lee, Beom Kyung Kim, Jin-Ha Yoon
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef
Lean Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Wolf in Sheep's Clothing
Xixi Fang, Chenhao Xu, Jun Lu, Runzhou Zhuang, Xiao Xu, Xuyong Wei
Cell Biochemistry and Function.2025;[Epub] CrossRef
Mistakes in the utilization of vibration-controlled transient elastography in the evaluation of liver fibrosis: a narrative review
Madunil Anuk Niriella, Uditha Bandara Dassanayake, Charith Priyanga Madurapperuma, Indeewari Prathibha Wijesingha, Arjuna Priyadarshin De Silva, Hithnadura Janaka de Silva
Expert Review of Gastroenterology & Hepatology.2025; 19(12): 1299. CrossRef
Transient Elastography and Fibroscan: Stethoscope of a Hepatologist in Today’s World
Sajid Jalil, Mangesh Pagadala, Nicholas Dunn, Hanna Blaney, Mohamed Elfeki, Nimish Thakral, Ashwani K. Singal
Current Hepatology Reports.2025;[Epub] CrossRef
Comparative analysis of non-invasive fibrosis markers: Insights from chronic HBV, HBV+HDV, and HCV infections
Aziza Saydullaevna Khikmatullaeva, Krestina Stepanovna Brigida, Nargiza Mirzakhidovna Мirrakhimova, Muazzam Alievna Аbdukadirova, Nargiz Sapievna Ibadullaeva, Allabergan Kadirovich Bayjanov, Nataliya Georgiyevna Kan, Malika Erkinovna Khodjaeva, Nargiza An
Infectious Medicine.2025; 4(4): 100220. CrossRef

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Hepatic neoplasm

Assessment of the postoperative prognosis in patients with hepatocellular carcinoma using vibration-controlled transient elastography: A systemic review and meta-analysis: Jung Hwan Yu, Ji Won Han, Young Ju Suh, Young Eun Chon, Hee Yeon Kim, Ji Hyun An, Young-Joo Jin, Miyoung Choi, Seung Up Kim, Dae Won Jun, Han Ah Lee, Mi Na Kim; Clin Mol Hepatol 2024;30(Suppl):S186-S198.
Published online August 21, 2024; DOI: https://doi.org/10.3350/cmh.2024.0366

Backgrounds/Aims
This meta-analysis examined whether preoperative vibration-controlled transient elastography (VCTE) can predict postoperative complications and recurrence in patients undergoing hepatic resection for hepatocellular carcinoma (HCC).
Methods
A systematic literature search was conducted using Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases. Out of 431 individual studies, thirteen published between 2008 and 2022 were included. Five studies focused on HCC recurrence, while eight examined postoperative complications.
Results
The meta-analysis of five studies on HCC recurrence showed that the high-risk group with a high VCTE score had a significantly increased recurrence rate after hepatic resection (hazard ratio 2.14). The cutoff value of VCTE in the high-risk group of HCC recurrence was 7.4–13.4 kPa, the sensitivity was 0.60 (95% confidence interval [CI] 0.47–0.72), and the specificity was 0.60 (95% CI 0.46–0.72). The area under the receiver operating characteristic curve (AUC) of the liver stiffness measured by VCTE to predict the HCC recurrence was 0.63 (95% CI 0.59–0.67). The meta-analysis on the postoperative complications revealed a significantly increased risk of postoperative complications in the high-risk group (12–25.6 kPa) with a high VCTE value (odds ratio [OR], 8.32). The AUC of the liver stiffness measured by VCTE to predict the postoperative complications was 0.87 (95% CI 0.84–0.90), the sensitivity was 0.76 (95% CI 0.55–0.89) and the specificity was 0.85 (95% CI 0.73–0.92).
Conclusions
This meta-analysis suggests that preoperative VCTE in patients undergoing hepatic resection for HCC is useful in identifying individuals at a high risk of postoperative complications and HCC recurrence.

Citations

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Comparison of HCC patients with and without MASLD after surgical resection
Chia-Jung Ho, Hao-Jan Lei, Chun-Ting Ho, Gar-Yang Chau, Shu-Cheng Chou, Elise Chia-Hui Tan, Pei-Chang Lee, Yi-Hsiang Huang, Ying-Ying Yang, Teh-Ia Huo, Ming-Chih Hou, Jaw-Ching Wu, Chien-Wei Su
JHEP Reports.2026; : 101768. CrossRef
Recent Trends in Noninvasive Tests for Assessing Hepatic Fibrosis in Patients with Chronic Liver Disease
Jung Hwan Yu
The Korean Journal of Medicine.2024; 99(5): 232. CrossRef

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2 Web of Science
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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

From invasive to intuitive: The emerging role of non-invasive models in hepatic decompensation: Editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)”: Akhil Deshmukh, Rakhi Maiwall; Clin Mol Hepatol 2025;31(2):577-580.
Published online August 19, 2024; DOI: https://doi.org/10.3350/cmh.2024.0661

Citations

Citations to this article as recorded by

Correspondence to editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)”
Chuan Liu, Ling Yang, Hong You, Gao-Jun Teng, Xiaolong Qi
Clinical and Molecular Hepatology.2025; 31(2): e155. CrossRef

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Original Articles

Hepatic neoplasm

Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-analysis: Han Ah Lee, Mi Na Kim, Hye Ah Lee, Miyoung Choi, Jung Hwan Yu, Young-Joo Jin, Hee Yeon Kim, Ji Won Han, Seung Up Kim, Jihyun An, Young Eun Chon; Clin Mol Hepatol 2024;30(Suppl):S172-S185.
Published online August 12, 2024; DOI: https://doi.org/10.3350/cmh.2024.0262

Backgrounds/Aims
Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR.
Methods
We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies’ methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models.
Results
We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2–13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4–11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa.
Conclusions
VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact.

Citations

Citations to this article as recorded by

2025 KASL clinical practice guidelines for management of hepatitis C
Eun Sun Jang, Nae Yun Heo, Jae Yoon Jeong, Jung Gil Park, Do Seon Song, Eun Ju Cho, Chang Hun Lee, Jae Seung Lee, Jae Hyun Yoon, Seul Ki Han, Young Kul Jung
Clinical and Molecular Hepatology.2026; 32(1): 1. CrossRef
Comment: Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus
Xinpu Miao, Haidong Wu, Jinrong Xu, Wei Cheng
Clinical and Molecular Hepatology.2025; 31(1): e23. CrossRef
Hepatocellular carcinoma surveillance after sustained virological response in chronic hepatitis C: Editorial on “Non-invasive prediction of post-sustained virological response hepatocellular carcinoma in hepatitis C virus: A systematic review and meta-ana
Ho Soo Chun, Minjong Lee
Clinical and Molecular Hepatology.2025; 31(1): 261. CrossRef
Longitudinal Effects of Glecaprevir/Pibrentasvir on Liver Function, Fibrosis, and Hepatocellular Carcinoma Risk in Chronic Hepatitis C: A Prospective Multicenter Cohort Study
Jung Hee Kim, Jae Hyun Yoon, Sung-Eun Kim, Ji-Won Park, Yewan Park, Gi-Ae Kim, Seong Kyun Na, Young-Sun Lee, Jeong Han Kim
Medicina.2025; 61(9): 1601. CrossRef
Precision Strategy for Hepatocellular Carcinoma Surveillance after Hepatitis C Cure: Debates across Guidelines
Masaaki Mino, Eiji Kakazu, Tatsuya Kanto
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Viral hepatitis

Vibration-controlled transient elastography for significant fibrosis in treatment-naïve chronic hepatitis B patients: A systematic review and meta-analysis: Mi Na Kim, Jihyun An, Eun Hwa Kim, Hee Yeon Kim, Han Ah Lee, Jung Hwan Yu, Young-Joo Jin, Young Eun Chon, Seung Up Kim, Dae Won Jun, Ji Won Han, Miyoung Choi; Clin Mol Hepatol 2024;30(Suppl):S106-S116.
Published online July 23, 2024; DOI: https://doi.org/10.3350/cmh.2024.0371

Backgrounds/Aims
Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of vibration-controlled transient elastography (VCTE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN).
Methods
The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of VCTE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of VCTE in the meta-analysis.
Results
Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 (95% confidence interval [CI], 0.66–0.86) and 0.72 (95% CI, 0.60–0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72–0.86). The optimal cutoff value of VCTE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50–0.76) and specificity of 0.83 (95% CI, 0.72–0.90).
Conclusions
Our study demonstrated that VCTE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

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Chronic Hepatitis B Infection: Patient Guidance
Lung‐Yi Mak, Jimmy Che‐To Lai, Ken Liu, Rashid Lui, Sakkarin Chirapongsathorn, Kuo Chao Yew, Mara Teresa Panlilio, Cosmas Rinaldi Adithya Lesmana, Ruveena Bhavani Rajaram, Liang Shen, Desmond Cheung, Lung‐Fai Wong, Hye Won Lee, Madhumita Premkumar, Anand
Journal of Gastroenterology and Hepatology.2026; 41(1): 61. CrossRef
Unraveling Demographic Patterns in Hepatitis B Clinical and Laboratory Profiles: Insights From a Ghanaian Cohort: A Retrospective Study
Napoleon Bellua Sam, Saeed Folorunsho Majeed, Adams Dramani
Health Science Reports.2025;[Epub] CrossRef
Head‐to‐Head Comparison of Long‐Term HCC Risk of Antivirals‐Treated Versus Untreated Low‐Level Viremia in HBV‐Compensated Cirrhosis
Nobuharu Tamaki, Daniel Q. Huang, Hyung Woong Lee, Soo Young Park, Yu Rim Lee, Dong Hyun Sinn, Tae Seop Lim, Hiroyuki Marusawa, Seng Gee Lim, Hironori Ochi, Masahiko Kondo, Yasushi Uchida, Haruhiko Kobashi, Koichiro Furuta, Masayuki Kurosaki, Beom Kyung K
Journal of Gastroenterology and Hepatology.2025; 40(6): 1595. CrossRef
Assessing Liver Fibrosis in Chronic Hepatitis B: Liver Biopsy or Non-Invasive Fibrosis Markers?
Deniz Borcak, Zuhal Yesilbag, Yusuf Emre Ozdemir, Adile Sevde Demir, Esra Salim Dogdas, Aysegul Inci Sezen, Esra Canbolat Unlu, Sevtap Senoglu, Hayat Kumbasar Karaosmanoglu, Kadriye Kart Yasar
Journal of Clinical Medicine.2025; 14(22): 8164. CrossRef
Vibration-Controlled Transient Elastography in Chronic Liver Disease: Current Research Insights
Ho Soo Chun
Clinical Ultrasound.2025; 10(2): 69. CrossRef
Recent Trends in Noninvasive Tests for Assessing Hepatic Fibrosis in Patients with Chronic Liver Disease
Jung Hwan Yu
The Korean Journal of Medicine.2024; 99(5): 232. CrossRef
Noninvasive Imaging Test to Assess Liver Fibrosis: Vibration-controlled Transient Elastography
Mi Na Kim
The Korean Journal of Gastroenterology.2024; 84(5): 201. CrossRef
Liver Fibrosis Assessment in Chronic Liver Diseases Using Elastography: A Comprehensive Review of Vibration-Controlled Transient Elastography and Shear Wave Elastography
Han Ah Lee
Clinical Ultrasound.2024; 9(2): 70. CrossRef

6,115 View
133 Download
6 Web of Science
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Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using vibration-controlled transient elastography: Systematic review and meta-analysis: Young-Joo Jin, Hee Yeon Kim, Young Ju Suh, Chae Hyeon Lee, Jung Hwan Yu, Mi Na Kim, Ji Won Han, Han Ah Lee, Jihyun An, Young Eun Chon, Dae Won Jun, Miyoung Choi, Seung Up Kim; Clin Mol Hepatol 2024;30(Suppl):S159-S171.
Published online July 23, 2024; DOI: https://doi.org/10.3350/cmh.2024.0163

Backgrounds/Aims
Liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE) can assess fibrotic burden in chronic liver diseases. The systematic review and meta-analysis was conducted to determine whether LSM using VCTE can predict the risk of development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients.
Methods
A systematic literature search of the Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases (from January 2010 to June 2023) was conducted. Of the 1,345 individual studies identified, 10 studies that used VCTE were finally registered. Hazard ratios (HRs) and the 95% confidence intervals (CIs) were considered summary estimates of treatment effect sizes of ≥11 kilopascal (kPa) standard for HCC development. Meta-analysis was performed using the restricted Maximum Likelihood random effects model.
Results
Among the ten studies, data for risk ratios for HCC development could be obtained from nine studies. When analyzed for the nine studies, the HR for HCC development was high at 3.33 (95% CI, 2.45–4.54) in CHB patients with a baseline LSM of ≥11 kPa compared to patients who did not. In ten studies included, LSM of ≥11 kPa showed the sensitivity and specificity for predicting HCC development were 61% (95% CI, 50–71%) and 78% (95% CI, 66–86%), respectively, and the diagnostic accuracy was 0.74 (95% CI, 0.70–0.77).
Conclusions
The risk of HCC development was elevated in CHB patients with VCTE-determined LSM of ≥11 kPa. This finding suggests that VCTE-determined LSM values may aid the risk prediction of HCC development in CHB patients.

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Baveno VII criteria to predict decompensation in compensated advanced chronic liver disease: Still some shades of grey: Susana G Rodrigues; Clin Mol Hepatol 2023;29(1):110-112.
Published online December 12, 2022; DOI: https://doi.org/10.3350/cmh.2022.0414

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Review

Steatotic liver disease

Identification of high-risk subjects in nonalcoholic fatty liver disease: Christiane Stern, Laurent Castera; Clin Mol Hepatol 2023;29(Suppl):S196-S206.
Published online December 5, 2022; DOI: https://doi.org/10.3350/cmh.2022.0431

Abstract
PDF

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide, and its burden is expected to increase due to the growing epidemic of obesity and diabetes. The key challenge among NAFLD patients is to identify those with advanced fibrosis (F3F4), who are at high risk of developing complications and will benefit from specialized management and treatment with new pharmacotherapies when they are approved. Liver biopsy appears unrealistic and unsuitable in practice, given the large number of high-risk patients and its well-known limitations. Non-invasive sequential algorithms using fibrosis-4 index as first-line test, followed by vibration-controlled transient elastography or patented blood test, are the best strategy for case finding of high-risk subjects. In fact, they are now recommended by several international guidelines, and should be used and disseminated to increase awareness among physicians beyond liver clinics where most NAFLD patients are seen.

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Original Article

Liver fibrosis, cirrhosis, and portal hypertension

The cut-off value of transient elastography to the value of hepatic venous pressure gradient in alcoholic cirrhosis: Se Ri Ryu, Jeong-Ju Yoo, Seong Hee Kang, Soung Won Jeong, Moon Young Kim, Young Kyu Cho, Young Chang, Sang Gyune Kim, Jae Young Jang, Young Seok Kim, Soon Koo Baik, Yong Jae Kim, Su Yeon Park, Baigal Baymbajav; Clin Mol Hepatol 2021;27(1):197-206.
Published online December 3, 2020; DOI: https://doi.org/10.3350/cmh.2020.0171

Background/Aims
The hepatic venous pressure gradient (HVPG) reflects portal hypertension, but its measurement is invasive. Transient elastography (TE) is a noninvasive method for evaluating liver stiffness (LS). We investigated the correlation between the value of LS, LS to platelet ratio (LPR), LS-spleen diameter-to-platelet ratio score (LSPS) and HVPG according to the etiology of cirrhosis, especially focused on alcoholic cirrhosis.
Methods
Between January 2008 and March 2017, 556 patients who underwent HVPG and TE were consecutively enrolled. We evaluated LS, LPR, and LSPS according to the etiology of cirrhosis and analyzed their correlations with HVPG.
Results
The LS value was higher in patients with alcoholic cirrhosis than viral cirrhosis based on the HVPG (43.5 vs. 32.0 kPa, P<0.001). There were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups, and the areas under the curves for the LPR and LSPS in subgroups according to HVPG levels were not superior to that for LS. In alcoholic cirrhosis, the LS cutoff value for predicting an HVPG ≥10 mmHg was 32.2 kPa with positive predictive value (PPV) of 94.5% and 36.6 kPa for HVPG ≥12 mmHg with PPV of 91.0%.
Conclusions
The LS cutoff value should be determined separately for patients with alcoholic and viral cirrhosis. In alcoholic cirrhosis, the LS cutoff values were 32.2 and 36.6 kPa for predicting an HVPG ≥10 and ≥12 mmHg, respectively. However, there were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups.

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Editorial

Viral hepatitis

Assessment of fibrotic burden among chronic hepatitis B virus-infected patients with normal transaminase level: Mi Young Jeon, Beom Kyung Kim, Seung Up Kim; Clin Mol Hepatol 2018;24(4):367-369.
Published online September 19, 2018; DOI: https://doi.org/10.3350/cmh.2018.1008

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Original Articles

Viral hepatitis

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases: San Juan López Cristina, Casado Martín Marta, González Sánchez Mercedes, Porcel Martín Almudena, Hernández Martínez Álvaro, Vega Sáenz Jose Luis, Parrón Carreño Tesifón; Clin Mol Hepatol 2018;24(4):384-391.
Published online July 4, 2018; DOI: https://doi.org/10.3350/cmh.2018.0004

Abstract
PDF

Backgrounds/Aims
The
objective
of our study was to determine the epidemiological, laboratory, and serological characteristics of patients with chronic hepatitis B virus (HBV) infection and normal transaminases. The study also aimed to evaluate liver damage by measuring the liver fibrosis (LF) grade and to identify possible factors associated with the presence of fibrosis.
Methods
A retrospective observational study was conducted in patients with chronic HBV infection and classified as inactive carriers or immune-tolerant. Epidemiological variables of age, sex, immigrant, alcohol consumption, and body mass index (BMI), as well as virological variables (HBV DNA) and transaminase level were collected throughout the follow-up. The LF grade was evaluated by transient elastography. The cutoff value for significant fibrosis (SF) was liver stiffness ≥7.9 kPa.
Results
A total of 214 patients were included in the analysis, and 62% of them had a BMI ≥25 kg/m2 . During follow-up, 4% of patients showed transaminase elevation (<1.5 times normal). Most patients had a viral DNA level <2,000 IU/mL (83%). Data on LF were available in 160 patients; of these, 14% had SF, 9% F3, and 6% F4. The variables associated with the presence of SF were transaminase alteration during follow-up, as 23% of patients with SF had elevated transaminases versus 3% of patients without SF (P<0.005), and BMI, as the vast majority of patients with SF (88%) had a BMI ≥25 kg/m2 versus 56% of patients without SF (P<0.05).
Conclusions
In patients with chronic HBV infection and normal transaminases, liver damage does not seem to be related to DNA levels, alcohol consumption, or immigrant status. SF seems to be associated with transaminase alteration during follow-up and elevated BMI. It is therefore recommended to measure LF grade with validated non-invasive methods in such patients.

Citations

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Alin Lazar, Ioan Sporea, Alexandru Popa, Raluca Lupusoru, Diana Gherhardt, Ruxandra Mare, Alexandru Apostu, Madalina Hnatiuc, Roxana Șirli
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A different detection method reveals a new role of alanine aminotransferase as an indicator of liver fibrosis
Pil Soo Sung
The Korean Journal of Internal Medicine.2020; 35(2): 295. CrossRef
Assessment of fibrotic burden among chronic hepatitis B virus-infected patients with normal transaminase level
Mi Young Jeon, Beom Kyung Kim, Seung Up Kim
Clinical and Molecular Hepatology.2018; 24(4): 367. CrossRef

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Nutritional and Metabolic liver disease

Protein and vitamin B6 intake are associated with liver steatosis assessed by transient elastography, especially in obese individuals: Yvelise Ferro, Ilaria Carè, Elisa Mazza, Francesco Provenzano, Carmela Colica, Carlo Torti, Stefano Romeo, Arturo Pujia, Tiziana Montalcini; Clin Mol Hepatol 2017;23(3):249-259.
Published online July 28, 2017; DOI: https://doi.org/10.3350/cmh.2017.0019

Abstract
PDF

Background/Aims
Although the detrimental effects of several dietary components on the promotion of nonalcoholic fatty liver disease are well known, no studies have assessed the role of dietary vitamin B6. Moreover, studies on the associations between dietary components or body composition indices and liver steatosis assessed by transient elastography are rare. Our aim was to identify the nutritional factors and anthropometric parameters associated with liver steatosis.
Methods
In this cross-sectional study, we enrolled 168 individuals (35% obese) who underwent a liver steatosis assessment by Controlled Attenuation Parameter measurement and nutritional assessment.
Results
Tertiles of vitamin B6 intake were positively associated with hepatic steatosis (B=1.89, P=0.026, confidence interval [CI] 0.03-0.80) as well as with triglycerides, glucose, alanine aminotransferase (ALT), and body mass index . In obese individuals, after multivariable analysis, the Controlled Attenuation Parameter score was still associated with triglycerides, ALT, and total protein intake (B=0.56, P=0.01, CI 0.10-1.02). Participants in tertile I (low intake) had a lower Controlled Attenuation Parameter than those in tertile III (P=0.01).
Conclusions
We found a positive association between hepatic steatosis or Controlled Attenuation Parameter score and vitamin B6/total protein intake, probably related to the high intake of meat. Vitamin B6 might have a pathogenic role related to the increase of hepatic steatosis.

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Transient elastography can be integrated into routine clinical practice for the evaluation of portal hypertension?: Beom Kyung Kim; Clin Mol Hepatol 2017;23(1):27-30.
Published online March 24, 2017; DOI: https://doi.org/10.3350/cmh.2017.0101

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The cutoff of transient elastography for the evaluation of portal hypertension should be different according to the etiology?
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Original Article

Liver fibrosis, cirrhosis, and portal hypertension

Transient elastography versus hepatic venous pressure gradient for diagnosing portal hypertension: a systematic review and meta-analysis: Gaeun Kim, Moon Young Kim, Soon Koo Baik; Clin Mol Hepatol 2017;23(1):34-41.
Published online March 7, 2017; DOI: https://doi.org/10.3350/cmh.2016.0059

Abstract
PDF

Background/Aims
Transient elastography (TE) has been proposed as a promising noninvasive alternative to hepatic venous pressure gradient (HVPG) for detecting portal hypertension (PH). However, previous studies have yielded conflicting results. We gathered evidence from literature on the clinical usefulness of TE versus HVPG for assessing PH.
Methods
We conducted a systematic review by searching databases for relevant literature evaluating the clinical usefulness of non-invasive TE for assessing PH in patients with cirrhosis. A literature search in Ovid Medline, EMBASE and the Cochrane Library was performed for all studies published prior to December 30, 2015.
Results
Eight studies (1,356 patients) met our inclusion criteria. For the detection of PH (HVPG ≥6 mmHg), the summary sensitivity and specificity were 0.88 (95% confidence interval [CI] 0.86-0.90) and 0.74 (95% CI 0.67-0.81), respectively. Regarding clinically significant PH (HVPG ≥10 mmHg), the summary sensitivity and specificity were 0.85 (95% CI 0.63-0.97) and 0.71 (95% CI 0.50-0.93), respectively. The overall correlation estimate of TE and HVPG was large (0.75, 95% CI: 0.65; 0.82, P<0.0001).
Conclusions
TE showed high accuracy and correlation for detecting the severity of PH. Therefore, TE shows promise as a reliable and non-invasive procedure for the evaluation of PH that should be integrated into clinical practice.

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Liver Imaging

Liver fibrosis, cirrhosis, and portal hypertension

What we need to know when performing and interpreting US elastography: So Hyun Park, So Yeon Kim, Chong Hyun Suh, Seung Soo Lee, Kyoung Won Kim, So Jung Lee, Moon-Gyu Lee; Clin Mol Hepatol 2016;22(3):406-414.
Published online September 25, 2016; DOI: https://doi.org/10.3350/cmh.2016.0106

Abstract
PDF

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Personalized management of cirrhosis by non-invasive tests of liver fibrosis: Grace Lai-Hung Wong, Wendell Zaragoza Espinosa, Vicnent Wai-Sun Wong; Clin Mol Hepatol 2015;21(3):200-211.
Published online September 30, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.3.200

Abstract
PDF

Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.

Citations

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Original Articles

Viral hepatitis

The factors associated with longitudinal changes in liver stiffness in patients with chronic hepatitis B: In Ku Yo, Oh Sang Kwon, Jin Woong Park, Jong Joon Lee, Jung Hyun Lee, In Sik Won, Sun Young Na, Pil Kyu Jang, Pyung Hwa Park, Duck Joo Choi, Yun Soo Kim, Ju Hyun Kim; Clin Mol Hepatol 2015;21(1):32-40.
Published online March 25, 2015; DOI: https://doi.org/10.3350/cmh.2015.21.1.32

Abstract
PDF

Background/Aims

Liver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS.

Methods

Between April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of ≤0 or >0 kPa, respectively, over a 1-year period), and their data were compared.

Results

No differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P<0.001). However, there were no differences in any other clinical characteristic. In the antiviral therapy (-) group, the initial LS was also higher in the LS improvement group (n=29) than in the LS deterioration group (n=26; 8.3 vs. 6.5 kPa, P=0.021), with no differences in any other clinical characteristic.

Conclusions

A higher initial LS was the only factor associated with LS improvement in patients with CHB in this study.

Citations

Citations to this article as recorded by

Predictive validation of qualitative fibrosis staging in patients with chronic hepatitis B on antiviral therapy
Hye Won Lee, Kiyong Na, Seung Up Kim, Beom Kyung Kim, Jun Yong Park, Ji Hae Nahm, Jung Il Lee, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Young Nyun Park
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The Influence of Histologic Inflammation on the Improvement of Liver Stiffness Values Over 1 and 3 Years
Jeong-Ju Yoo, Yeon Seok Seo, Young Seok Kim, Soung Won Jeong, Jae Young Jang, Sang Jun Suh, Hyung Joon Yim, Ki Tae Suk, Dong Joon Kim, Kwang-Hyub Han, Seung Up Kim, Bora Lee, Sang Gyune Kim
Journal of Clinical Medicine.2019; 8(12): 2065. CrossRef
Diagnostic Performance of Serum Asialo-α1-acid Glycoprotein for Advanced Liver Fibrosis or Cirrhosis in Patients with Chronic Hepatitis B or Nonalcoholic Fatty Liver Disease
Seung Up Kim, Mi Young Jeon, Tae Seop Lim
The Korean Journal of Gastroenterology.2019; 74(6): 341. CrossRef
Reversal of liver cirrhosis: current evidence and expectations
Young Kul Jung, Hyung Joon Yim
The Korean Journal of Internal Medicine.2017; 32(2): 213. CrossRef
Improvement of Liver Fibrosis after Long-Term Antiviral Therapy Assessed by Fibroscan in Chronic Hepatitis B Patients With Advanced Fibrosis
Young Eun Chon, Jun Yong Park, Sung-Min Myoung, Kyu Sik Jung, Beom Kyung Kim, Seung Up Kim, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han
American Journal of Gastroenterology.2017; 112(6): 882. CrossRef
Using transient elastography to predict hepatocellular carcinoma recurrence after radiofrequency ablation
Yu Rim Lee, Soo Young Park, Seung Up Kim, Se Young Jang, Won Young Tak, Young Oh Kweon, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang‐Hyub Han, Keun Hur
Journal of Gastroenterology and Hepatology.2017; 32(5): 1079. CrossRef
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Liver fibrosis, cirrhosis, and portal hypertension

Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis: Kyoung Min Moon, Gaeun Kim, Soon Koo Baik, Eunhee Choi, Moon Young Kim, Hyoun A Kim, Mee Yon Cho, Seung Yong Shin, Jung Min Kim, Hong Jun Park, Sang Ok Kwon, Young Woo Eom; Clin Mol Hepatol 2013;19(4):389-398.
Published online December 28, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.4.389

Abstract
PDF

Background/Aims

We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis.

Methods

Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated.

Results

The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4.

Conclusions

The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.

Citations

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Liver fibrosis, cirrhosis, and portal hypertension

The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis: Jong Ho Chung, Hyung Su Ahn, Sang Gyune Kim, Yun Nah Lee, Young Seok Kim, Soung Won Jeong, Jae Young Jang, Sae Hwan Lee, Hong Soo Kim, Boo Sung Kim; Clin Mol Hepatol 2013;19(2):156-164.
Published online June 27, 2013; DOI: https://doi.org/10.3350/cmh.2013.19.2.156

Abstract
PDF

Background/Aims

Several noninvasive methods have recently been developed for the evaluation of liver fibrosis. The accuracy of transient elastography (TE), acoustic-radiation-force impulse (ARFI) elastography, and real-time elastography (RTE) in predicting liver fibrosis were evaluated.

Methods

Seventy-four patients who had undergone a liver biopsy within the previous 6 months were submitted to evaluation with TE, ARFI, and RTE on the same day.

Results

There were significant correlations between fibrosis stage and liver stiffness measurement (LSM) using the three tested methods: TE, r²=0.272, P=0.0002; ARFI, r²=0.225, P=0.0017; and RTE, r²=0.228, P=0.0015. The areas under the receiver operating characteristic curves (AUROC) for the diagnosis of significant fibrosis (≥F2, Metavir stage) by TE, ARFI, RTE, TE/platelet count (PLT), velocity of shear wave (Vs)/PLT, and elasticity score (Es)/PLT were 0.727, 0.715, 0.507, 0.876, 0.874, and 0.811, respectively. The AUROC for the diagnosis of cirrhosis by TE, ARFI, RTE, TE/PLT, Vs/PLT, and Es/PLT were 0.786, 0.807, 0.767, 0.836, 0.819, and 0.838, respectively. Comparisons of AUROC between all LSMs for predicting significant fibrosis (≥F2) produced the following results: TE vs. RTE, P=0.0069; ARFI vs. RTE, P=0.0277; and TE vs. ARFI, P=0.8836. Applying PLT, the ability of each LSM to predict fibrosis stage significantly increased: TE/PLT vs. TE, P=0.0004; Vs/PLT vs. ARFI, P=0.0022; and Es/PLT vs. RTE, P<0.0001. However, the ability to predict cirrhosis was not enhanced, combining LSM and PLT.

Conclusions

TE and ARFI may be better methods for predicting significant liver fibrosis than RTE. This predictive ability increased significantly when accounting for platelet count. However, all of the measures had comparable efficacies for predicting cirrhosis.

Citations

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Clinical applications of transient elastography: Kyu Sik Jung, Seung Up Kim; Korean J Hepatol 2012;18(2):163-173.
Published online June 26, 2012; DOI: https://doi.org/10.3350/cmh.2012.18.2.163

Abstract
PDF

Chronic liver disease represents a major public health problem, accounting for significant morbidity and mortality worldwide. As prognosis and management depend mainly on the amount and progression of liver fibrosis, accurate quantification of liver fibrosis is essential for therapeutic decision-making and follow-up of chronic liver diseases. Even though liver biopsy is the gold standard for evaluation of liver fibrosis, non-invasive methods that could substitute for invasive procedures have been investigated during past decades. Transient elastography (TE, FibroScan®) is a novel non-invasive method for assessment of liver fibrosis with chronic liver disease. TE can be performed in the outpatient clinic with immediate results and excellent reproducibility. Its diagnostic accuracy for assessment of liver fibrosis has been demonstrated in patients with chronic viral hepatitis; as a result, unnecessary liver biopsy could be avoided in some patients. Moreover, due to its excellent patient acceptance, TE could be used for monitoring disease progression or predicting development of liver-related complications. This review aims at discussing the usefulness of TE in clinical practice.

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Original Article

Clinical factors influencing Liver stiffness as measured by transient elastography (FibroscanⓇ) in patients with chronic Liver disease: Rack Cheon Bae, M.D., Han Jin Cho, M.D., Jong Taek Oh, M.D., Eung Kap Lee, M.D., Jun Heo, M.D., Keun Young Shin, M.D., Soo Young Park, M.D., Min Kyu Jeong, M.D., Seong Woo Jeon, M.D., Chang Min Cho, M.D., Won Young Tak, M.D., Young Oh Kweon, M.D.; Korean J Hepatol 2010;16(2):123-130.
Published online June 25, 2010; DOI: https://doi.org/10.3350/kjhep.2010.16.2.123

Abstract
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Background/Aims
Transient elastography as performed using the FibroscanⓇ is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (lSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the lSM value obtained by the FibroscanⓇ is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the lSM value obtained using transient elastography as performed using the FibroscanⓇ in patients with chronic liver disease. Methods: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the FibroscanⓇ, laboratory test, ultrasound, and/or abdominal computed tomography. Results: The 298 patients were aged 47.8±12.9 years (mean±SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had lSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that lSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). Conclusions: This study reveals that age, GGT, and albumin are clinical factors influencing lSM values. This reinforces the need to interpret lSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings.

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