Multidisciplinary panel provides guidance on elastography for liver fibrosis

The Society of Radiologists in Ultrasound (SRU) convened a panel of specialists last October to discuss the use of elastography for liver fibrosis, summarizing its findings in a consensus statement published in Radiology.

Lead author Richard G. Barr, MD, is a radiologist at Southwoods Imaging in Boardman, Ohio, professor of radiology at Northeastern Ohio Medical University and an SRU fellow. He said the group chose to study elastography for the liver because it’s still a relatively new technique in that organ, with the ability to assess a number of different diseases of the liver.

 “Any etiology that affects the liver ends up progressing to fibrosis, so this technology can be looked at for monitoring liver fibrosis from a wide variety of diseases,” Barr said, listing hepatitis and nonalcoholic fatty liver disease (NALFD) as specific examples.

To ensure that its recommendations were as helpful as possible, the panel included specialists in radiology, pathology, hepatology and basic science. The inquiry included shear-wave elastography and 2-D shear-wave elastography, which employ acoustic radiation force technology, MR elastography and transient elastography, the latter an ultrasound-based technology that does not employ image guidance.

“We wanted to get all interested parties involved in the consensus,” Barr said. He added that it ended up being a wise decision, because the experts were able to teach each other valuable new information.

The panel’s recommendations may prove to provide helpful guidance to many radiologists.

“This is relatively new to U.S. radiologists, so we think this paper gives a nice overview as to what clinicians are looking for and where this can be used,” Barr said. “It also gives a really good review of how to collect the data properly—what to do and what not to do. It gives some guidance on how to report the results.”

The SRU’s report does include one bit of information that is different from what is currently being practiced by most physicians, Barr said. It states that best use of elastography is to help identify patients as belonging to one of three groups: those with no or minimal fibrosis, those with severe fibrosis, and those in between. Breaking patients down in these basic categories, according to the report, is more effective than the current METAVIR scoring system, which has too much overlap between stages and allows for interpretation errors between pathologists.

The entire consensus statement can be found here.