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Elastography May Predict Decompensation in Patients with Liver Disease

MR-based hepatic elastography involves mechanical stimulation of the liver to determine liver stiffness, which can be used as an index for how much fibrosis is present. Baylor University Medical Center at Dallas is one of the few medical centers in the nation to offer this advanced imaging technology.

A recent study at the Mayo Clinic, co-authored by Sumeet Asrani, MD, now a hepatologist on the medical staff at Baylor Dallas, examined the role of magnetic resonance elastography in compensated and decompensated liver disease. Researchers hypothesized that liver shear stiffness could be an important non-invasive predictor of hepatic decompensation.

“Elastography is very helpful in determining if a patient has cirrhosis, but we wanted to see if it would predict how a patient with compensated cirrhosis would fare long term,” Dr. Asrani said. “Previously, we’ve had no good non-invasive tools to predict decompensation.”

In the study, which was published in the May 2014 issue of Journal of Hepatology, 167 patients with compensated disease had baseline elastography. At 27-months follow-up, 7 percent had decompensation. Dr. Asrani and colleagues determined that a patient with compensated cirrhosis and liver stiffness above 5.8 kilopascals was five times more likely to develop decompensation within the next two years.

“Cirrhotics who had higher liver stiffness were more likely to have decompensation,” Dr. Asrani said. “This gives us additional information on how to care for patients. If a patient has low stiffness, maybe we don’t need to follow him or her every six months. Alternatively, patients with higher stiffness may benefit from early interventions, such as prophylactic antibiotics or, if they have hepatitis C, receive antiviral therapy sooner rather than later.”

Researchers at Baylor Dallas are also looking into the role of ultrasound-based elastography in predicting decompensation after a ​​liver transplant.