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Detecting and staging hepatic fibrosis is important in the treatment of chronic liver diseases that can progress to cirrhosis.  Liver biopsy is the standard method of detecting and staging fibrosis but a new, noninvasive alternative is now in use at Baylor University Medical Center at Dallas (BUMC) and Baylor Scott & White All Saints Medical Center – Fort Worth (BSWASMC).  Ultrasound (US) based liver elastography has replaced the need for a liver biopsy for many liver disease patients and decreased the number of biopsies by 90%.

Elastography measures the hardness of the liver through a medical imaging modality that looks at how fast sound waves travel through the liver. In a soft, healthy liver, waves travel slowly.  In a stiff, hard liver, such as in a cirrhotic liver, the sound waves travel fast.  "Elastography measures the liver stiffness.  It is easy on the patient and easy to perform," according to Maria O'Connor, Nurse Practitioner at Baylor University Medical Center.  "Patients are very pleased with the easy process versus getting a biopsy.  It is painless, takes only 5- 10 minutes and results are available immediately."  

Elastography is vital in the busy hepatology offices at BUMC and BSWASMC.  "We use elastrography to determine the amount of liver that is scarred before starting hepatitis C treatment," says hepatology nurse practitioner, Allison Moore.  "We need to know the level of scarring to determine which type of medication to prescribe and how long the patient will require therapy.  Insurance companies require this information before they will approve the expensive Hep C medications."

In addition, Sumeet Asrani, MD, MSc, a hepatologist on staff at Baylor University Medical Center, is researching different uses of elastrography in clinical practice.  "Until now, elastrography was just used to diagnose cirrhosis.  We are now checking to see if the technology can help us predict which patients will run into trouble with their liver diseases in the future.  Elastography will tell us if the stiffness of the liver improves after hepatitis C treatment or some other intervention like weight loss or stopping alcohol. We already know that cirrhotics who have higher liver stiffness are more likely to get sicker more quickly and have decompensation. "

This new technology gives physicians the information they need to determine how often a liver patient should be seen in the clinic.  Low stiffness means fewer visits to the doctor.  A harder liver means the patient likely needs more frequent monitoring.  Dr. Asrani says, "Researchers at Baylor Dallas are also looking into the role of ultrasound-based elastography to predict how transplant patients will fare in the future."

Normal Liver


Some Fibrosis


Advanced Fibrosis and some Cirrhosis



Graphics Courtesy of SuperSonic Imagine