Hepatopathy: non-invasive tests to assess liver disease

By Cristiano Antonino On May 6, 2022

The term chronic hepatopathy refers to all chronic inflammatory liver diseases that can lead to alterations in the structure of the organ, impairing its function to the point of complete malfunction

Causes of liver disease

The most common causes of chronic liver disease are:

viral infection;
alcohol abuse;
metabolic syndrome determined, in turn, by the presence of overweight, dyslipidemia, diabetes mellitus, high blood pressure;
autoimmune diseases;
use of certain drugs or hepatotoxic substances.

From chronic suffering to liver fibrosis: the stages

Chronic liver disease evolves over time into liver fibrosis, which occurs when the liver attempts to repair and replace damaged cells with scar tissue.

This occurs in 4 progressive stages

mild (grade 1): fibrosis is limited to the portal vein area;
moderate (grade 2): fibrosis begins to spread, creating scarring nodules;
medium (grade 3): fibrosis reaches the centre of the organ;
severe (grade 4): the liver is permanently damaged and the scar tissue prevents it from functioning properly. This grade is known as cirrhosis of the liver.

Diagnostic techniques for assessing fibrosis: from biopsy to new shear-wave ultrasounds

While in the past invasive techniques, such as liver biopsy, were used to assess the degree of liver fibrosis, non-invasive tests are now available to assess the elasticity of the liver, which correlates with the degree of fibrosis.

These are ultrasound examinations using ultrasound, which are non-invasive, repeatable, free of side effects, and easy to perform in an outpatient setting.

The most widely used of these is transient hepatic elastography, better known as Fibroscan, a dedicated machine that has fully replaced liver biopsy and is able to assess the presence of liver cirrhosis.

This non-invasive diagnostic test is useful for the doctor to decide whether to treat the patient and how to monitor the progress of the disease.

Liver pathology: shear-wave elastography

Today, alongside the Fibroscan, other ARFI elastography techniques such as shear-wave elastography have been developed and widely validated.

This is a state-of-the-art technology that uses acoustic ultrasound scattering within the tissue.

Specifically, these ultrasounds diffuse into the tissue in different ways depending on the resistance they encounter and thus allow the assessment of liver elasticity which correlates with the degree of fibrosis in the liver.

This innovative methodology is integrated within a state-of-the-art ultrasound scanner.