Liver Stiffness And Elastography

My group has contributed to the clinical interpretation of liver stiffness and to the development of elastography from a fibrosis test into a dynamic measure of liver disease.

We were the first to demonstrate that liver stiffness is determined not only by fibrosis but also by several rapidly reversible and non-fibrotic factors. We showed that elevated central venous pressure, for example in heart failure, markedly increases liver stiffness; that mechanical cholestasis increases stiffness independently of fibrosis; and that liver stiffness falls during alcohol detoxification as hepatic inflammation resolves. These findings established that measured liver stiffness contains both an inflammatory and a fibrotic component. We also demonstrated that non-collagenous tissue deposits, including amyloid, can produce markedly elevated stiffness.

These discoveries fundamentally changed the interpretation of elastography and led to inflammation-adapted cut-off values and practical diagnostic algorithms combining liver stiffness with transaminases, ultrasound and reassessment after reversible confounders have been removed. Further studies addressed XL-probe performance, ascites, pregnancy, spleen stiffness, controlled attenuation parameter, prognostic endpoints and therapeutic monitoring. The 2020 book Liver Elastography: Clinical Use and Interpretation integrates these findings into a comprehensive framework for clinical application.

Selected publications

Extrahepatic cholestasis increases liver stiffness (FibroScan) irrespective of fibrosis. Millonig G et al. Hepatology. 2008;48(5):1718�1723.
Increased liver stiffness in alcoholic liver disease: differentiating fibrosis from steatohepatitis. Mueller S et al. World J Gastroenterol. 2010;16(8):966�972.
Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with HCV and ALD. Mueller S et al. Liver Int. 2015;35(12):2514�2521.
Non-invasive diagnosis of liver fibrosis in patients with alcohol-related liver disease by transient elastography: an individual patient data meta-analysis. Nguyen-Khac E et al. Lancet Gastroenterol Hepatol. 2018;3(9):614�625.
Spleen stiffness to liver stiffness ratio significantly differs between ALD and HCV and predicts disease-specific complications. Elshaarawy O et al. JHEP Rep. 2019;1(2):99�106.

Further information

For additional background, historical material and original research data on liver stiffness and transient elastography, please visit my dedicated Liver Stiffness Homepage.