Multiparametric ultrasound as a new concept of assessment of liver tissue damage

Figure 3 Interpretation of liver stiffness value with acoustic radiation force impulse techniques. Based on some published studies, the consensus panel Baveno VII proposed a vendor-neutral “rule of 4” (5, 9, 13, and 17 kPa) for the acoustic radiation force impulse techniques for viral etiologies and nonalcoholic fatty liver disease, liver stiffness of 5 kPa (1.3 m/sec) or less has a high probability of being normal. Values greater than 13 kPa (2.1 m/sec) are highly suggestive of compensated advanced chronic liver disease (cACLD). There is a probability of clinically significant portal hypertension with liver stiffness values greater than 17 kPa (2.4 m/sec), but additional patient testing may be required. In some patients with nonalcoholic fatty liver disease, the cutoff values for cACLD may be lower and follow-up or additional testing in those with values between 7 kPa and 9 kPa is recommended[10]. For other causes such as alcoholic hepatitis, primary biliary cirrhosis, Wilson’s disease, autoimmune hepatitis, sclerosing cholangitis, and drug-induced liver disease, there is insufficient data to make a conclusion. ¹Liver stiffness less than 9 kPa (1.7 m/sec), in the absence of other known clinical signs, rules out compensated advanced chronic liver disease (cACLD). ²Values between 9 kPa (1.7 m/sec) and 13 kPa (2.1 m/sec) are suggestive of compensated advanced chronic liver disease but may need further testing for confirmation. cACLD: Compensated advanced chronic liver disease; CSPH: Clinically significant portal hypertension.