Hepatic elasticity in patients with ascites: evaluation with real-time tissue elastography.

Abstract

Transient elastography is a rapid, noninvasive, and reproducible approach to assessment of liver fibrosis by measurement of liver elasticity. However, transient elastographic measurements are of limited utility in patients with ascites or severe obesity. The aim of this study was to determine whether measurements of liver stiffness with real-time tissue elastography can be altered for patients with ascites. The subjects were 54 patients being treated at a university hospital between January and December 2009. In 42 patients, real-time tissue elastography to evaluate liver stiffness was performed before and after injection to produce artificial ascites for radiofrequency ablation. The other 12 patients had ascites due to cirrhosis, and liver stiffness was measured with real-time tissue elastography before and after control of ascites. Elastic ratios evaluated with real-time tissue elastography did not differ significantly before and after injection for artificial ascites or before and after control of ascites. This ratio was the same for patients with and those without cirrhosis and was unaffected by distance between the body surface and the targeted liver area. Stable values thus were measured with real-time tissue elastography. Liver stiffness can be measured reproducibly with real-time tissue elastography even in patients with ascites. This method has the potential of being superior to transient elastography for assessment of liver stiffness, particularly in patients with decompensated cirrhosis.