Increased liver stiffness measurement values using transient elastography in Egyptian patients with acute viral hepatitis

Transient elastography (TE) is one of the most widely used noninvasive techniques for the assessment of the stage of liver fibrosis. This technique is a rapid, painless, non-invasive, reproducible, can be used in different liver diseases, it takes information from a much larger portion of the tissue in comparison with liver biopsy. Increased liver stiffness (LS) is not always diagnostic of fibrosis as the presence of significant necroinflammation or extrahepatic cholestasis may increase LS values in the absence of fibrosis [1,2]. Different studies were suggested that TE results may be influenced by Alanine Aminotransferase (ALT) flares [3,4]. Normal ranges of LS are much harder to be established because histology from normal liver is rarely available. An earlier smallscaled study using normal liver tissues from subjects undergoing donation for liver transplantation have identified a normal cutoff LS of < 7.2 kilopascal (kPa) [5] where as cirrhosis is generally present at levels above 12-14 kPa [6]. Although cut-off values for advanced fibrosis and cirrhosis have been well established for different diseases, the normal reference range of liver stiffness measurement (LSM) in specific population groups have not been well defined, especially from large population studies [7].