How Non-Invasive Technologies Help Enable Earlier Detection of Liver Disease

Jon Gingrich, CEO, Echosens North America
NOVEMBER 28, 2019
liver
Photo/Thumb have been modified. Courtesy of natali_mis - stock.adobe.com.

Americans face a silent epidemic that continues to escalate: More than 30% of the U.S. population has some degree of non-alcoholic fatty liver disease (NAFLD), an asymptomatic condition characterized by elevated levels of fat in the liver, and the most common type of liver disease in the Western world. Linked to diabetes, obesity, insulin resistance and other metabolic risk factors, NAFLD affects 75 to 100 million adults in the U.S. In fact, the rise in adult obesity rates in the U.S. and worldwide has led to more people experiencing liver damage and associated health issues.

The staggering rise of NAFLD and its subtype non-alcoholic steatohepatitis (NASH) — a potentially progressive liver disease that can lead to cirrhosis, hepatocellular carcinoma (HCC), liver cancer, liver transplantation and death — is raising alarms across the healthcare continuum.

Given the enormity of these challenges, there is a critical need for earlier diagnosis and detection of liver disease.

Thanks to the availability of non-invasive technology, it is now possible to quickly perform a liver assessment at the point of care and avoid painful, expensive biopsies or other extensive testing. This approach provides physicians with the data they need to guide treatment and potentially address disease earlier in the trajectory.
 

Adoption of Non-invasive Technology

Fortunately, there has been an uptick in the adoption of accurate non-invasive measures of liver health at the point of care, including the U.S. military and Department of Veterans Affairs, health plans and payers shifting to value-based reimbursement models, and hospitals and specialists.

As the first line of defense against the advancement of liver disease, more healthcare providers now use non-invasive technology via transient elastography, a non-imaging modality that quantitatively measures liver stiffness and fat, both of which are critically important components for the diagnosis and monitoring of chronic liver diseases, including NAFLD and NASH.

Most importantly, NAFLD can be reversible if caught in the early stages and accompanied by lifestyle changes. A quick, non-invasive tool for examining liver health shows great promise for preventing more serious conditions, such as end-stage liver disease or liver cancer.
 

The Value of Transient Elastography

A non-invasive technology to assess liver health at the point of care via transient elastography, a non-imaging modality that quantitatively measures liver stiffness and fat, produces consistent measurements that can be combined with blood biomarkers to produce scores that are easily interpreted by the healthcare provider. This gives clinicians information they can use to refer patients to a specialist or modify care plans in real time, if needed. Wider availability of this easy-to-use technology for diagnosis and monitoring can make a critical difference in the lives of individuals who face chronic liver disease.

Some devices assess liver stiffness via a patented technique called Vibration Controlled Transient Elastography (VCTE). VCTE is recognized worldwide as the most extensively studied point of care technology for liver stiffness assessment. VCTE has been included in over 2,000 peer review publications and is the non-invasive reference across most clinical practice guidelines. 

In the VCTE assessment, a shear wave is mechanically induced by a tap or vibration on the patient’s side. The shear wave speed is then measured with pulse echo ultrasound. The faster the shear wave travels, the stiffer the liver tissue. The interpretation of the tissue stiffness by VCTE across different etiologies of liver disease has been the subject of guidelines and peer reviewed publications.   

To complement the VCTE assessment, some devices estimate the fat content in the liver with a technique called Controlled Attenuation Parameter. The pulse echo ultrasound signal used to measure the speed of the shear wave is affected by the amount of fat present in liver tissue. The greater the fat content in liver tissue, the less ultrasound signal returns to the probe. This attenuation of ultrasound signal is measured simultaneously with the examination of liver stiffness, reducing the examination time.

Moreover, with innovative non-invasive technologies, care plans can be adjusted in real time. A rapid, easily performed examination of the liver can provide the information and data needed to help prevent disease progression and more serious conditions, such as end-stage liver disease or liver cancer.

For patients, this ability to access immediate and actionable information not only reduces the burden of multiple visits and specialist referrals, but also may increase engagement in lifestyle modification programs with the intent to ultimately reverse this life-threatening disease and related comorbidities.

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