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Elastography for the non-invasive assessment of liver disease: limitations and future developments
  1. T J S Cross,
  2. J D Mitchell,
  3. M E Cramp
  1. Hepatology Department, Derriford Hospital, Plymouth, UK
  1. Dr T J S Cross, Hepatology Department, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, UK; tjscross{at}hotmail.com

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We read the article by Vizzutti et al (Gut 2009;58:157–60) with great interest; however, we are uncertain that the proposed algorithm for the non-invasive assessment of fibrosis evolution in patients with chronic hepatitis C (CHC) infection is the best way to utilise the information provided by transient elastography (TE).

The role of non-invasive tests for liver fibrosis is still evolving. Historically, liver biopsy was used to target treatment for patients only with moderate to advanced fibrosis (METAVIR ⩾F2). In the United Kingdom, liver biopsy has not been a requirement to guide antiviral therapy since 2006.1 Therefore, irrespective of fibrosis stage, patients with CHC, and without contra-indications, can …

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