Liver and spleen stiffness measurement in the prediction of hepatocellular carcinoma in chronic liver disease

One of the primary complications of cirrhosis and portal hypertension is the occurrence of hepatocellular carcinoma (HCC), which is among the most common malignancies worldwide. There is limited availability of predictive non-invasive markers for primary HCC development in compensated advanced chronic liver disease (cACLD) patients. The reference standard method of assessing prognosis for cACLD patients, beyond liver fibrosis assessed by histology, is the measurement of the hepatic venous pressure gradient (HVPG). HVPG ≥ 10 mmHg is associated with an increased risk of HCC in these patients. However, these methods are expensive and invasive and are available only at referral centers. In the last decade, several studies have focused on the evaluation of several, simple, non-invasive tests (NITs) as predictors of HCC development. Among these methods, attention has particularly been paid to the elastographic techniques for the assessment of liver and spleen stiffness. We have reviewed the current literature about vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), and other ultrasound-based elastographic techniques (e.g., SWE) in predicting primary HCC occurrence and recurrence. Despite promising results, the overall heterogeneity resulting from the variability in the populations analyzed, the differences in the elastographic techniques used, the design and methodological quality of the available studies, prevented us from drawing definite conclusions on the liver and spleen stiffness role for predicting HCC occurrence and recurrence in chronic liver disease patients.