Transient elastography seems to be more useful than ultrasonography in identifying liver disease related to alpha-1 antitrypsin deficiency (AATD), according to a study presented at the American Thoracic Society (ATS) 2022 International Conference.

The authors of the study said that larger prospective studies are needed to establish the use of the technique in staging liver disease and determining the prognosis of patients with AATD.

Currently, ultrasonography is the most widely used technique to identify AATD-related liver disease. However, transient elastography can more accurately assess the presence of steatosis and fibrosis.

Continue Reading

Here, a team of researchers from Ireland led by Noel G. McElvaney, MD, DSc, analyzed 74 patients with AATD to compare the 2 techniques. All 74 patients underwent transient elastography, while 45 also underwent ultrasonography. Thirty-five patients had the ZZ genotype, 13 had the SZ genotype, and 26 had the MZ genotype.

Read more about AATD prognosis

The results showed that 27 patients did not show any evidence of steatosis on ultrasonography, while 18 did. However, 2 of these patients did not actually have steatosis. Transient elastography identified 14 patients with steatosis. Three patients were identified as having liver fibrosis using ultrasonography. These patients also had signs of fibrosis on transient elastography. 

Ultrasonography showed no evidence of liver cirrhosis in 42 patients, but all of them had fibrosis on transient elastography. Similarly, 3 patients were identified as having cirrhosis with ultrasonography, 2 of whom had fibrosis. These results were in agreement with the transient elastography results. However, only a little more than half (57%) of the patients with no evidence of fibrosis on ultrasonography had a concordant result on transient elastography.

The authors also reported that “increasing liver fibrosis and lower steatosis grade were associated with ZZ phenotype, while the inverse was seen with milder disease.”


Fraughen D, Yousuf H, Herron M, et al. The use of transient elastography for assessing for alpha-1 antitrypsin-related liver disease and its discordance with liver ultrasonography. Poster presented at: American Thoracic Society (ATS) 2022 International Conference; May 13-18, 2022; San Francisco, CA.