Advantages and limitations of liver stiffness measurement

Liver stiffness is a physical characteristic that correlates strongly with liver fibrosis.

Liver stiffness measurement is not affected by extrahepatic fibrosis or inflammation, is relatively easy to perform, and has good diagnostic accuracy and reproducibility.

The limitations of liver stiffness measurement are:

it can be influenced by necro-inflammatory activity in the liver, cholestasis, hepatic congestion and recent alcohol or food intake
obtaining liver stiffness measurements can be technically challenging in obese patients
as with liver biopsy, liver stiffness is subject to sampling error in liver diseases with non-uniform distribution (such as primary sclerosing cholangitis)
it is subject to inter- and intra-observer variability.

Despite these limitations, liver stiffness measurement is more sensitive and specific for cirrhosis than tests based on serum markers.

Liver stiffness is measured using specialised ultrasound or magnetic resonance-based elastography. Ultrasound elastography modalities include:

vibration-controlled transient elastography (VCTE)
point shear wave elastography / acoustic radiation force impulse imaging (pSWE/ARFI)
2-dimensional shear wave elastography (2D-SWE).

Cut-off values for stages of fibrosis are not interchangeable between VCTE and other ultrasound elastography modalities, nor can results be directly compared, due to the differing technologies.

Note: Cut-off values for stages of fibrosis are not interchangeable between VCTE and other ultrasound elastography modalities, nor can results be directly compared.