ELASTOGRAPHY IN THE NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS: DIAGNOSTIC PERFORMANCE, RISK STRATIFICATION, AND CLINICAL UTILITY IN CHRONIC LIVER DISEASE

Abstract

DOI: https://doi.org/10.46296/gt.v9i18.0391

Abstract

Background: Liver fibrosis is the major histologic determinant of prognosis across chronic liver diseases. Non-invasive elastographic techniques increasingly replace repeated biopsy for risk stratification and longitudinal assessment. Objective: To summarize current evidence on vibration-controlled transient elastography (VCTE), point shear-wave elastography (pSWE), two-dimensional shear-wave elastography (2D-SWE), and magnetic resonance elastography (MRE), emphasizing diagnostic performance, confounders, integration with serum biomarkers, and clinical utility. Methods: Updated clinical review of practice guidelines, systematic reviews, meta-analyses, and relevant comparative studies available through August 2026. Results: All modalities provide clinically meaningful liver stiffness information, but their thresholds are technique- and disease-specific. VCTE has the broadest implementation and validation; 2D-SWE combines stiffness assessment with conventional ultrasound; MRE provides the most robust diagnostic performance for significant and advanced fibrosis but is less accessible. Interpretation requires attention to fasting status, inflammation, cholestasis, congestion, obesity, and technical quality. Sequential pathways combining FIB-4 and elastography improve triage and reduce unnecessary specialist referral or biopsy. Conclusions: Elastography is now a core component of non-invasive fibrosis assessment. Technique selection and threshold interpretation should be individualized to disease etiology, pretest probability, and the clinical decision at stake.

Keywords: elastography; liver fibrosis; VCTE; FibroScan; shear wave; 2D-SWE; magnetic resonance elastography; FIB-4; MASLD.