Rad

Elastography

Elastography, Vibration-Controlled Transient Elastography, Fibroscan, Magnetic Resonance Elastography, MR Elastography

Second-Line study for evaluation of MASLD or other Chronic Liver Disease related Liver Fibrosis
1. May avert need for invasive testing (e.g. liver biopsy)
Confirmation or first-line study with intermediate to high probability of fibrosis
1. Fibrosis Probability Score
2. NAFLD Fibrosis Score

Recent meal
1. May transiently increase liver stiffness
2. Patient should fast 3 hours before study
Acute liver inflammation
1. Liver transaminases >5x normal
Recent Alcohol use
Right-sided Heart Failure
Severe Obesity (BMI >40 kg/m2)

Most accurate for measuring Liver Fibrosis
Preferred if BMI >36.65 kg/m2
MR Elastography (MRE) score > 3.62 kPa is suggestive of advanced fibrosis
1. MRE < 2.5 kPa: Normal (F0)
2. MRE 2.5 to 3.5 kPa: Mild to moderate fibrosis (F1 to F2)
3. MRE 3.5 to 4.0 kPa: Moderate to bridging fibrosis (F2 to F3)
4. MRE 4.0 - 5.0 kPa: Advanced bridging fibrosis (F3 to F4)
5. MRE = 5.0 kPa: Cirrhosis (F4)
Tertiary Center Imaging Biomarkers (e.g. proton density fat fraction, iron corrected T1 mapping)
1. Consider when other results are inconclusive for significant Hepatic Fibrosis

MR Elastography is preferred for accuracy (but is less available and much higher cost)
1. Fibroscan cost is estimated at $35
Imaging study with high sensitivity for even mild Liver Fibrosis
1. May be limited by operator experience and morbidly obese
2. Highest accuracy in advanced fibrosis (stage F3) or Cirrhosis (stage F4)
3. Most useful in excluding advanced fibrosis or Cirrhosis
Fibroscan > 9.9 kPa is suggestive of advanced fibrosis
1. Low Risk <8 kPa
2. Intermediate risk 8-12 kPa
3. High risk >12 kPa
References
1. Myers (2012) Hepatology 55(1): 199-208 [PubMed]