FibroScan (Transient Elastography)
FibroScan is the best-known elastography test. A probe placed over the liver measures stiffness. It also estimates liver fat with a CAP score. The scan takes about 5 to 10 minutes.
AI Summary Liver elastography is a painless scan that estimates scarring (fibrosis) by measuring liver stiffness in kilopascals. Tests include FibroScan, Velacur, and shear wave elastography. Doctors order them to look for scarring early, monitor known liver conditions, and sometimes avoid a biopsy. Results depend on device, quality checks, body size, and recent food. A high number calls for follow-up, not a diagnosis, so your care team reads it with your other results.
Source: www.liverdirectory.com
Elastography & Fibrosis Testing
Medically Reviewed.
Elastography is a group of painless tests that estimate how stiff the liver is. Stiffness matters because scar tissue, called fibrosis, makes the liver firmer.
This page covers ultrasound-based tests such as FibroScan, Velacur, and shear wave elastography. It explains how they work, when doctors order them, and what the results can mean.
These tests can often help your care team check for fibrosis without a liver biopsy. They do not name the cause of liver disease, so doctors read them alongside your blood tests, imaging, and health history.
Use the links on this page to read about each test. Your care team chooses the test that fits your situation.
On this page
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Liver stiffness basics
What Is Liver Elastography?
Liver fibrosis is scarring that builds up when the liver stays injured or inflamed for a long time. Common causes include viral hepatitis, alcohol-related liver disease, and fatty liver disease (also called MASLD or NAFLD).
Elastography measures how stiff liver tissue is. Most ultrasound-based tests send a gentle vibration, called a shear wave, through the liver and time how fast it travels. The wave moves faster through stiffer tissue, and stiffer tissue usually means more scarring. The result is called liver stiffness and is reported in kilopascals (kPa).
Doctors use three main imaging methods to assess fibrosis: transient elastography, shear wave elastography, and MR elastography. They use them to estimate how much scarring is present and to track it over time.
Elastography does not diagnose a specific disease. It shows how much scarring may be present so your care team can decide what to do next.
Types of tests
Elastography Tests in This Group
Each test has its own page with more detail. Here is what sets them apart.
Velacur
Velacur uses ultrasound-based shear waves, an external vibration source, and a scanning probe to measure liver stiffness and liver fat. It adds detailed imaging and automated quality checks, which aim to make results less dependent on the operator.
Shear Wave Elastography (SWE)
SWE measures liver stiffness using shear waves. It comes in two forms: point-SWE and 2D-SWE.
ARFI Elastography
ARFI elastography is part of this group of stiffness tests. Its page explains how it works and how it compares with the others.
2D-SWE Elastography
2D-SWE is one of the shear wave methods used to assess liver fibrosis. Its page covers what sets it apart.
Compared side by side
How the Main Tests Differ
Doctors choose among these tests based on what is available and what your situation needs.
| Test | How it works | What it reports | Good to know |
|---|---|---|---|
| FibroScan (transient elastography) | A probe on the skin sends a gentle vibration into the liver and times the wave. | Liver stiffness (kPa) and liver fat (CAP score, dB/m) | Takes about 5 to 10 minutes. An XL probe can reduce failed readings in people with obesity. |
| Velacur | Ultrasound shear waves with an external vibration source and a scanning probe. | Liver stiffness (kPa) and liver fat (dB/m) | Adds detailed imaging and automated quality checks. |
| Shear wave elastography (SWE) | Measures stiffness during an ultrasound exam. Comes in point-SWE and 2D-SWE forms. | Liver stiffness (kPa) | Ranks with transient elastography and MRE as a main imaging method for fibrosis. |
| MR elastography (MRE) | Adds vibrations to an MRI scan to map stiffness across the liver. | A picture of stiffness across the whole liver | Uses magnets and radio waves, not radiation. Its kPa cutoffs are lower than ultrasound-based tests. |
MR elastography is covered under Cross-Sectional Imaging. It is shown here for comparison.
When it's recommended
Why Your Doctor May Order Elastography
Your doctor may suggest one of these tests at several points in your care.
To Look for Scarring Early
Abnormal liver blood tests, metabolic risk factors such as obesity, diabetes, or high cholesterol, long-term use of medicines that can affect the liver, or a history of heavy alcohol use can all lead a doctor to check for fibrosis.
To Monitor a Known Liver Condition
Doctors use elastography to follow people with hepatitis B, hepatitis C, fatty liver disease, or alcohol-related liver disease. Repeat scans show whether stiffness is holding steady or changing.
To Rule Out Advanced Disease Without a Biopsy
In people with inactive hepatitis B and normal ALT, transient elastography is preferred over biopsy to rule out severe fibrosis and cirrhosis. Finding cirrhosis matters because it guides checks for complications such as portal hypertension and liver cancer.
To Follow Up a Blood-Test Score
Imaging after a blood-based score, such as FIB-4, can raise diagnostic confidence and may reduce unnecessary biopsies.
What to expect
What Happens on Test Day
Ultrasound-based elastography is painless and usually done in a clinic or hospital.
What Happens During the Scan
- You lie on your back with the right side of your abdomen exposed.
- A probe is placed on the skin over your liver.
- The device sends painless vibrations into the liver and measures how fast they travel. Faster waves mean a stiffer liver.
- The device takes several readings and reports your liver stiffness. Some devices also report liver fat.
- Your doctor reviews the numbers with your blood tests, imaging, and health history.
Ask your care team whether you need to fast before the scan. Recent food intake can raise stiffness readings.
Understanding results
How to Read Liver Stiffness Results
Fibrosis is often grouped into stages from F0 to F4. Higher stiffness usually points to a higher stage.
- Fibrosis Stages
- F0 to F1 means no or mild scarring. F2 is moderate, F3 is severe, and F4 is cirrhosis, or advanced scarring.
- Low Stiffness
- Stiffness under 5 kPa on transient elastography or shear wave elastography generally rules out significant fibrosis when the chance of liver disease is low. For MR elastography, the matching value is under 2.5 kPa.
- Middle Range
- Values of about 8 to 11 kPa on transient elastography or shear wave elastography suggest significant fibrosis. On MR elastography, that range is about 3.1 to 3.5 kPa.
- High Stiffness
- Values of 12 kPa or higher (3.6 kPa or higher on MRE) fit advanced fibrosis. Values of 15 kPa or higher suggest cirrhosis.
- Liver Fat Score
- A fat score such as CAP, reported in dB/m, estimates fat in the liver. Scores above about 238 dB/m suggest fatty liver. Body weight and the probe type can affect this score.
What a Result Means
A high result is a reason for follow-up, not a diagnosis. Your doctor may repeat the test or order blood work, other imaging, or a biopsy.
Cutoffs vary by device, cause of liver disease, and patient factors. Your result page or doctor may use different numbers. Always read your own report with your care team.
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Result accuracy factors
What Can Affect Your Results
Elastography is useful, but no single number tells the whole story.
Quality Checks Matter
A valid transient elastography session needs at least 10 valid readings, a success rate above 60%, and an IQR below 30% of the median stiffness. An IQR is a quality check that shows how much the readings vary. Results that miss these marks may need a repeat scan.
Other Conditions Can Raise Readings
Several conditions can push stiffness readings higher than the true level of scarring. These include active ALT flares, blocked bile flow outside the liver, congestive heart failure, recent food intake, and heavy alcohol use.
Body Size Can Affect Reliability
Unreliable results can reach up to 20% in some studies, mostly in people with a high BMI or thick tissue over the chest wall. A larger XL probe was developed to reduce failed readings in people with obesity.
Some Stages Are Harder to Pin Down
Transient elastography finds cirrhosis (F4) more reliably than earlier advanced fibrosis (F3). Doctors may combine it with a blood score or another test to settle unclear results.
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Common questions
Answers to Common Elastography & Fibrosis Testing Questions
Does an elastography scan hurt?
No. Ultrasound-based elastography is painless and non-invasive. You lie on your back with the right side of your abdomen exposed, and a probe rests on the skin over your liver. The device sends gentle vibrations into the liver and measures how fast they travel.
How long does a liver elastography scan take?
About 5 to 10 minutes for FibroScan and Velacur. Your appointment may run longer with check-in and setup. The device takes several readings during the scan. If the readings miss quality checks, you may need a repeat scan. Your doctor then reviews the numbers with your blood tests, imaging, and health history.
Can elastography replace a liver biopsy?
Sometimes. Noninvasive tests are safer and easier to repeat than biopsy, and transient elastography is preferred over biopsy for ruling out severe fibrosis in some people with hepatitis B. If results are unclear or your doctor needs a tissue answer, a biopsy may still be advised. A liver biopsy remains the most precise way to stage fibrosis.
Does a high stiffness number mean I have cirrhosis?
No. A high stiffness value is a reason for follow-up, not a diagnosis. Values of 15 kPa or higher suggest cirrhosis with high specificity, but cutoffs vary by device and cause of liver disease. Other conditions can also raise readings, such as active ALT flares, congestive heart failure, recent food intake, and heavy alcohol use. Your doctor reads the number with your other results and may repeat the test or order blood work, other imaging, or a biopsy.
Do I need to fast before the scan?
Possibly. Recent food intake can raise stiffness readings, so a reading may look higher than the true level of scarring. Follow the instructions your clinic gives you about eating before the scan. If you did not get instructions, ask your care team before the day of your test.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.