Fibrosis Assessment by Liver Stiffness

Elastography is most useful for fibrosis staging when dynamic confounders are recognized and removed from the interpretation.

Liver stiffness performs particularly well for advanced fibrosis and cirrhosis, but fixed cut-off values can misclassify patients when inflammatory activity is high. Our work therefore moved from universal thresholds toward context-adapted interpretation, combining stiffness with transaminases and clinical information.

The practical consequence is a two-step approach: first exclude or treat reversible causes of elevated stiffness, then interpret the remaining value as the more stable fibrosis-related component. Serial measurements are especially informative when disease activity changes rapidly.

Conceptual range of liver stiffness generated by matrix and pressure-related components.

Inflammation-adapted interpretation improves fibrosis staging when transaminases are elevated.

Selected publications

Inflammation-adapted liver stiffness values for improved fibrosis staging in patients with hepatitis C virus and alcoholic liver disease. Mueller S et al. Liver Int. 2015;35(12):2514–2521.
Increased liver stiffness in alcoholic liver disease: differentiating fibrosis from steatohepatitis. Mueller S et al. World J Gastroenterol. 2010;16(8):966–972.
Liver stiffness: a novel parameter for the diagnosis of liver disease. Mueller S, Sandrin L. Hepat Med. 2010;2:49–67.