Clinical applications, limitations and future role of transient elastography in the management of liver disease

Table 3 Comparison of non-invasive modalities for assessment of fibrosis

Non-invasive test	Advantages	Disadvantages
Transient elastography	Easy to perform	Requires costly equipment
	Painless and comfortable	Unreliable in patients with severe obesity and ascites
	Can be done in clinic or office	Requires technical expertise
	Provides immediate results for clinician	Requires fasting
	Well-validated	Interpretation of LSM result dependent on etiology, ALT, etc.
	Can be performed reliably in obese patients with the use of XL probe	Only assesses part of the liver
	Readily available in most centres
Serum markers	Easy to perform	Results can be confounded by biochemical abnormalities
	Inexpensive	Indirect reflection of liver fibrosis
	Does not require training or equipment	Does not assess liver stiffness directly
	Well-validated	Some tests are proprietary and are relatively costly
	Easily repeatable
MRE	Multi-dimensional assessment	High cost
	Able to assess whole liver	Limited availability
	Operator independence	Cannot be performed in subjects with claustrophobia
	Can be performed in obese patients and those with ascites	Long examination time
	Can be integrated as part of a comprehensive MRI examination	Cannot be performed in livers with iron overload
ARFI/SWE	Higher success rate compared to TE (using M probe)	Requires special equipment and technical expertise
	Similar accuracy to TE	Operator-dependent
	Can be performed in obese patients and those with ascites	Not widely available
	Can assess whole liver
	Can assess specific part of the liver (i.e., region of interest)

TE: Transient elastography; MRE: Magnetic resonance elastography; ARFI: Acoustic radiation force impulse; SWE: Shear wave elastography; LSM: Liver stiffness measurement; ALT: Alanine transaminase; MRI: Magnetic resonance imaging.