Elastography

Why this test may be ordered

• To check for liver fibrosis (scarring) in people with liver disease or at high risk
• To help diagnose liver conditions and guide treatment choices
• To monitor how well treatment for liver disease is working
• To check how much fat is in the liver and predict serious problems

Preparation and collection

Wear a loose-fitting shirt or sweater that can be easily pulled up. You may need to fast (not eat or drink) for several hours before the test. If having an MRE, remove all metal objects and inform your provider about any medical devices or metal inside your body. Tell your provider if you are or could be pregnant.

For ultrasound elastography: You lie on a table, gel is applied to your skin, and a transducer is moved across your abdomen. You hold your breath for 10-15 seconds while vibrations are sent into your liver. For MRE: You lie on a narrow table, a driver device sends painless vibrations into your liver, and you are slid into an MRI machine. You hold your breath for 10-15 seconds during vibrations.

There are no known risks to having an ultrasound elastography. There is little risk to having an MRE for most people. If being inside a small space makes you nervous, your provider may give medicine to help you relax. If you are or could be pregnant, let your provider know.

Understanding results

Your elastography results will be studied by a radiologist and sent to your provider. They show how much stiffness is in your liver (fibrosis score) and fat content (CAP score). Fibrosis scores range from F0-F1 (normal or minimal scarring) to F4 (cirrhosis). CAP score indicates the percentage of fat in your liver (normal is 5% or less).

• F0-F1: Little or no scarring in your liver (normal). Limitation: Accuracy may be affected by liver inflammation (from illness or alcohol), tumors, obesity, or abnormal fluid buildup in the abdomen. Next step: Routine follow-up with your healthcare provider as recommended.
• F2: Moderate scarring in your liver. Limitation: Accuracy may be affected by liver inflammation, tumors, obesity, or abnormal fluid buildup. Next step: Discuss treatment for the underlying cause and consider lifestyle changes (diet, exercise) with your healthcare provider.
• F3: Severe scarring in your liver. Limitation: Accuracy may be affected by liver inflammation, tumors, obesity, or abnormal fluid buildup. Next step: Discuss treatment for the underlying cause and lifestyle changes with your healthcare provider; monitoring is important to prevent progression.
• F4 (cirrhosis): Very severe scarring (cirrhosis) in your liver. Limitation: Accuracy may be affected by liver inflammation, tumors, obesity, or abnormal fluid buildup. Next step: Discuss treatment to manage cirrhosis and prevent further damage; lifestyle changes may improve some scarring.

• Liver inflammation (swelling) from illness or alcohol can affect accuracy
• Tumors in the liver can affect accuracy
• Obesity can affect accuracy
• Abnormal fluid buildup in the abdomen (ascites) can affect accuracy

What to do next

Talk with your healthcare provider about your results. If you have mild to severe fibrosis or fatty liver disease, treatment of the cause and lifestyle changes (diet, exercise) may improve your condition. If you have cirrhosis, treating the cause may prevent worsening and may slowly improve some scarring.

• Do you have any known liver disease (e.g., hepatitis B or C, fatty liver) or risk factors such as alcohol use, diabetes, or obesity?
• Have you experienced symptoms like fatigue, poor appetite, unexplained weight loss, nausea, or right-sided abdominal pain?
• Are you currently taking any medications that could affect your liver?
• Do you have any metal implants or devices, or a history of claustrophobia (if considering MRE)?
• Have you had previous liver tests showing inflammation or damage?

Evidence source

U.S. National Library of Medicine: Elastography