Chronic liver disease and cirrhosis affect millions of peoples worldwide, cause range from alcoholism, hepatitis B and hepatitis C and hepatotoxic drugs. Unfortunately, Chronic liver disease and cirrhosis have long latent period before their clinical presentation. The gold standard for assessment of liver fibrosis is biopsies which is not only expensive, painful and have potential for complications. They often need to be repeated for assessment of progression or resolution. Further liver biopsies rely on small tissue sample which can also yield inadequate results. By early detection of patients at risk of developing liver cirrhosis, we may be able to stop, delay and possibly revert progression of disease and reduce complications. Easy to do, noninvasive procedure and easily repeatable, liver elastography provides quantitative data to assess tissue stiffness which is virtual biopsy.

The introduction of liver elastography is invaluable to reduce the requirement for liver biopsy, to allow for follow–up of patients undergoing new antiviral therapy with chronic liver disease, and to allow for preoperative assessment of those with liver cancer for optimal selection of therapy options.

Grey scale sonographic evaluation of liver morphology for the prediction of the presence and status of cirrhosis is invaluable but subjective^1,2,3. Furthermore, it is not uncommon to have normal appearing liver even with quite advanced disease. Historically, therefore, diagnosis and staging of liver cirrhosis have been performed based on invasive liver biopsy. At histology, liver fibrosis is graded from METAVIR stage F0, indicating a normal liver, through to METAVIR stage F4, indicating cirrhosis^4,5,6. Patients with METAVIR stage F2 and F3 are felt to have clinically important fibrosis necessitating special attention and referral to hepatology service as these patients are at risk for portal hypertension, liver failure, and development of HCC.

This article reviews the clinical significance of liver elastography, its advantage over gray scale ultrasonography and our experience.