Liver elastography, comments on EFSUMB elastography guidelines 2013

Table 3 Advantages and disadvantages of non-invasive methods to evaluate liver fibrosis

Parameters	Transient elastography	ARFI	2D-SWE	MR Elastography	Serum biomarkers
Advantages	High and rapid performance	High and rapid performance	High and rapid performance	High performance (applicability)	Availability
	Reproducibility	Reproducibility	Reproducibility	Reproducibility	Reproducibility
	Easy to learn	Easy to learn	Easy to learn, large ROI	Examination of the whole liver	Low cost
		Combined with conventional ultrasound	Combined with conventional ultrasound	Combined with conventional MRI
		Obesity and ascites are not limiting	Ascites are not limiting	obesity and ascites are not limiting
Disadvantages	Technical requirements (equipment) without additional use	Technical requirements (ultrasound equipment)	Technical requirements (ultrasound equipment)	Technical requirements (MRI equipment)	Non-specific (hyperbilirubinemia, hemolysis, inflammation, others)
	Intermediate cost	Intermediate cost	Intermediate cost	Extremely high cost, time consuming	Relatively high cost, limited availability (patent)
	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis
	Blind selection of region of interest			Not applicable in case of iron deposition	Results not immediately available
	Restricted value in obese patients and ascites	Narrow range of values, small ROI
	False positive values in patients with acute hepatitis, cholestasis, and heart failure	Quality criteria not well defined	Quality criteria not well defined

ARFI: Acoustic radiation force impulse; SWE: Shear wave elastography; ROI: Region of interest; MRI: Magnetic resonance imaging.