Transient elastography (FibroScan®) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand?

Table 1 Limitations of transient elastography with controlled attenuation parameter

Limitations	Explanation
Ascites	Elastic waves do not travel through liquids
Obesity	BMI > 30 kg/m2 is associated with TE failure. With the development of the XL probe, the failure rate in obese patients has decreased
Acute hepatitis	Tissue changes in acute hepatitis may increase LSM
Chronic hepatitis with transaminases flare	At ALT levels greater than 5 × the upper normal limit, there is a risk of overestimating the fibrosis stage. LSM interpretations in patients with high ALT levels must be made with caution
Extrahepatic cholestasis	Increases LSM independently of fibrosis stage
Congestive heart failure	May lead to increased LSM because of an increased blood volume in the liver
Narrow intercostal spaces	Associated with a lower success rate or failed acquisition of LSM. Reduced failure rate with the development of the S probe

BMI: Body mass index; LSM: Liver stiffness measurement; ALT: Alanine-aminotransferase.