Sukocheva O, Ow TW, Harding D, Le Mire M, Tse E. Liver stiffness measurements in patients with metabolic dysfunction-associated steatotic liver disease: Updates on the method effectiveness and perspectives. World J Hepatol 2025; 17(7): 106675 [DOI: 10.4254/wjh.v17.i7.106675]
Corresponding Author of This Article
Olga Sukocheva, Senior Scientist, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Port Road, Adelaide 5000, South Australia, Australia. olga.sukocheva@sa.gov.au
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jul 27, 2025; 17(7): 106675 Published online Jul 27, 2025. doi: 10.4254/wjh.v17.i7.106675
Liver stiffness measurements in patients with metabolic dysfunction-associated steatotic liver disease: Updates on the method effectiveness and perspectives
Olga Sukocheva, Tsai-Wing Ow, Damian Harding, Marc Le Mire, Edmund Tse
Olga Sukocheva, Tsai-Wing Ow, Damian Harding, Marc Le Mire, Edmund Tse, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide 5000, South Australia, Australia
Damian Harding, Edmund Tse, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5000, South Australia, Australia
Author contributions: Sukocheva O and Tse E designed this review and wrote the first draft; Harding D, Ow TW, and Le Mire M edited manuscript, contributed valuable insights, and extended discussion and conclusion sections; Tse E supervised the project; All authors have read and approved the final version of this manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Olga Sukocheva, Senior Scientist, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Port Road, Adelaide 5000, South Australia, Australia. olga.sukocheva@sa.gov.au
Received: March 4, 2025 Revised: May 1, 2025 Accepted: June 25, 2025 Published online: July 27, 2025 Processing time: 143 Days and 6.2 Hours
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most widespread chronic liver disease signified by serious life-threatening conditions. The prevalence of MASLD increases along the growing prevalence in obesity and metabolic syndrome. To minimize costs and complications, non-invasive diagnostic tools, including transient elastography (TE), were introduced for assessment of MASLD. TE measures liver stiffness (LS), a clinical marker for the diagnosis of liver fibrosis and cirrhosis. LS measurements are based on ultrasound wave imaging and quantification. Vibration-controlled TE, including FibroScan®, is commonly used TE methods which can accurately identify the degree of liver fibrosis and cirrhosis progression. TE was reported to predict the progression towards hepatocellular carcinoma, portal hypertension, and varices. However, the accuracy of LS diagnostics alone in patients with MASLD remains controversial. TE measurements have several limitations, including inadequate precision due to focal liver lesions, cholestasis, inflammation, and other pathological and anatomical factors which can lead to the stiffness variability. Overestimations of TE readings were reported in obese patients with body mass index (BMI) over 30 kg/m2, and older patients with ascites, diabetes, or hypertension. Not all MASLD patients have high BMI. The prevalence of obesity among MASLD patients varies worldwide, indicating the urgent need for comprehensive diagnostic tools. In patients with MASLD, improved diagnostic accuracy has been demonstrated by combining LS measurements with other blood test-based scores and simple clinical parameters (agile scores based on age, sex, platelet count, aminotransferases, and diabetes). This study reviews the limitations of TE-based diagnostics and discusses the combined scoring algorithm. In conclusion, the sequence of LS measurements along assessment of other important clinical markers is an effective, low-cost, reliable tool to identify and monitor fibrosis progression in MASLD.
Core Tip: Clinical diagnostics of metabolic dysfunction-associated steatotic liver disease (MASLD) relies on non-invasive diagnostic tools, such as transient elastography (TE)/FibroScan®. TE measures liver stiffness, an important clinical marker of liver fibrosis and cirrhosis. However, TE measurements have limited accuracy in obese patients. This study reviews the limitations of TE-based diagnostics and discusses the combined scoring algorithm. Data review indicates that in patients with MASLD reliable diagnostic accuracy can be achieved by combining FibroScan® measurements with various blood test-based scores, including agile and fibrosis score indicators.
