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Elastometry (fibroscanning) of the liver
Last reviewed: 04.07.2025
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The liver elastometry method allows one to assess the presence of fibrosis by generating vibration impulses and, based on the results of computer analysis, to judge the change in elastic properties and the rate of fibrosis progression. Indirect instrumental assessment of the severity of fibrosis by measuring the elasticity of the liver using the Fibroscan device is based on the generation of low-frequency oscillations transmitted to the liver tissue. The propagation speed of elastic waves is determined by the elasticity of the liver tissue.
Fibroscan was invented and designed in France in the early 2000s. It entered serial production in 2003, and was registered with the Russian government in 2006.
The theoretical basis for the development of elastometry was the clinical experience of interpreting the results of liver compaction during palpation in favor of severe liver fibrosis or cirrhosis.
The Fibroscan device is represented by an ultrasound transducer in which a source of medium-amplitude and low-frequency oscillations is installed. The oscillations generated by the sensor are transmitted to the liver tissues being examined and create elastic waves that modulate the reflected ultrasound. The propagation speed of elastic waves is determined by the elasticity of the liver tissue. The total volume of liver tissue being examined averages 6 cm 3, which is many times greater than that in a liver puncture biopsy.
Elastography, being a non-invasive study, is absolutely safe. This advantage allows using the method much more often than liver biopsy, which makes it possible to more accurately assess the nature of the course of chronic liver diseases and the effectiveness of the treatment. The cost of elastography is lower than that of liver biopsy. The study is carried out within 5 minutes and is not accompanied by unpleasant sensations for the patient. The results of elastography are comparable in information content to biopsy data.
[ Indications for elastography
- liver cirrhosis at its various stages (in order to confirm the diagnosis and monitor treatment);
- chronic viral hepatitis;
- carriage of the virus after infectious hepatitis;
- cryptogenic hepatitis (of unknown etiology);
- autoimmune hepatitis;
- fatty infiltration of the liver with increased activity of liver enzymes or fatty liver degeneration;
- alcoholic liver disease with signs of cytolysis and cholestasis;
- toxic liver damage, long-term jaundice;
- prolonged increase in transaminase activity against the background of drug therapy for other diseases;
- sclerosing cholangitis, prolonged, uncontrollable increase in bilirubin.
Methodology for conducting liver elastometry
No special preparation for the procedure is required. The examination does not cause any unpleasant sensations. During liver elastometry using the Fibroscan device, the patient lies in a supine position with an exposed abdomen and lower chest, with the right arm maximally abducted. The sensor transducer is installed in the sixth to eighth intercostal space along the mid-axillary line in the projection of the right lobe of the liver. The sensor is accurately positioned using the U3 visualization window. A homogeneous area of the liver free of vascular structures, with a diameter of more than 5 mm, is selected for examination. The sensor focusing zone is 25-65 mm from the skin surface. After the sensor is correctly installed, at least 7 reliable measurements are taken, which allows the resulting liver elasticity value, expressed in kilopascals (kPa), to be calculated using a computer program. The assessment of successful measurements is calculated as the ratio of the number of reliable measurements to the total number of studies. In this case, the permissible interquartile ratio IQR is no more than 1/4 of the elasticity indicator.
Thus, liver elastometry allows for an analysis of the liver structure, and an assessment of its morphological and functional indicators (the ratio of fibrosis to normally functioning tissue) in various pathologies.
Taking into account the high diagnostic accuracy (96-97%) of determining the degree of fibrosis, fibroscanning can be considered an alternative method for diagnosing viral hepatitis, cirrhosis, and elastometry can also be used as a monitoring method in assessing the effectiveness of treatment and the severity of the disease.