Ultrasound Elastography to Assess Liver Fibrosis: A Systematic Review and Meta-Analysis

Abstract

Objective:

The aim of this systematic review and meta-analysis was to analyze the accuracy of three ultrasound elastography-based techniques: two-dimensional shear wave elastography, point shear wave elastography, and transient elastography. These sonographic techniques were used to provide liver fibrosis staging, compared with liver biopsy. An additional goal was to evaluate the factors that might contribute to diagnostic variations, which could harm reliability, affect early detection, and delay management of liver fibrosis.

Materials and Methods:

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The literature search was performed across multiple search engines to curate published evidence, based on studies published between 2015 and 2025. An additional criterion was that these studies had to include both liver biopsy and sonography assessments, to be included.

Results:

This review is based on 29 studies with a total of 4552 patients. The findings indicated that ultrasound elastography demonstrated superior diagnostic performance, with an area under the curve of 0.931, a sensitivity of 88.8%, and a specificity of 89.2%. As liver fibrosis progressed, the accuracy of predicting cirrhosis was increased. Variability in results was primarily attributed to operator expertise, a body mass index greater than 30 kg/m², the presence of hepatic steatosis, and the underlying cause of liver disease. The elastography methods demonstrated comparable performance, indicating their applicability in clinical settings, despite some data heterogeneity.

Conclusion:

Ultrasound elastography was found to have high accuracy in staging liver fibrosis, particularly in detecting advanced fibrosis and cirrhosis, and therefore may reduce the need for invasive liver biopsies. However, standardization remains challenging in obese patients and in cases of acute inflammation. Protocol harmonization and standardized operator training should be prioritized in future multicenter studies, to minimize variability. Addressing these gaps will result in elastography having the potential to transform liver disease management through earlier and more accurate diagnoses.