The prognosis and management of chronic liver diseases depend mainly on the amount and progression of liver fibrosis. As liver fibrosis progresses without appropriate intervention, this process will lead to deterioration of liver function and hemodynamics, complications due to portal hypertension, and an increased tendency for hepatocarcinogenesis.

Thus, accurate determination of the presence and degree of liver fibrosis is of importance in choosing treatment strategies, evaluating responses to treatment and the risks of developing liver-related complications, and predicting prognosis in patients with chronic liver disease.

To assess the severity of liver fibrosis, liver biopsy remains the “gold standard”. However, liver biopsy is often limited by its invasiveness and rare, but serious, complications, including bleeding, pneumothorax, and procedure-related death. Moreover, repeated liver biopsy examinations within a short time interval are impractical. Additionally, concerning the reliability of pathological examinations, both sampling errors and variability in histological interpretation may occur.

Ideally, a method of evaluating liver fibrosis should accurately determine the presence of significant fibrosis, and be readily available, highly reproducible, and widely applicable to liver diseases of various etiologies. Although liver biopsy does not fulfil all these criteria, it has remained the gold standard, likely due to the absence of a better alternative.

Liver stiffness measurement (LSM) using transient elastography (TE) was introduced as a promising non-invasive method for assessment of liver fibrosis. TE has been proved to be a reliable and accurate surrogate for liver biopsy in terms of prediction of significant fibrosis or cirrhosis.