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Also called: Elastography, Shear wave elastography, Liver stiffness

Elastography Ultrasound: Measuring Tissue and Liver Stiffness

Elastography adds a stiffness measurement to the ultrasound exam. How the methods differ, what can distort a reading, and what to check before paying for the option.

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Four ways to measure stiffness

Elastography rests on a simple idea: stiff tissue deforms less, and carries shear waves faster, than soft tissue.

Units: shear-wave speed in m/s converts to stiffness in kPa as roughly 3 × speed², so 1.5 m/s is about 6.8 kPa.
MethodHow it worksResultTypical use
Strain elastographyGentle compression or the body’s own movement; the system compares how much tissue deformsColour map and strain ratio — relative, not absoluteBreast and thyroid nodules, superficial lesions
Point shear wave (pSWE)An acoustic push creates shear waves in a small sample box and their speed is measuredA number in m/s or kPaLiver stiffness on a general ultrasound system
2D shear wave (2D-SWE)Shear-wave speed measured across a region and shown as a colour map over the imageColour map plus m/s or kPaLiver, breast and thyroid
Transient elastographyA dedicated device sends a mechanical pulse and tracks it, without a full ultrasound imageLiver stiffness in kPa; some devices also estimate liver fatHepatology and fatty-liver clinics

Ultrasound system or a FibroScan-type device?

FibroScan, made by Echosens, is the best-known transient elastography device, so “FibroScan machine” is often used for any liver-stiffness test. It is a dedicated liver instrument and does not produce a diagnostic image of the liver. Shear-wave elastography on a general ultrasound system measures stiffness while you also see the liver, gallbladder, spleen and any focal lesion.

Dedicated transient elastography

Quick, standardised liver-stiffness readings with a large published evidence base, often with a fat estimate — but a separate device with no general imaging.

Shear wave on an ultrasound system

Stiffness measured in the same exam as the liver scan, with the sample box placed under image guidance. Usually a licensed option tied to specific probes.

Strain elastography

A qualitative add-on for breast and thyroid lesions, read alongside B-mode and Doppler rather than on its own.

What can distort a liver reading

Elastography measures stiffness, and several things besides scarring raise it. Results are interpreted by the clinician using guideline cut-offs for the specific method and machine — values differ between manufacturers, so follow a patient on the same platform where possible.

  • Eating shortly before the test — protocols ask patients to fast for a few hours beforehand.
  • Active liver inflammation, such as acute hepatitis or a flare of chronic disease.
  • Congestion from heart failure, and obstruction of bile flow.
  • Breathing and movement — readings are taken during a short, relaxed breath-hold.
  • A sample box too close to the liver capsule or over large vessels; follow the depth and placement your protocol sets.
  • Too few valid measurements, or a wide spread between them — report the reliability figures with the result.

Where elastography is used

Fatty liver disease

Following patients with metabolic dysfunction-associated steatotic liver disease (MASLD, previously called NAFLD), alongside blood-based scores.

Chronic liver disease

Monitoring liver stiffness over time in viral hepatitis and other chronic liver disease, in hepatology and gastroenterology clinics.

Breast and thyroid

Adding stiffness information to B-mode and Doppler when characterising nodules and masses.

Breast ultrasound equipment

What to check when buying

  • Whether elastography is standard or a licensed option on the quoted platform, and its price if added later.
  • Which method — strain, point shear wave or 2D shear wave — and which probes support it (convex for liver; linear for breast and thyroid).
  • Whether the system shows reliability indicators, such as the spread of measurements or a quality map.
  • Whether a fat or attenuation measurement is offered, if you run a fatty-liver clinic.
  • Report templates that record the method, units, number of measurements and their spread.
  • Applications training on one standard measurement protocol for every user.

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Frequently asked questions

What is elastography in ultrasound?
A technique that measures how stiff tissue is, either as a relative colour map (strain) or as a number from the speed of shear waves. It is used mainly for the liver, breast and thyroid.
Is shear wave elastography the same as FibroScan?
No. FibroScan is a dedicated transient elastography device that measures liver stiffness without a full image. Shear-wave elastography runs on an ultrasound system under image guidance. Values from different methods are not directly interchangeable.
Why fast before liver elastography?
Eating increases blood flow to the liver, which can raise stiffness readings for a while. Protocols therefore ask for a few hours of fasting before the test.
Does every ultrasound machine have elastography?
No. It is usually a licensed option on mid- and higher-tier platforms and works only with specific probes, so check that it is listed on the quotation.

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