Advantages and disadvantages of noninvasive methods to evaluate liver fibrosis

Parameters	Transient elastography	pARFI	2D-SWE	MR elastography	Serum biomarkers
Advantages	High accuracy, rapid results	High accuracy	High accuracy	High accuracy	Availability
	Reproducibility	Reproducibility	Reproducibility	Reproducibility	Reproducibility
	Very easy to learn	Easy to learn	Easy to learn, larger measurement area than other ultrasound techniques	Examination of the whole liver	Biomarker indices (APRI, FIB-4 and GPR) are low cost and easy to calculate^*
		Conventional ultrasound images are also obtained	Conventional ultrasound images are also obtained	Conventional MR images are also obtained	Biomarker indices can be performed in real-time
		Obesity and ascites are not limiting	Ascites is not limiting	Obesity and ascites are not limiting
Disadvantages	Technical requirements (elastography equipment)	Technical requirements (ultrasound equipment)	Technical requirements (ultrasound equipment)	Technical requirements (MR imaging equipment)	Nonspecific (eg, hyperbilirubinemia, hemolysis, inflammation)
	Intermediate cost	Intermediate cost	Intermediate cost	High cost, time-consuming	Proprietary biomarker panels are relatively high cost
	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis	Limited recognition of intermediate stages of fibrosis
	Blind selection of measurement area			Not applicable in case of iron deposition	Results from proprietary tests not immediately available
	Restricted value in patients with obesity or ascites	Narrow range of values, small measurement area		Potential need for sedation
	False positive values in patients with acute hepatitis, cholestasis, and heart failure	Quality criteria not well-defined	Quality criteria not well-defined

2D-SWE: two-dimensional shear wave elastography; APRI: aspartate aminotransferase to platelet ratio; FIB-4: index combining three biochemical values (platelet count, alanine aminotransferase, aspartate aminotransferase) and age; GPR: gamma-glutamyl transpeptidase to platelet ratio; MR: magnetic resonance; pARFI: point-shear wave elastography using acoustic radiation force impulse.

* For details on these biomarker indices of fibrosis, refer to UpToDate content on noninvasive assessment of hepatic fibrosis.

Reference:

Cui XW, Friedrich-Rust M, De Molo C, et al. Liver elastography, comments on EFSUMB elastography guidelines 2013. World J Gastroenterol 2013; 19:6329.

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Advantages and disadvantages of noninvasive methods to evaluate liver fibrosis