From the Guidelines
Ultrasound elastography is a non-invasive imaging technique that measures tissue stiffness or elasticity, providing valuable diagnostic information about various pathological conditions, particularly useful for evaluating liver fibrosis. It works by applying slight compression to tissues and measuring their deformation response, as abnormal tissues like tumors or fibrosis typically have different stiffness compared to surrounding healthy tissue. There are several types of ultrasound elastography, including strain elastography, shear wave elastography, and acoustic radiation force impulse imaging, each with specific applications 1. This technology is particularly useful for evaluating liver fibrosis, breast lesions, thyroid nodules, and prostate abnormalities without requiring invasive biopsies. The procedure is performed during a standard ultrasound examination, with the elastography component adding only a few minutes to the total scan time. Results are typically displayed as color-coded maps overlaid on conventional ultrasound images, where different colors represent varying degrees of tissue stiffness.
According to a recent study published in 2025, ultrasound-based elastography, including transient elastography (TE) and shear wave elastography (SWE), has become a prominent tool in the clinical arena for staging liver fibrosis in chronic liver disease 1. The study highlights the importance of considering potential confounders and limitations of imaging-based noninvasive liver disease assessment, such as changes in hepatic parenchyma caused by inflammation, vascular congestion, or recent food intake. The use of ultrasound elastography has been widely disseminated worldwide due to its noninvasive nature, and it is now available at most adult and pediatric hepatology referral centers. However, it is essential to be aware of the potential limitations and confounders of this technique to ensure accurate interpretation of results.
Some of the key benefits of ultrasound elastography include its safety, relatively low cost, and wide availability, making it an attractive option for patients and clinicians alike. Additionally, the procedure provides immediate results without radiation exposure, which is a significant advantage over other imaging modalities. The most recent study published in 2025 provides a comprehensive review of the current state of imaging-based noninvasive liver disease assessment, including ultrasound elastography, and highlights its potential as a valuable tool in the diagnosis and management of liver disease 1. Overall, ultrasound elastography is a valuable diagnostic tool that provides valuable information about tissue stiffness and elasticity, and its use is expected to continue to grow in the coming years.
Key points to consider when using ultrasound elastography include:
- The technique is non-invasive and provides immediate results without radiation exposure
- It is particularly useful for evaluating liver fibrosis, breast lesions, thyroid nodules, and prostate abnormalities
- There are several types of ultrasound elastography, including strain elastography, shear wave elastography, and acoustic radiation force impulse imaging
- The procedure is relatively low cost and widely available
- Potential confounders and limitations, such as changes in hepatic parenchyma caused by inflammation or recent food intake, should be considered when interpreting results.
From the Research
Definition of US Elastography
- US elastography is an extension of the ancient art of palpation and of earlier US methods for viewing tissue stiffness, such as echopalpation 2.
- It is a technique that uses ultrasound to provide an estimation of tissue stiffness by measuring the degree of distortion under the application of an external force 3.
Types of US Elastography
- There are 3 main types of US elasticity imaging:
- Elastography that tracks tissue movement during compression to obtain an estimate of strain.
- Sonoelastography that uses color Doppler to generate an image of tissue movement in response to external vibrations.
- Tracking of shear wave propagation through tissue to obtain the elastic modulus 2.
- Other modalities may be used for elasticity imaging, the most powerful being magnetic resonance elastography 2.
Clinical Applications of US Elastography
- US elastography has potential for enhancing the specificity of US and mammography for cancer detection, particularly in breast mass elastography 2.
- It has been successfully used to image lesions in the thyroid, prostate gland, pancreas, and lymph nodes 2, 4.
- Evaluation of diffuse disease including cirrhosis and transplant rejection is also possible using both imaging and nonimaging methods 2, 5.
- Vascular imaging including myocardium, blood vessel wall, plaque, and venous thrombi has also shown great potential 2, 5, 4.
- US elastography may also be important in assessing the progress of ablation therapy 2, 5.