What is the interpretation of elastography results showing a liver stiffness of 4.8 kilopascals (kPA), an attenuation coefficient (ACE) of 270 decibels per meter (dB/m), and a vibration-controlled transient elastography (VCTE) fat fraction (VDFF) of 10.8%?

Interpretation of Elastography Results: 4.8 kPA, ACE 270 dB/m, VDFF 10.8%

Liver Stiffness Measurement (4.8 kPA)

The liver stiffness measurement of 4.8 kPA indicates normal liver elasticity with no evidence of significant fibrosis or cirrhosis. This value falls below the established thresholds for fibrosis in all major liver disease etiologies.

• The value of 4.8 kPA is well below the cutoff of 7.1-7.9 kPA that would suggest mild to moderate fibrosis (F2) in non-alcoholic fatty liver disease (NAFLD) 1
• This measurement is significantly lower than the 12.5 kPA threshold used to diagnose cirrhosis in patients with chronic liver diseases 1
• The value falls within the normal range of liver stiffness, with the upper limit of normal being approximately 5-5.5 kPA 1
• This result reliably excludes advanced fibrosis (F3-F4), as values below 7.9 kPA have been shown to have a negative predictive value of up to 100% for advanced fibrosis in NAFLD 2, 3

Controlled Attenuation Parameter (ACE 270 dB/m)

• The attenuation coefficient (ACE) of 270 dB/m indicates moderate hepatic steatosis (fatty liver) 1
• This parameter measures ultrasound attenuation through the liver tissue and correlates with the degree of fat deposition in the liver 1
• Despite the presence of steatosis, the normal liver stiffness value suggests that there is no significant fibrosis at this time 1

Vibration-Controlled Transient Elastography Fat Fraction (VDFF 10.8%)

• The VDFF of 10.8% represents a moderate degree of hepatic steatosis, consistent with the ACE measurement 1
• This value confirms the presence of fatty liver disease but without evidence of fibrotic changes 1

Clinical Implications

• These findings are consistent with non-alcoholic fatty liver disease (NAFLD) without significant fibrosis 1
• The risk of liver-related complications is very low with this liver stiffness value, as patients with transient elastography values <9.5 kPA have minimal rates of liver-related events 4
• Regular monitoring is recommended as NAFLD can progress over time, particularly with metabolic risk factors 4

Recommended Follow-up

• Repeat liver stiffness measurement in 12 months to assess for any progression of fibrosis 4
• Address modifiable risk factors that could contribute to disease progression (weight management, diabetes control, alcohol cessation) 4
• No need for liver biopsy at this stage, as non-invasive tests are sufficient for monitoring 1, 4
• Monitor liver biochemistry (ALT, AST, bilirubin, albumin) every 6 months as fluctuations may indicate disease activity 4

Factors That May Affect Measurement Accuracy

• Recent physical exercise can artificially increase liver stiffness values; patients should rest for at least 10 minutes before examination 5
• Measurements should be performed after fasting for at least 4 hours, as postprandial state can affect results 1
• Severe obesity may affect the reliability of measurements, though modern probes have improved this limitation 6
• Repeating measurements in cases with borderline or high values can improve diagnostic accuracy 3

In summary, these elastography results indicate moderate hepatic steatosis (fatty liver) without significant fibrosis, consistent with non-alcoholic fatty liver disease in an early stage that requires monitoring but not immediate interventional management.