What are the simplified FibroScan (transient elastography) kPa cut‑offs for fibrosis stages (F0‑F4) in adults with chronic hepatitis C, chronic hepatitis B, NAFLD/NASH, alcohol‑related liver disease, and primary biliary cholangitis or primary sclerosing cholangitis?

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FibroScan kPa Cutoffs by Liver Disease

Use these disease-specific thresholds to stage fibrosis and guide management decisions, recognizing that cutoffs vary by etiology and that transient elastography (TE) performs best for detecting cirrhosis across all liver diseases.

Chronic Hepatitis C

Significant Fibrosis (≥F2): 7.0 kPa (sensitivity 75%, specificity 84%) 1

Advanced Fibrosis (≥F3): 10.0 kPa (sensitivity 87%, specificity 88%) 1

Cirrhosis (F4): 13.0 kPa (sensitivity 88%, specificity 94%) 1

  • These thresholds are derived from 54 studies and represent the most extensively validated cutoffs in liver disease 1
  • The diagnostic accuracy improves progressively from F2 to F4, with area under ROC curve (AUROC) of 0.95 for cirrhosis detection 1
  • Combining FibroScan with FIB-4 increases diagnostic accuracy to 88% for F≥2,95% for F≥3, and 95% for F4, potentially avoiding liver biopsy in most patients 2

Chronic Hepatitis B

Significant Fibrosis (≥F2): 7.0 kPa (sensitivity 78%, specificity 79%) 1

Advanced Fibrosis (≥F3): 8.0 kPa (sensitivity 87%, specificity 83%) 1

Cirrhosis (F4): 11.0 kPa (sensitivity 81%, specificity 87%) 1

  • Based on 59 studies, these cutoffs are slightly lower than hepatitis C due to different fibrosis patterns 1
  • Critical caveat: Active inflammation (ALT >5× upper limit of normal) significantly elevates stiffness values independent of fibrosis stage, potentially overestimating disease severity 3
  • Patients with ALT 1-5× normal have moderately elevated values; ideally measure after 2-4 weeks of viral suppression when feasible 3

NAFLD/NASH

Significant Fibrosis (≥F2): 7.0-8.2 kPa (sensitivity 79%, specificity 74%) 1

Advanced Fibrosis (≥F3): 8.0-10.0 kPa (sensitivity 81%, specificity 79%) 1

Cirrhosis (F4): 12.0-13.0 kPa (sensitivity 91%, specificity 87%) 1

  • The <8.0 kPa threshold rules out advanced fibrosis with 93% sensitivity, making it highly reliable for excluding significant disease 4, 5
  • The 8.0-12.0 kPa range represents indeterminate risk requiring hepatology referral and consideration of MR elastography or biopsy 4, 5
  • NAFLD cutoffs show wider ranges (4.8-16.4 kPa for F≥2) across studies due to heterogeneous populations and metabolic confounders 1
  • Always calculate FIB-4 first; proceed to FibroScan only if FIB-4 ≥1.3 (or ≥2.0 if age ≥65 years) 4

Alcohol-Related Liver Disease (ALD)

Significant Fibrosis (≥F2): 7.8 kPa (sensitivity 80%, specificity 91%) 1

Advanced Fibrosis (≥F3): 11.0-12.0 kPa (sensitivity 76-87%, specificity 81-92%) 1

Cirrhosis (F4): 15.0-18.0 kPa (sensitivity 90-93%, specificity 85-86%) 1

  • Perform FibroScan only after minimum 2 weeks of alcohol abstinence, as recent consumption falsely elevates liver stiffness independent of fibrosis 4
  • The <8.0 kPa cutoff reliably excludes advanced fibrosis in abstinent patients 4
  • Higher cirrhosis thresholds (15-18 kPa) compared to viral hepatitis reflect different pathophysiology 1

Primary Biliary Cholangitis (PBC)

Significant Fibrosis (≥F2): 8.8 kPa (sensitivity 67%, specificity 100%) 1

Advanced Fibrosis (≥F3): 10.7 kPa (sensitivity 90%, specificity 93%) 1

Cirrhosis (F4): 16.9 kPa (sensitivity 93%, specificity 99%) 1

  • PBC shows excellent specificity for all fibrosis stages, particularly for excluding significant fibrosis (100% specificity at 8.8 kPa) 1
  • Based on limited data (single study), these cutoffs require validation in larger cohorts 1
  • Extrahepatic cholestasis falsely elevates measurements; ensure biliary obstruction is excluded before interpretation 6

Primary Sclerosing Cholangitis (PSC)

Significant Fibrosis (≥F2): 8.7 kPa (sensitivity 81-89%, specificity 72-88%) 1

Advanced Fibrosis (≥F3): 9.6 kPa (sensitivity 90%, specificity 82-93%) 1

Cirrhosis (F4): 14.4 kPa (sensitivity 69-100%, specificity 88-98%) 1

  • Based on only 2 studies; wide sensitivity range (69-100%) for cirrhosis reflects small sample sizes 1
  • PSC presents unique challenges due to patchy fibrosis distribution and biliary strictures that may elevate stiffness independent of parenchymal fibrosis 1
  • Consider MR elastography for more accurate assessment in PSC given these limitations 1

Critical Technical Validity Requirements

All FibroScan results must meet these criteria to be clinically reliable:

  • ≥10 successful measurements obtained 4, 5
  • Success rate ≥60% 4, 5
  • Interquartile range (IQR) <30% of median value 4, 5
  • Patient fasted ≥3-4 hours before examination 5

Common causes of invalid measurements:

  • Obesity (BMI >28 kg/m²)—use XL probe 6, 7
  • Ascites—FibroScan cannot be performed reliably 6
  • Narrow intercostal spaces 6
  • Active acute hepatitis—wait until ALT normalizes 6, 3
  • Right heart failure—causes falsely elevated values 5

Comparative Performance: MR Elastography (MRE)

For NAFLD, MRE cutoffs are approximately 3× lower than TE:

  • F≥2: 3.2-3.6 kPa (sensitivity 78%, specificity 90%) 1
  • F≥3: 3.6-3.9 kPa (sensitivity 82-93%, specificity 90-95%) 1
  • F4: 6.7 kPa (sensitivity 91%, specificity 95%) 1

MRE demonstrates superior diagnostic accuracy (AUROC 0.92 for F≥2,0.89 for F≥3) compared to TE (AUROC 0.83 for both) in NAFLD 1, but is less accessible and more expensive 1

Management Algorithm by FibroScan Result

<8.0 kPa (Low Risk):

  • Repeat in 2-3 years if metabolic risk factors persist 4, 5
  • Repeat in 3-5 years if risk factors controlled 5

8.0-12.0 kPa (Indeterminate):

  • Refer to hepatology for monitoring 4, 5
  • Consider MRE or biopsy for definitive staging 4
  • Re-evaluate in 2-3 years 4

>12.0-12.5 kPa (High Risk/Cirrhosis):

  • Urgent hepatology referral 4, 5, 8
  • Initiate HCC surveillance with ultrasound every 6 months 8
  • Screen for esophageal varices 8
  • Monitor every 6 months 4

>20-25 kPa (Clinically Significant Portal Hypertension):

  • High risk for variceal bleeding 4
  • Requires endoscopic surveillance 4
  • Predicts clinical decompensation 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Guideline

Use of FibroScan in Liver Disease Diagnosis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Interpreting FibroScan Results for Liver Fibrosis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Research

Transient elastography for the diagnosis of liver fibrosis.

Expert review of medical devices, 2010

8
Guideline

Management of F4 Cirrhosis Diagnosed on FibroScan

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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