Medical liver illustration for a clinician guide to liver elastography reporting

What Should a Liver Elastography Report Mention?

Liver elastography is increasingly used to assess the risk of liver fibrosis in patients with Fatty Liver/MASLD and other chronic liver diseases. However, the clinical value of an elastography examination depends not only on the final kPa number but also on how the measurement was obtained and whether its quality can be assessed.

A useful report should allow the treating clinician to understand the technique, the reliability of the examination, the actual measurements and the appropriate clinical interpretation.

1. Identify the Elastography Technique

The report should clearly state which technology was used. Examples include:

Vibration-controlled transient elastography (VCTE/FibroScan)
Point shear-wave elastography (pSWE)
2D shear-wave elastography (2D-SWE)

This is essential because kPa values from different techniques should not automatically be treated as interchangeable. Reference ranges and validated thresholds depend on the method and clinical indication.

2. Mention the Probe or Transducer

For VCTE, the report should identify the probe used, such as the M or XL probe when applicable. For ultrasound elastography, the report should identify the transducer used and, where relevant, the examination preset.

Probe selection can affect feasibility and measurements, particularly in patients with increased body habitus.

3. State the Fasting Status

The report should document whether the patient was fasting and, ideally, the duration of fasting. Food intake can influence liver stiffness, so fasting status is clinically relevant when interpreting an elevated or borderline measurement.

4. Report Liver Stiffness Clearly

The principal fibrosis-related measurement should be reported prominently:

Median liver stiffness measurement
Unit — usually kPa, or m/s if that is the validated output of the system
Measurement technique
Number of valid measurements

For VCTE, the median rather than an isolated individual reading is generally used for interpretation.

5. Include IQR and IQR/Median for VCTE

For FibroScan/VCTE, the report should ideally include:

Median LSM
IQR
IQR/median ratio
Number of valid measurements
Whether the examination met the system’s reliability criteria

An IQR/median of ≤30% is a commonly used reliability criterion for VCTE when the median stiffness is greater than 7.1 kPa. More recent expert approaches also emphasize the absolute IQR and the clinical context rather than relying on the 30% rule alone.

6. For Ultrasound Elastography, Include Quality Information

For pSWE or 2D-SWE, the report should document the quality indicators provided by the particular manufacturer and technique. Depending on the system, these may include:

Number of measurements
Median or mean stiffness
Interquartile range or variability measure when available
Measurement dispersion
Confidence map or quality map for 2D-SWE
Whether measurements were technically adequate
ROI location and depth when relevant

Because different ultrasound manufacturers use different quality indicators, the report should not simply copy a FibroScan reliability rule onto every ultrasound elastography system.

7. Include CAP or Quantitative Liver-Fat Assessment When Available

If the examination is performed with FibroScan, the report should include the CAP value in dB/m when CAP was obtained.

If ultrasound is being used, the report should specify the actual fat-quantification technology and its result, rather than simply writing “fatty liver present.” Examples include vendor-specific attenuation measurements or quantitative ultrasound fat parameters.

CAP and ultrasound fat-quantification values should not be treated as identical scales.

8. Report the Ultrasound Findings Separately

When elastography is performed as part of a diagnostic ultrasound examination, the report should not contain only the kPa value. Clinicians may also need:

Liver size and contour
Parenchymal echogenicity/steatosis assessment
Focal liver lesions, if present
Portal vein and hepatic vessels when clinically indicated
Spleen size
Ascites
Biliary tree/gallbladder findings
Other relevant abdominal findings

9. Mention Technical Limitations

A high-quality report should state important limitations rather than presenting an apparently precise number when the examination was technically difficult.

Relevant limitations can include:

High body mass index or difficult acoustic window
Inappropriate or changed probe selection
Ascites
Inadequate fasting
Failure to obtain sufficient valid measurements
High measurement variability
Respiratory or movement-related difficulty
Recent exercise or other factors that may influence stiffness

10. State Important Confounders

Liver stiffness does not represent fibrosis alone. The report or clinical note should prompt consideration of factors that can increase stiffness independently of chronic fibrosis, including:

Active hepatic inflammation
Cholestasis
Hepatic congestion from cardiac disease
Recent food intake
Recent strenuous exercise
Acute liver injury

These factors become particularly important when the measured stiffness is unexpectedly high.

11. Do Not Automatically Assign F1–F4 From One Number

A report should avoid statements such as “10 kPa = F3” without specifying the disease, technique and validated reference standard.

Fibrosis thresholds differ according to:

Underlying liver disease
VCTE versus pSWE versus 2D-SWE
Probe and device
Patient population
Presence of inflammation or other confounders

A more useful conclusion is to state the validated risk category or interpretation appropriate for the technique and clinical indication, while advising clinical correlation.

12. Consider Including a Clinician-Friendly Impression

The final impression should translate the technical measurement into clinically useful information without overstating certainty.

For example:

VCTE liver stiffness: 6.8 kPa, 10 valid measurements, IQR/median 14%, technically reliable examination. CAP 292 dB/m, consistent with substantial hepatic steatosis. In the clinical context of suspected MASLD, the stiffness measurement is in a low-risk range for advanced fibrosis. Correlate with FIB-4 and clinical/laboratory findings.

This format gives the clinician the actual measurement, quality information, fat assessment and interpretation in one place.

Suggested Liver Elastography Reporting Template

Report element	What to document
Clinical indication	MASLD/Fatty Liver, abnormal LFTs, viral hepatitis, alcohol-related liver disease, etc.
Technique	VCTE/FibroScan, pSWE or 2D-SWE
Device	Manufacturer/model when relevant
Probe/transducer	M/XL or ultrasound transducer/preset
Fasting status	Yes/no and duration when available
LSM	Median stiffness with unit
Measurements	Number of valid measurements
Variability	IQR and IQR/median for VCTE; device-specific quality parameters for SWE
Fat assessment	CAP in dB/m or specific ultrasound fat-quantification metric
Technical quality	Reliable/limited/failed, with reason if applicable
Confounders	Inflammation, cholestasis, congestion, recent meal/exercise, etc.
Ultrasound findings	Liver, spleen, portal system, biliary tract and other relevant findings
Impression	Technique-specific fibrosis-risk interpretation and clinical correlation

What Should NOT Be Written?

“kPa = fibrosis stage” without identifying the validated context.
“CAP 300 = severe fibrosis.” CAP assesses steatosis, not fibrosis.
A kPa result without the technique used.
A stiffness result without any indication of measurement quality.
A conclusion that ignores active inflammation, cholestasis or congestion.
Direct comparison of raw kPa values from different elastography platforms without method-specific interpretation.

Why This Matters in Fatty Liver

For patients with MASLD, elastography is usually one part of a broader fibrosis-risk assessment. A clinician may combine elastography with FIB-4, platelet count, AST/ALT, metabolic risk factors and conventional imaging. Patients with indeterminate or high-risk findings may require hepatology assessment or additional non-invasive testing.

Key Takeaways for Clinicians

Always identify the elastography technique.
Report the median liver stiffness and unit.
Document valid measurements and quality/reliability parameters.
For VCTE, include IQR and IQR/median whenever available.
For ultrasound SWE, use the manufacturer’s validated quality indicators.
Include CAP or the specific quantitative fat metric when available.
Document fasting status and relevant confounders.
Do not automatically translate one kPa number into F1–F4 without method- and disease-specific validation.
Provide a concise, technique-specific clinical impression and recommend correlation with other fibrosis-risk tests.

References

Dr. Moxit Shah, DM Endocrinology — Ahmedabad

For assessment of Fatty Liver, Diabetes, insulin resistance, Weight Loss and metabolic disorders:

Vishuddha Endocrine Clinic
104-105, Elite Magnum, Bhuyangdev Cross Road, Opp. Utsav Elegance, Vardhmannagar Society, Ghatlodiya/Memnagar, Ahmedabad, Gujarat 380061
Phone: +91 99799 92797

Dr. Moxit Shah, DM Endocrinology

Written and medically reviewed by

Dr. Moxit Shah

DM Endocrinology (IPGMER & SSKM Hospital, Kolkata) · Consultant Endocrinologist, Vishuddha Endocrine Clinic, Ahmedabad

With over 10 years of clinical experience, Dr. Moxit Shah provides personalised, evidence-based treatment for diabetes, thyroid disorders and medical weight loss, with a strong focus on long-term disease control.

What Should a Liver Elastography Report Mention? A Practical Guide for Clinicians