Liver Elastography: Stiffness Thresholds for Significant Fibrosis and cACLD
Liver Stiffness Thresholds According to SRU (2020 Update)
According to the consensus recommendations of the Society of Radiologists in Ultrasound (2020 update), ultrasound shear wave elastography values are interpreted according to the ranges provided below. Units are given in kPa with an equivalent in m/s.
| Stiffness (kPa / m/s) | Interpretation |
|---|---|
| <5 kPa (1.3 m/s) | High probability of normality |
| 5–9 kPa (1.3–1.7 m/s) | In the absence of other known clinical signs — excludes compensated advanced chronic liver disease (cACLD); if clinical signs are present, an additional confirmatory test may be required |
| 9–13 kPa (1.7–2.1 m/s) | Suggests cACLD, additional test required for confirmation |
| 13–17 kPa (2.1–2.4 m/s) | Highly suspicious for cACLD |
| >17 kPa (2.4 m/s) | Highly suspicious for clinically significant portal hypertension |
The thresholds provided relate to the assessment of cACLD and clinically significant portal hypertension. A separate numerical threshold for 'significant fibrosis' is not provided in the source fragments [to be clarified].
Clinical Application
Values in the range of 5–9 kPa in the absence of clinical signs allow for the exclusion of cACLD; if clinical signs are present, an additional confirmatory test is recommended. The ranges of 9–13 and 13–17 kPa reflect an increasing likelihood of cACLD, and exceeding 17 kPa shifts the interpretation towards clinically significant portal hypertension.
Frequently asked questions
What threshold excludes cACLD?
5–9 kPa (1.3–1.7 m/s) in the absence of other clinical signs excludes cACLD; if signs are present, a confirmatory test is needed (SRU, 2020 update).
What value indicates clinically significant portal hypertension?
Stiffness >17 kPa (2.4 m/s) is highly suspicious for clinically significant portal hypertension (SRU, 2020 update).
What does the range 13–17 kPa mean?
13–17 kPa (2.1–2.4 m/s) is highly suspicious for cACLD (SRU, 2020 update).
What value is considered likely normal?
<5 kPa (1.3 m/s) — high probability of normality (SRU, 2020 update).
Is there a threshold for significant fibrosis in the fragments?
A separate numerical threshold for significant fibrosis is not provided in the source fragments — [to be clarified].