Ultrasound-based liver elastography: a narrative review of technical principles and interpretation of results

In recent years, noninvasive methods for assessing liver fibrosis have significantly transformed hepatology practices, reducing the need for liver biopsy. Among these, elastography techniques have become widely used tools for staging fibrosis in patients with chronic liver disease. Currently, various modalities are available, including transient elastography, point shear wave elastography, two-dimensional shear wave elastography, and magnetic resonance elastography; the first three are ultrasound-based techniques, whereas the last is a magnetic resonance imaging-based technique. In this context, ultrasound-based liver elastography stands out as a reliable, reproducible method with high accuracy. This narrative review aims to present the technical principles of ultrasound-based shear wave elastography, discuss the factors that influence measurement reliability, and provide practical guidance for result interpretation. The topics addressed include acquisition protocols, methodological limitations, potential confounding factors, and clinically relevant cutoff values. In conclusion, when applied under appropriate indications with adequate technical quality and interpretation, ultrasound-based liver elastography is a valuable, complementary tool for managing chronic liver disease.