# Comparison Between Transient Elastography and Point Shear Wave Elastography in the Assessment of Liver Fibrosis According to the Grade of Liver Steatosis

## TL;DR

This study compares two liver stiffness measurement techniques in patients with fatty liver disease, finding they agree well for mild to moderate cases but less so for severe cases.

## Contribution

First comparison of transient elastography and point shear wave elastography in Metabolic Dysfunction-Associated Steatotic Liver Disease, stratified by steatosis grade.

## Key findings

- Fibroscan® and pSWE showed strong correlation and agreement in mild to moderate steatosis (S0 to S2).
- Agreement between the two techniques decreased significantly in patients with severe steatosis (S3).

## Abstract

Background: Transient elastography (TE), using Fibroscan® and point shear wave elastography (pSWE), are two techniques used to estimate liver fibrosis. The aim of our study was to compare, for the first time, these two techniques in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), stratifying the analysis on the basis of the grades of steatosis. Methods: We recruited 85 consecutive MAFLD patients who underwent liver stiffness (LS) measurement performed by Fibroscan® and pSWE on the same day. Severity of steatosis was estimated by Fibroscan® and expressed as controlled attenuation parameter (CAP), ranging from S0 to S3. Spearman’s “r” coefficient was used to calculate the correlation and Bland–Altman graphs was used to evaluate the agreement. Results: In general, the correlation and agreement between Fibroscan® and pSWE were substantial (r = 0.66, p < 0.001 and bias= −0.64 ± 2.48, respectively). When data were analyzed according to the grade of steatosis, an increasing significant correlation was observed going from S0 to S2 (r = 0.79, r = 0.81, and r = 0.85, respectively), whereas a low correlation and agreement were observed for S3 patients (r = 0.48, p = 0.003, bias= −0.95 ± 2.51). Conclusions: Fibroscan® and pSWE are equivalent techniques to estimate liver fibrosis in patients with mild to moderate steatosis, while in presence of severe steatosis their agreement is low.