Which noninvasive test is used to stage liver fibrosis in cirrhosis and to monitor progression?

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Elastography is used to noninvasively stage liver fibrosis and to monitor progression. It works by measuring liver tissue stiffness, which increases as fibrosis advances. The most common form, FibroScan, uses ultrasound to generate shear waves and quantify stiffness in kilopascals. Higher stiffness values correlate with greater fibrosis stages, allowing clinicians to assess baseline fibrosis and track changes over time without a biopsy. This approach can often reduce the need for invasive liver biopsy, though it has limitations: inflammation, cholestasis, or fatty change can falsely elevate stiffness, and obesity or certain body habitus can affect accuracy. Other options like endoscopy are for assessing portal hypertension and varices, not fibrosis staging; biopsy is invasive and has sampling variability, and urinalysis does not assess fibrosis.