Journal of Medical Ultrasonics

, Volume 40, Issue 4, pp 325–357 | Cite as

JSUM ultrasound elastography practice guidelines: liver

  • Masatoshi Kudo
  • Tsuyoshi Shiina
  • Fuminori Moriyasu
  • Hiroko Iijima
  • Ryosuke Tateishi
  • Norihisa Yada
  • Kenji Fujimoto
  • Hiroyasu Morikawa
  • Masashi Hirooka
  • Yasukiyo Sumino
  • Takashi Kumada
Review Article


In diffuse liver disease, it is extremely important to make an accurate diagnosis of liver fibrosis prior to determining indications for therapy or predicting treatment outcome and malignant potential. Although liver biopsy has long been the gold standard in the diagnosis of liver fibrosis, it is still an invasive method. In addition, the sampling error is an intrinsic problem of liver biopsy. Non-invasive serological methods for the diagnosis of liver fibrosis can be affected by factors unrelated to the liver. Recently, after the introduction of FibroScan, it became possible to measure liver fibrosis directly and non-invasively by elastography, which has attracted attention as a non-invasive imaging diagnostic tool for liver fibrosis. In addition, real-time tissue elastography is currently being used to conduct clinical trials at many institutions. Moreover, virtual touch quantification enables the observation of liver stiffness at any location by simply observing B-mode images. Furthermore, the recently developed ShearWave elastography visualizes liver stiffness on a color map. Elastography is thought to be useful for all types of diffuse liver diseases. Because of its association with portal hypertension and liver carcinogenesis, elastography is expected to function as a novel prognostic tool for liver disease. Although various elastographic devices have been developed by multiple companies, each device has its own measurement principle, method, and outcome, creating confusion in clinical settings. Therefore, it is extremely important to understand the characteristics of each device in advance. The objective of this guideline, which describes the characteristics of each device based on the latest knowledge, is for all users to be able to make the correct diagnosis of hepatic fibrosis by ultrasound elastography.


Elastography Elasticity Shear wave Stiffness Strain Liver fibrosis 


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2013

Authors and Affiliations

  • Masatoshi Kudo
    • 1
  • Tsuyoshi Shiina
    • 2
  • Fuminori Moriyasu
    • 3
  • Hiroko Iijima
    • 4
  • Ryosuke Tateishi
    • 5
  • Norihisa Yada
    • 1
  • Kenji Fujimoto
    • 6
    • 7
  • Hiroyasu Morikawa
    • 8
  • Masashi Hirooka
    • 9
  • Yasukiyo Sumino
    • 10
  • Takashi Kumada
    • 11
  1. 1.Department of Gastroenterology and HepatologyKinki University School of MedicineOsakasayamaJapan
  2. 2.Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan
  3. 3.Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
  4. 4.Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan
  5. 5.Department of Gastroenterology, Graduate School of MedicineThe University of TokyoTokyoJapan
  6. 6.Department of Internal MedicineNagayama HospitalOsakaJapan
  7. 7.Division of Clinical ResearchONH Minamiwakayama Medical CenterTanabeJapan
  8. 8.Department of Hepatology, Graduate School of MedicineOsaka City UniversityOsakaJapan
  9. 9.Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineToonJapan
  10. 10.Division of Gastroenterology and HepatologyToho University Ohmori Medical CenterTokyoJapan
  11. 11.Department of Gastroenterology and HepatologyOgaki Municipal HospitalOgakiJapan

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