Tissue Elastography Research Articles

The value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies in the biopsy naive patients

Objective To estimate the value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies(TB) in the biopsy naive patients. Methods From June 2016 to December 2017, 178 patients with suspicious prostate cancer were retrospectively evaluated. The age of patients was 54-87 years(median 70 yesrs). Serum PSA level before biopsy was 1.5-95.0 ng/ml(median 13.2 ng/ml), in which 70 cases with PSA 20 ng/ml.All patients underwent transrectal ultrasound(TRUS), real-time tissue elastography (RTE) and contrast-enhanced ultrasonography(CEUS). All positive sites on imaging undergoing two-core TB and 10 core-systematic biopsy (SB). The detection rates and positive rates of biopsy for any cancer(PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB. Pathological findings of each biopsy core was analyzed for Gleason grade and the single-core length of prostate cancer. Results The total detection rate for PCa was 48.8%(87/178). The diagnostic accuracy of PCa did not significantly differ between TB 35.5%(63/178) and SB 42.8%(76/178) groups. There was no significant difference between the proportion of CsPCa in TB group and SB group [80%(50/63) vs. 66%(50/76), P=0.21]. TB had an obvious higher single-core positive rate for prostate cancer 60.6%(449/740)and an obvious higher single-core positive rate for high-risk prostate cancer[10.3%(76/740)] than SB [29.7%(530/1 780) and 5.5%(98/1 780) ], with statistically signficant difference (P<0.001, P=0.002). TB also had a higher single-core length of prostate cancer than SB [6.80(0.20-15.00)mm vs. 5.50(0.06-18.00)mm, P<0.05]. Conclusions This study revealed a similar rate of prostate cancer detection between multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies(TB) and 10 core-systematic biopsy (SB). TB maybe tend to detect higher proportion of high-risk PCa. Key words: Prostatic neoplasms; Targeted biopsies; Contrast-enhanced ultrasonography; Elastography

A 2D finite element model for shear wave propagation in biological soft tissues: Application to magnetic resonance elastography.

Dynamic elastography is a virtual palpation tool that aims at investigating the mechanical response of biological soft tissues in vivo. The objective of this study is to develop a finite element model (FEM) with low computational cost for reproducing realistically wave propagation for magnetic resonance elastography in heterogeneous soft tissues. Based on the first-order shear deformation theory for moderately thick structures, this model is developed and validated through comparison with analytical formulations of wave propagating in heterogeneous, viscoelastic infinite medium. This 2D-FEM is then compared to experimental data and a 3D-FEM using a commercial software. Our FEM is a powerful promising tool for investigations of magnetic resonance elastography.

Artificial CO2-water Leg-bath Facilitates Recovery From Muscle Hardness Caused By Resistance Exercise

Facilitation of the blood stream and oxygen consumption of the muscle by a local immersion of the extremities into high concentration carbon dioxide water (CO2-water, CO2≥1000ppm), suggests an improvement of muscle performance and joints flexibility. PURPOSE: In the present study, we investigated whether the immersion of extremities including agonist muscles into artificially made CO2-water influenced recovery of the increased muscle hardness induced by a resistance exercise. METHODS: The healthy male college students (n=11, age; 18-19 yrs, height; 168.6±4.5 cm, weight; 66.2±9.3 kg) participated in this study. The subjects performed 100 times calf raise resistance exercise and immersed lower legs into tap-water or artificial CO2-water at 35 °C for 10 minutes immediately after the exercise. Blood flow in the immersed skin (BFskin) and electrocardiogram (ECG) were recorded continuously throughout the experiment. Hardness of the gastrocnemius medialis (MG) was evaluated using ultrasound real-time tissue elastography. Visual analog scale test on muscle pain (VAS) and muscle hardness measurements were performed at 3 time points (prior to exercise, immediately after exercise, at 10 min after exercise). The strain ratio (SR) between the MG and a reference material was calculated. RESULTS: BFskin in the CO2-water leg-bath was significantly higher than that in the tap-water leg-bath (CO2 -water vs. tap-water, 5.5±1.8 vs. 2.1±1.2 ml·min-1·100g-1, p<0.05). At 10 min after exercise, CO2 -water treatment compared with the tap-water treatment, SR decreased significantly quicker (1.37±0.28 vs. 0.67±0.08, p<0.05). In addition, VAS at recovery 10 min became smaller in the CO2-water than the tap-water (18.1±10.2 vs. 33.9±16.2 mm, p<0.05). CONCLUSIONS: We reported previously that the muscle blood flow in the immersed part was larger in CO2-water than tap-water of a same temperature. In addition to a local effect of CO2, suppression of muscular sympathetic activity may also contribute to the increase in local blood flow. Facilitation of muscle hardness recovery shown in this study might be caused by the increased muscle blood flow. The present study suggested that high concentration artificial CO2-water immersion may contribute to rapid recovery from the high intensity exercise-induced muscle fatigue.

Contractile property measurement of the torn supraspinatus muscle using real-time tissue elastography

In the restoration of shoulder abduction, decreased contractility of the torn rotator cuff muscle may be a cause of a poor result. The aim of this study was to investigate the relationship between the contractile property of the torn supraspinatus muscle measured by real-time tissue elastography and the Goutallier stage as modified by Fuchs et al. METHODS: The muscular hardness of the torn supraspinatus muscle was measured in 32 patients at rest and during isometric contraction with the shoulder abducted to 60° in the scapular plane. The muscular hardness was calculated as the strain ratio. Fatty degeneration was assessed according to the modified Goutallier stage. Because the activity value (defined as the difference between the strain ratio at rest and the strain ratio during isometric contraction) estimated the contractile property of the muscle, stepwise multiple regression analysis was used to compare the activity value with age, sex, side, time from injury onset to obtaining the measurements, and modified Goutallier stage. The mean activity value was 0.26 ± 0.16. Fatty degeneration of the supraspinatus muscle was grade 0 in 5 patients, grade 1 in 16, grade 2 in 10, and grade 3 in 1. The activity value was significantly correlated only with the modified Goutallier stage (r = -0.78, P < .001). The contractile property of the supraspinatus muscles decreased with an increase in the modified Goutallier stage. Real-time tissue elastography can measure the contractile property of the muscles before surgery and thus may be a predictor for the resulting restoration of lost muscle function.

Ultrasound and Infrared-Based Imaging Modalities for Diagnosis and Management of Cutaneous Diseases.

Non-invasive bedside imaging tools are becoming more prevalent for assessing cutaneous lesions. Ultrasound used at specific frequencies allows us to assess margins of lesions to minimize the extent of the biopsy that is performed and improve cosmetic outcomes. Vascularity, seen on Doppler ultrasound and contrast-enhanced ultrasound, and stiffness, assessed on tissue elastography, can help differentiate between benign and malignant lesions for clinicians to be more judicious in deciding whether to biopsy. Moreover, research has shown the efficacy in using ultrasound in monitoring flares of hidradenitis suppurativa, a disease affecting apocrine gland-rich areas of the body, for which the current gold standard involves examining and scoring inflammatory lesions with the naked eye. Infrared-based modalities have also been on the uptrend to aid in clinical decision-making regarding suspiciousness of lesions. Reflectance confocal microscopy has lateral resolution that is comparable to histopathology and it has been shown to be an appropriate adjunctive tool to dermoscopy, specifically when evaluating melanomas. Optical coherence tomography has utility in determining lesion thickness because of its depth penetration, and spectrophotometric intracutaneous analysis is becoming more popular as a tool that can be used by general practitioners to know when to refer to dermatology regarding worrisome pigmented lesions. Strides have been made to incorporate electrical impedance spectroscopy alongside dermoscopy in decision-making regarding excision, although the evidence for its use in the clincial setting remains inconclusive. This paper reviews the efficacy and drawbacks of these techniques in the field of dermatology and suggests future directions.

P1-5-02. Evaluation of facial muscle elasticity with real-time tissue elastography – Examination in cases with synkinesis following peripheral facial nerve paresis

The study was performed to clarify the relationship between facial muscle elasticity measured by real-time tissue elastography (RTE) and the clinical phenotypes of peripheral facial nerve paresis (PFP). We examined the orbicularis oculi muscles of nine PFP patients with synkinesis by RTE. The strain ratio (SR) of the muscle to an acoustic coupler was calculated as an index of muscle elasticity. We also recorded and integrated electromyograms of left and right orbicularis oculi muscles, respectively. The value on the affected side was divided by that on the healthy side. The value obtained in the resting state was defined as Contracture Index (CI), and that in the whistling state was defined as Synkinesis Index (SI). We studied the correlation between SR and various clinical phenotypes including CI, SI, age, the degree of paralysis, the duration of therapy, the degree of facial asymmetry, and the degree of synkinesis. The degree of paralysis was negatively correlated with SR ( ρ = −0.86, p

Evaluation of the activities of the medial and lateral heads of quadratus plantae in flexion movements of the lateral four toes using ultrasound real-time tissue elastography

Quadratus plantae (QP), one of the plantar intrinsic foot muscles, assist plantarflexion of the lesser toes. QP has medial and lateral muscle heads with different anatomical structures. The two heads of this muscle may have different roles in foot function. Ultrasound real-time tissue elastography (RTE) measurements have allowed quantitative assessment of deep-layer muscle elasticity. The purpose of this study was to determine the activity of the QP in flexion movements of the lateral four toes using RTE.Thirteen healthy subjects performed maximal voluntary contractions using a hand-held dynamometer with external belt fixation for each toe flexion movement. The elasticity of the muscles were measured using RTE during rest and flexion of each toe. The strain ratio of the muscle to that in an acoustic coupler was calculated as an index of muscle elasticity. Higher strain ratio values imply lower elasticity.The strain ratio of the medial head of QP for second toe flexion (0.10±0.11) was significantly stiffer than at rest (0.34±0.33). The strain ratios of the lateral head of QP for flexion of the second (0.32±0.19), third (0.41±0.37), fourth (0.33±0.26), and fifth (0.45±0.39) toes were significantly stiffer than at rest (1.02±0.68). These results suggest that the medial head of QP has a role in assisting second-toe flexion, and the lateral head has a role in assisting flexion of all four lateral toes.

Vascular ultrasound, the potential of integration of multiparametric ultrasound into routine clinical practice.

Ultrasound has traditionally been regarded as the first-line imaging modality for screening, diagnostic evaluation and monitoring treatment and disease progression of vascular pathology, including both the arterial and the venous branch of the vascular system. Albeit of its well-tolerated nature, wide availability and low cost, ultrasound above all, has the advantage of providing the clinician with clinically significant information related to both intraluminal irregularities and extravascular disease. Ultrasound has the potential not only to anatomically describe tissues but also to assess physiology by evaluating blood flow characteristics in real time. The already fundamental role of ultrasound has been even more expanded with the introduction of newer techniques like contrast-enhanced ultrasound, tissue-elastography and 3D ultrasound and the incorporation of research advances into clinical practice. The purpose of this review is to present and discuss some of the latest advances in the field of vascular ultrasound in attempt to illustrate how the adoption of multiparametric ultrasound into everyday clinical practice could address the patient's needs. Pathology and applications discussed include carotid and aortic disease, portal and peripheral venous abnormalities. Widespread availability of modern technology in ultrasound devices has made the application of contrast-enhanced ultrasound, tissue elastography and 3D ultrasound feasible options, ready to contribute to the diagnostic performance of the ultrasonographic technique.

EUS elastography: How to do it?

Strain elastography as used in EUS (EUS-real-time tissue elastography [RTE]) is a qualitative technique and provides information on the relative stiffness between one tissue and another. This article reviews the principles, technique, and interpretation of EUS-RTE in various organs. It includes information on how to optimize the technique as well as a discussion on pitfalls and artifacts. We also refer to the article describing RTE using conventional ultrasound transducers.

A Normalized Shear Deformation Indicator for Ultrasound Strain Elastography in Breast Tissues: An In Vivo Feasibility Study.

The shear deformation under loads contains useful information for distinguishing benign breast lesions from malignant ones. In this study, we proposed a normalized shear deformation indicator (NSDI) that was derived from the concept of principal strains. Since the NSDI requires both high-quality axial and lateral (parallel and perpendicular to the beam, resp.) displacement estimates, a strategy combining high-quality speckle tracking with signal “denoising” was employed. Both techniques were previously published by our group. Finite element (FE) models were used to identify possible causes for elevated NSDI values in and around breast lesions, followed by an analysis of ultrasound data acquired from 26 biopsy-confirmed in vivo breast lesions. We found that, theoretically, the elevated NSDI values could be attributed to two factors: significantly hardened tissue stiffness and increasing heterogeneity. The analysis of in vivo data showed that the proposed NSDI values were higher (p < 0.05) among malignant cancers as compared to those measured from benign ones. In conclusion, our preliminary results demonstrated that the calculation of NSDI value is feasible and NSDI could add value to breast lesion differentiation with current clinical equipment as a postprocessing tool.

Splenic elasticity measured with real-time tissue elastography is a predictive tool for portal hypertension and esophageal varices: a pilot study

目的：Real-time tissue elastography（RTE）を用いて慢性肝疾患における脾硬度測定を行い臨床的意義を検討した．対象および方法：対象は慢性肝疾患78例で 脾RTE画像から脾硬度を算出しspleen index（SI），PLT，APRI，肝硬度との関連を検討した．そのうち40例で超音波を用いた門脈圧亢進所見との関連を検討した．さらに食道静脈瘤（EV）の有無を確認できた73例で脾硬度をEV＋群，－群の2群間で比較検討し，EV＋34例で発赤所見（RC）等のEV内視鏡所見と比較検討した．結果と考察：SI，PLT，APRI，肝硬度と脾硬度の間には良好な相関関係を認め，脾硬度と門脈圧亢進所見の間にも良好な相関関係を認めた．EV＋群と－群の間では＋群の方が有意に脾硬度が上昇し（p＜0.0001），特にRC＋群は－群よりもさらに上昇した（p＜0.05）．EVおよびRC＋診断能をROC曲線を用いて検討したところ，脾硬度はEV（AUROC：0.93，cut off値72.2で感度84.6％，特異度91.2％），RC＋（AUROC：0.81，cut off値42.7で感度78.6％，特異度81.0％）で共に肝硬度よりも高かった．以上より脾硬度は門脈圧およびEVの有無と密接に関連することが示唆された．結論：RTEは慢性肝疾患における脾硬度評価に有用であり，EVの有無や出血を予測できるものと思われた．

Estimation and validation of patient-specific high-resolution lung elasticity derived from 4DCT.

Lung diseases are commonly associated with changes in lung tissue's biomechanical properties. Functional imaging techniques, such as elastography, have shown great promise in measuring tissue's biomechanical properties, which could expand the utility and effectiveness of radiotherapy treatment planning. We present a novel methodology for characterizing a key biomechanical property, parenchymal elasticity, derived solely from 4DCT datasets. Specifically, end-inhalation and end-exhalation breathing phases of the 4DCT datasets were deformably registered and the resulting displacement maps were considered to be ground-truth. A mid-exhalation image was also prepared for verification purposes. A GPU-based biomechanical model was then generated from the patient end-exhalation dataset and used as a forward model to iteratively solve for the elasticity distribution. Displacements at the surface of the lungs were applied as boundary constraints for the model-guided tissue elastography, while the inner voxels were allowed to deform according to the linear elastic forces within the biomechanical model. A convergence criteria of 10% maximum deformation was employed for the iterative process. The lung tissue elasticity estimation was documented for a set of 15 4DCT patient datasets. Maximum lung deformations were observed to be between 6 and 31 mm. Our results showed that, on average, 89.91±4.85% convergence was observed. A validation study consisting of mid-exhalation breathing phases illustrated an accuracy of 87.13±10.62%. Structural similarity, normalized cross-correlation, and mutual information were used to quantify the degree of similarity between the following image pairs: (a) the model-generated end-exhalation and ground-truth end-exhalation, and (b) model-generated mid-exhalation images and ground-truth mid-exhalation. Overall, the results suggest that the lung elasticity can be measured with approximately 90% convergence using routinely acquired clinical 4DCT scans, indicating the potential for a lung elastography implementation within the radiotherapy clinical workflow. The regional lung elasticity found here can lead to improved tissue sparing radiotherapy treatment plans, and more precise monitoring of treatment response.

Value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients

Objective To assess the value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients. Methods Sixty-four elderly patients suspected of prostate cancer (PCA) were enrolled from December 2015 to December 2016.Sixty-four patients with 72 nodules underwent transrectal ultrasound (TRUS), contrast-enhanced transrectal ultrasound (CETRUS) and transrectal real-time tissue elastography (TRTE). A combination of systematic biopsy and suspicious site-targeted biopsy was conducted.The accuracies of different detection methods for prostate cancer were assessed against the gold standard of histological examination of prostate biopsy samples. Results Among the 72 nodules, 31 were prostatic hyperplasia, 5 were chronic prostatitis, 35 were prostatic cancer, and one was prostatic lymphoma.There were significant differences in enhancement strength, enhancement time fast-in and degree of elasticity on TRTE and CETRUS between the malignant and benign groups (χ2=28.794, 10.889, 52.898; P=0.000, 0.001, 0.000, respectively). When the 35 PCA nodules were divided into two subgroups based on the Gleason score, there were statistically significant differences in enhancement strength, homogeneity of enhancement, and enhancement time fast-in and fast-out between them (χ2=6.073, 12.315, 4.717, 18.093; P=0.048, 0.001, 0.030, 0.000, respectively). The combination of CETRUS and TRTE in diagnosing prostate nodules produced a sensitivity of 83.3%, a specificity of 86.1%, an accuracy of 84.7%, a positive predictive value of 85.7%, and a negative predictive rate of 83.8%, better than either method alone. Conclusions Multi-modal image-guided transrectal ultrasonography has an advantage in providing information on the perfusion and elasticity of prostate nodules in the elderly patients and thus has important clinical value for the diagnosis of prostate nodules. Key words: Prostatic neoplasms; Ultrasonography; Contrast media; Elasticity imaging techniques

Assessment of using 360° endorectal ultrasound and real-time elastography in the diagnosis of benign and malignant rectal neoplasms in elderly patients

Objective To evaluate the value of endorectal ultrasonography (ERUS) combined with real-time elastography in the diagnosis of benign and malignant rectal neoplasms in elderly patients. Methods Fifty-six consecutive patients with rectal neoplasms underwent ERUS and real-time tissue elastography at Beijing Hospital from February 2016 to December 2016.The imaging results were compared with results from postoperative or colonoscopic findings. Results Histopathological examinations identified 50 cases of adenocarcinomas, 5 cases of adenomas and 1 case of neurilemmoma.The accuracy, sensitivity and specificity of ERUS in the diagnosis of benign and malignant rectal neoplasms were 89.3% (50/56), 92.0% (46/50), and 66.7% (4/6), respectively.The accuracy, sensitivity and specificity of real-time elastography in the diagnosis of benign and malignant rectal neoplasms were 80.4% (45/56), 82.0% (41/50), and 66.7%(4/6), respectively.However, there was no significant difference in sensitivity and specificity (χ2=3.20 and 0.50, P=0.074 and 0.480) between the two approaches.With the combination of ERUS and real-time elastography in the diagnosis of benign and malignant rectal neoplasms, the sensitivity and specificity were 75.4% and 98.6% for the series method and 88.9% and 44.5% for the parallel method. Conclusions Although elastography may not improve the accuracy of the diagnosis of benign and malignant rectal neoplasms, the strain information it provides can be used as a basis for subsequent diagnosis and treatment decisions. Key words: Rectal neoplasms; Elasticity imaging techniques; Ultrasonography

The activity of quadratus plantae in toe flexion movements using ultrasound real-time tissue elastography

The activity of quadratus plantae in toe flexion movements using ultrasound real-time tissue elastography

Diagnosis of Fibrosis and Activity by a Combined Use of Strain and Shear Wave Imaging in Patients with Liver Disease

Objective: Performing shear wave imaging is simple, but can be difficult when inflammation, jaundice, and congestion are present. Therefore, the correct diagnosis of liver fibrosis using shear wave imaging alone might be difficult in mild-to-moderate fibrosis cases. Strain imaging can diagnose liver fibrosis without the influence of inflammation. Therefore, the combined use of strain and shear wave imaging (combinational elastography) for cases without jaundice and congestion might be useful for evaluating fibrosis and inflammation. Methods: We enrolled consecutive patients with liver disease, without jaundice or liver congestion. Strain and shear wave imaging, blood tests, and liver biopsy were performed on the same day. The liver fibrosis index (LF index) was calculated by strain imaging; real-time tissue elastography, and the shear wave velocity (V_s) was calculated by shear wave imaging. Fibrosis index (F index) and activity index (A index) were calculated as a multiple regression equation for determining hepatic fibrosis and inflammation using histopathological diagnosis as the gold standard. The diagnostic ability of F index for fibrosis and A index for inflammation were compared using LF index and V_s. Results: The total number of enrolled cases was 388. The area under the receiver operating characteristic (AUROC) was 0.87, 0.80, 0.83, and 0.80, at diagnosis of fibrosis stage with an F index of F1 or higher, F2 or higher, F3 or higher, and F4, respectively. The AUROC was 0.94, 0.74, and 0.76 at diagnosis of activity grade with an A index of A1 or higher, A2 or higher, and A3, respectively. The diagnostic ability of F index for liver fibrosis and A index for inflammation was higher than for other conventional diagnostic values. Conclusions: The combined use of strain and shear wave imaging (combinational elastography) might increase the positive diagnosis of liver fibrosis and inflammation.

Intraoperative real-time tissue elastography during laparoscopic hepatectomy

BackgroundReal-time tissue elastography during open hepatectomy facilitates the differential diagnosis of liver tumors by providing information on elasticity. This study investigated the utility of intraoperative real-time tissue elastography (IORTE) during laparoscopic hepatectomy (LH). MethodsBetween 2012 and 2014, IORTE was performed during LH for 21 hepatocellular carcinomas (HCCs), 16 adenocarcinomas and 5 other tumors in 32 patients. The elasticity images were classified into six categories according to the modified criteria on the elasticity type of liver tumors, in which type 1 tumors show more strain than the surrounding liver and type 6 tumors no strain. The concordance of the IORTE findings with those of the pathological examination of the tumors was assessed (The registration no. 1418). ResultsAmong the 21 HCCs, 20 were classified as “HCC pattern” (type 3, 4, or 5), resulting in a sensitivity of 95.2%, a specificity of 66.7% and an accuracy of 81.0%. Ten out of the 16 adenocarcinomas were classified as “adenocarcinoma pattern” (type 6), resulting in a sensitivity of 62.5%, a specificity of 92.3% and an accuracy of 81.0%. ConclusionIORTE is feasible and provides useful information on the elasticity of liver tumors in LH, in which conventional tumor palpation is difficult.

OP12.11: Prediction of cervical changes and premature birth by cervical image pattern analysis using real‐time tissue elastography

OP12.11: Prediction of cervical changes and premature birth by cervical image pattern analysis using real‐time tissue elastography

Impact of transrectal real-time tissue elastography guiding biopsy combined with peak strain index for diagnosing prostate cancer

Objective To evaluate the value of transrectal real-time tissue elastography (RTE) targeted prostate biopsy in the peripheral zone combined with peak strain index. Methods One hundred and forty-one patients with suspicious prostate lesions in the peripheral zone were evaluated from February 2011 to February 2014. All the patients underwent RTE with a mean age of 71.6 years, PSA of 30 ng/ml, prostate volume of 50.3 ml and measured peak strain index (PSI) . The diagnostic value of PSI was assessed by receiver operating characteristic (ROC) curve. Two-core RTE combined with PSI targeted prostate biopsy was taken and subsequently a 10-core systematic biopsy was taken. The value of RTE was evaluated. The data of targeted biopsy and systematic biopsy in prostate were both reviewed and statistically compared. Results Cancer was detected in 72 of 141 patients (PSI, mean 24.79), and 69 patients had benign prostate disease (PSI, mean 3.02). PSI value of prostate cancer was significantly higher than that of the benign lesions (P 0.05). Conclusions RTE combined PSI can improve the detection rate of prostate cancer in the peripheral zone and likewise guide targeted biopsy combined with systematic biopsy to detect more moderate or high risk prostate cancer. Key words: Prostatic neoplasms; Transrectal real-time tissue elastography; Strain index; Biopsy

Diagnosing liver fibrosis: a narrative review of current literature for dermatologists.

Chronic liver disease is a growing problem worldwide due to obesity, alcohol-related liver disease and viral hepatitis. Liver fibrosis is generally asymptomatic and patients may not present until they have advanced cirrhosis, when the scope for reversibility is limited. Identification of asymptomatic individuals at an early stage is fundamental to reversing the rising toll of liver-related morbidity and mortality. Awareness of liver disease and the techniques for diagnosis is important for dermatologists, not only due to the burden of disease in the general population but also because some dermatology cohorts may have an elevated risk. For example, there is an increased prevalence of metabolic syndrome and excess alcohol use in those with psoriasis and hidradenitis suppurativa. In isolation, standard liver function tests lack sensitivity to detect advanced fibrosis and cirrhosis and are of limited value. Traditionally diagnosis has relied on liver biopsy, which remains the gold standard but is both costly and invasive. There have been several recent advances in the development of noninvasive alternatives. These include scoring systems combining clinical and conventional laboratory parameters for use as screening tools, direct serum biomarkers of fibrogenesis and tissue elastography using both ultrasound (Fibroscan) and magnetic resonance. This review summarizes current and future noninvasive diagnostic techniques for evaluation of liver fibrosis.