Evaluation of liver fibrosis using diffusion-weighted virtual magnetic resonance elastography and ultrasound elastography

VMRE demonstrates insufficient diagnostic accuracy for fibrosis staging in both HBV and non-HBV populations, with only limited ability to distinguish extreme fibrosis stages (F0 vs. F4) in HBV patients. While showing excellent technical reproducibility (ICC = 0.972), its poor discriminative performance (AUC 0.45-0.76 across groups) and inability to differentiate intermediate stages preclude clinical utility. In contrast, USE achieved consistently superior diagnostic accuracy (AUC 0.86-0.95) with practical threshold values, supporting its preference over VMRE especially in centers lacking access to standard MRE. Further VMRE development requires technical optimization and larger validation studies.