Advances in imaging - Elastography.

Chronic liver disease (CLD) affects over a billion people worldwide. Liver fibrosis is the key driver of liver-related complications and mortality. Elastography has been a transformative tool in hepatology allowing diagnosing and staging liver fibrosis non-invasively, and is evolving beyond these purposes into a prognostication tool. By measuring tissue stiffness, elastography techniques such as shear-wave and magnetic resonance elastography (MRE) offer critical insights into liver fibrosis, portal hypertension, and the progression of disease. MRE stands out for its reliability across fibrosis stages and robustness in obese patients affected by metabolic liver disease. Spleen stiffness measurement (SSM) complements liver assessments, enhancing the identification of portal hypertension and refining patient risk stratification. This review covers current clinical applications but also anticipates future innovations such as artificial intelligence based algorithms that could expand elastography's clinical impact so improving patient outcomes.