Limited Agreement of Different Elastography Techniques in Assessing Liver Stiffness in Postmenopausal Women with Early-Stage Metabolic Dysfunction-Associated Steatotic Liver Disease

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease. Accurate staging of hepatic fibrosis is pivotal for risk stratification; however, ultrasonography (US)-based elastography techniques may yield variable results across various technologies and manufacturers. The present study aimed to assess the concordance of liver stiffness (LS) measurements between two different US elastography technologies and manufacturers in patients with MASLD. Methods: This cross-sectional study included 68 postmenopausal women with MASLD. LS was measured using two-dimensional shear wave elastography (2D-SWE) on a LOGIQ™ E10 device and both 2D-SWE and point SWE (pSWE) on an Acuson Sequoia device. Hepatic steatosis was quantified using the ultrasound-guided attenuation parameter (UGAP). Results: The LS measurements were 5.0 ± 1.3 kPa with 2D-SWE on LOGIQ™ E10, 4.3 ± 1.5 kPa with 2D-SWE on Acuson Sequoia, and 3.8 ± 0.8 kPa with pSWE on Acuson Sequoia. A significant, but low correlation was found between LOGIQ™ E10 2D-SWE and Acuson Sequoia pSWE (rs = 0.25, p = 0.045), and a moderate correlation between Acuson Sequoia 2D-SWE and pSWE (rs = 0.37, p = 0.002). No correlation was shown for 2D-SWE between the two different manufacturers. Bland–Altman analysis showed moderate-to-poor agreement of LS values between the three different US elastography techniques. Conclusions: LS measurements differed across US elastography technologies and manufacturers in postmenopausal women with early-stage MASLD. These findings highlight the need to standardize existing US elastography devices before elastography-derived LS can be applied interchangeably in MASLD diagnostic algorithms.