Abstract
Background: Liver fibrosis is a serious and progressive complication of chronic liver disease that may ultimately lead to cirrhosis, portal hypertension, liver failure, and hepatocellular carcinoma if left undetected and untreated. Accurate staging of fibrosis is therefore essential for guiding therapeutic decisions, evaluating disease progression, and determining the urgency of clinical intervention. While liver biopsy has long been regarded as the gold standard for fibrosis staging, its invasive nature, associated risks, and limited suitability for repeated monitoring have driven the development of non-invasive alternatives. Grayscale ultrasound and elastography represent two widely available imaging modalities that together offer a comprehensive, non-invasive approach to hepatic evaluation. However, data specifically examining their combined diagnostic utility and mutual correlation in the context of histological METAVIR staging within South Asian clinical populations remain limited.
Objective: To correlate gray-scale ultrasound findings with elastography-derived liver stiffness measurements as a non-invasive tool for liver fibrosis assessment and staging using the METAVIR scoring system in patients with chronic liver disease.
Methods: A cross-sectional, multicenter observational study was conducted on 110 patients with suspected chronic liver disease presenting to diagnostic centers in Rahim Yar Khan, Pakistan. The age range was 31 to 68 years (mean 45.4 ± 6.3 years), comprising 63 males (57.3%) and 47 females (42.7%). All patients underwent grayscale ultrasonography for liver echotexture and morphological assessment, as well as transient elastography for liver stiffness measurement in kilopascals (kPa). Fibrosis was staged using the METAVIR scoring system (F0–F4) based on established elastography cutoff values. Spearman rank correlation and simple linear regression analyses were performed to determine the strength, direction, and predictive value of the association between liver stiffness and fibrosis stages.
Results: Liver stiffness values demonstrated a consistent progressive increase across all METAVIR fibrosis stages, ranging from a mean of 5.9 ± 0.3 kPa in F0 (no fibrosis) to 58.3 ± 27.1 kPa in F4 (cirrhosis).
Spearman correlation analysis revealed a very strong positive association between liver stiffness measurement and fibrosis stage (rs = 0.91, p < 0.005). Linear regression confirmed liver stiffness as a powerful independent predictor of fibrosis severity, with β = 0.042, R² = 0.83, and p < 0.005, indicating that 83% of the variation in fibrosis stage was explained by kPa values alone. On grayscale ultrasound, increased hepatic echogenicity and coarsened echotexture corresponded with higher elastography stiffness values, reflecting advancing fibrosis.
Conclusion: Ultrasound elastography demonstrates a highly reliable and statistically significant correlation with METAVIR fibrosis staging, firmly establishing its value as a non-invasive diagnostic tool for liver fibrosis assessment. The progressive relationship between grayscale ultrasound findings and elastography-derived stiffness values supports the integrated use of both modalities in clinical practice, offering a practical, reproducible, and patient-friendly alternative to invasive liver biopsy