Shear-Wave Elastography: Principles, Techniques, and Clinical Considerations

Hepatic fibrosis is a critical determinant of prognosis in chronic liver disease, and accurate staging is essential for guiding management. While liver biopsy has long been the reference standard, its limitations have motivated the development of non-invasive methods such as shearwave elastography (SWE). SWE provides real-time, quantitative liver stiffness measurements with high reproducibility when performed under standardized protocols. This review outlines the physical principles of SWE, compares point SWE (p-SWE) and two-dimensional SWE (2D-SWE), and summarizes current guideline-based cutoff values for fibrosis staging. Practical considerations, including patient preparation, probe placement, breath control, measurement protocols, and quality control, are discussed. SWE has emerged as a reliable and widely applicable tool for non-invasive fibrosis assessment and, with standardized protocols and technological advances, is expected to play an increasingly central role in hepatology practice.