Transient elastography (TE) has emerged as a pivotal noninvasive tool for assessing the liver stiffness measurement (LSM) in patients with primary biliary cholangitis (PBC). This review provides a comprehensive analysis of its diagnostic performance and its role in prognostic stratification. In terms of diagnosis, TE has demonstrated superior accuracy for staging liver fibrosis across multiple validation studies, achieving area under the receiver operating characteristic curve (AUROC) values as high as 0.99 for the detection of cirrhosis, consistently outperforming standard serological indices such as the AST-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4). The prognostic significance of TE is profound and multifaceted. The LSM is strongly and independently correlated with the development and severity of portal hypertension and is a major driver of clinical outcomes in patients with PBC. LSM values ≥15 kPa indicate a significantly increased risk of hepatic decompensation, which is consistent with the Baveno VII consensus. In addition, the combination of TE and platelet counts can also effectively reduce unnecessary endoscopic screenings for varices.
Rui et al. (Wed,) studied this question.