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Evidence to Improve Care

Transient Elastography for Assessment of Liver Fibrosis and Steatosis


Ontario Health Technology Advisory Committee Recommendations

OHTAC recommends that transient elastography be publicly funded to diagnose and assess the degree of liver fibrosis.

OHTAC recommends against publicly funding controlled attenuation parameter for the diagnosis of steatosis (fatty liver).

Read the full OHTAC Recommendation



The liver is the largest internal organ in the human body. It is located in the upper right portion of the abdomen, beneath the diaphragm and above the stomach. The liver supports many important bodily functions, including the storage of nutrients and digestion, as well as aiding the body’s immune system.

Liver disease can cause abdominal pain and swelling, swelling in the legs and ankles, chronic fatigue, and confusion, and can increase the risk of infection and cancer. Causes of liver disease include chronic viral hepatitis, alcoholic liver disease and non-alcoholic fatty liver disease.

If liver damage is detected early, the underlying cause may be treated effectively and sometimes the damage can be reversed.


Testing for liver disease

The standard test for liver fibrosis is a biopsy. A biopsy is performed by inserting a needle into a patient’s liver to take a sample of the tissue. However, there are new, less invasive and cost-effective options to check liver health.

Transient elastography is a non-invasive test that uses stiffness to determine whether or not a patient has liver fibrosis. Transient elastography can also be used to determine the severity of fibrosis.

A similar test called the controlled attenuation parameter uses ultrasound to determine whether a patient has hepatic steatosis.

Health Quality Ontario reviewed the evidence to determine the accuracy of transient elastography and controlled attenuation parameter.




Transient Elastography for Assessment of Liver Fibrosis and Steatosis: An Evidence-Based Analysis
November 2015 (PDF)

Transient Elastography and Controlled Attenuation Parameter for Diagnosing Liver Fibrosis and Steatosis in Ontario: An Economic Analysis
November 2015 (PDF)


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The Ministry of Health and Long-Term Care is currently reviewing this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry has a standardized process in place to review Health Quality Ontario recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.


Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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