Skip to main content

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)


Use of this site, and the interpretation of the information contained here, is subject to important terms and conditions. Use of this site and information except in accordance with these terms and conditions is expressly prohibited.

The Ministry of Health is currently reviewing this recommendation.

The Ministry of Health 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.

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone