What elastography measures
Elastography measures liver stiffness in kilopascals (kPa). Stiffer liver = more scarring (fibrosis). The test uses sound waves to measure how fast they travel through liver tissue — faster travel = stiffer tissue.
Most systems also measure liver fat content as a separate parameter: CAP (on FibroScan, in dB/m) or UAP (on iLivTouch, also in dB/m). Both are graded S0–S3 from no significant fat to severe steatosis.
Why GLP-1 patients benefit from elastography specifically
Three reasons:
- Baseline staging. If you have metabolic risk factors and an indeterminate FIB-4, elastography clarifies whether you have significant fibrosis. This matters because patients with significant fibrosis benefit more from treatment than those with simple fatty liver.
- Treatment response. A repeat elastography at 12 months shows whether your liver has actually improved on GLP-1 therapy. Trial responders typically show 4–7 kPa reduction at one year on semaglutide.
- Decision-making. A clear elastography signal supports continuing treatment, dose adjustments, or specialist referral if response is poor.
kPa thresholds for MASLD
| kPa | Stage | Meaning |
|---|---|---|
| < 8 | F0–F1 | Minimal fibrosis |
| 8–12 | F2–F3 | Significant fibrosis — monitor closely |
| > 12 | F3–F4 | Advanced fibrosis / cirrhosis — specialist referral |
These ranges apply to MASLD specifically. They differ for hepatitis B (treat above 7 kPa per WHO 2024) and hepatitis C.
What response looks like on GLP-1 therapy
In trial data, semaglutide responders show:
- kPa reduction of 4–7 from baseline at 12 months
- CAP/UAP reduction reflecting reduced steatosis (often one full S-grade)
- ALT/AST normalisation in most patients
- Histological MASH resolution in around 63% of treated patients (ESSENCE)
A reduction of ≥5 kPa between elastography measurements is considered clinically meaningful under Baveno VII criteria — the threshold most monitoring guidelines now use.
Practical monitoring cadence
- Before starting GLP-1: FIB-4 + LFTs. Elastography if FIB-4 indeterminate.
- 3 months: Repeat LFTs only.
- 6 months: LFTs + clinical review.
- 12 months: Full repeat including elastography if it was indicated at baseline.
- Annually thereafter: While on long-term GLP-1 therapy and at risk.
Frequently asked questions
How often should I get elastography on GLP-1?
If indicated at baseline (FIB-4 indeterminate), repeat at 12 months on treatment. After that, annually while on long-term therapy and at risk. More frequent monitoring is rarely needed.
What is a normal liver stiffness score on elastography?
For MASLD, below 8 kPa is reassuring. 8–12 kPa is significant fibrosis warranting monitoring. Above 12 kPa is advanced fibrosis — specialist referral. Thresholds differ for hepatitis B and C.
Is elastography better than a FibroScan?
FibroScan is a brand of transient elastography. Guided 2D shear wave elastography (iLivTouch and similar) is a different technology that produces a kPa result in similar ranges. Both are valid; the choice depends on the clinic.
Will my elastography improve on Ozempic?
Most responders show 4–7 kPa reduction at 12 months on semaglutide. Whether you respond depends on baseline severity, weight loss achieved, and ongoing metabolic control. Repeat scanning at 12 months gives you a clear answer.
Find a GLP-1-friendly elastography clinic
Search participating clinics for a baseline or 12-month follow-up scan. Most appointments take 10–15 minutes and produce a report your GP can use the same week.
This page is educational and not medical advice. Always discuss your GLP-1 treatment and liver monitoring with your GP.