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In a recent issue of the Medical Ultrasonography we have read with great interest the article by Bota et al [1]. We would like to thank the authors for their comprehensive contribution. However, we would like to report few concerns regarding this study from a methodological point of view. First, the measurements of ARFI were performed in the right liver lobe through the intercostal space [1]. Uslu et al demonstrated that subcostal approach to the liver parenchyma was significantly superior to intercostal approach for the evaluation of stiffness in their study [2]. It is also crucial to state that there is heterogeneity in the whole liver regarding the fibrotic distribution. Different fibrotic stages may be measured in different segments of liver either by liver biopsy or non-invasive methods. In this point of view, it would have been more relevant if the authors had assessed the liver fibrosis levels of the patients according to different liver segments and noted the distribution of the measurements of these segments. Second, in the present study, it was stated that all liver specimens obtained by liver biopsy were at least 2 cm long. However, it was demonstrated in most of the trials that a 25 mm long biopsy was considered an optimal specimen for accurate evaluation of liver fibrosis [3]. It would have been relevant, if the authors had mentioned these conditions as limitations. We think that ARFI elastography may be a useful method for diagnosing the liver cirrhosis. Further studies are needed to indicate the role of ARFI method in the management of liver fibrosis level and cirrhosis.

How useful is ARFI elastography for predicting the significant fibrosis and compensated liver cirrhosis?