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Liver stiffness measurement (LSM) based on transient elastography (TE, FibroScan) is gaining in popularity for noninvasive assessment of liver fibrosis. However, LSM has limitations, which have not yet been thoroughly evaluated. We prospectively investigated the frequency and determinants of LSM failure and unreliable results over a 5-year period, based on 13,369 examinations (134,239 shots). LSM failure was defined as zero valid shots, and unreliable examinations were defined as fewer than 10 valid shots, an interquartile range (IQR)/LSM greater than 30%, or a success rate less than 60%. LSM failure occurred in 3. recently reported to define normality. 3 Liver stiffness measured by means of TE correlates with hepatic fibrosis stages, both in chronic hepatitis C 4,5 and in other chronic liver diseases. [6][7][8][9][10][11][12][13][14] The diagnostic accuracy of liver stiffness measurement (LSM) is excellent for cirrhosis, 15-17 and, among noninvasive methods, TE appears to be the most accurate for early detection of cirrhosis. 18 Because TE is a user-friendly technique that can be performed rapidly (less than 5 minutes) at the bedside, with immediate results and high patient acceptance, it is likely to become an important tool in clinical practice in the near future. [19][20][21][22] However, TE has limitations: LSM results may be influenced by acute liver injury (as reflected by ALT flares), with a risk of overestimating liver stiffness, 6,23,24 and also by extrahepatic cholestasis. 25 In addition, LSM is difficult in patients who are obese or who have narrow intercostal spaces, and impossible in patients with ascites (in whom the diagnosis of cirrhosis is obvious). The TE interpreta-

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