**7. Further research**

Although our results showed that RTE was inferior to Fibroscan in determining the early stage of liver fibrosis(Fig 2 and 3), Figure 4 indicated that the performance of RTE compares favorably with that of Fibroscan for detecting liver cirrhosis in patients with chronic hepati‐ tis. Unfortunately the best method for the analysis and quantification of RTE remains un‐ clear, but this may be determined by future multicenter studies using larger patient cohorts and the combination of these parameters will enable improvement of the accuracy of assess‐ ing hepatic fibrosis.

Fibroscan has been reported to have several limitations and disadvantages in evaluating pa‐ tients with obesity and ascites. In fact, in our study, we evaluated successfully all patients with RTE, while Fibroscan measurements could not be obtained for fourteen patients be‐ cause of obesity and liver atrophy (data not shown).

In the future, a combination of imaging modalities and serological parameters or of different imaging modalities will improve further the accuracy in differentiating fibrosis stages. Inter‐ estingly, Castera et al. reported that the best results were achieved by a combination of Fi‐ broscan and the Fibro Test [22]. Although ARFI, the most recent technology, Fibroscan, and MRE are all based on shear wave propagation, RTE is constructed by an original theory which is based on tissue distortion. The best diagnostic accuracy will be obtained by com‐ bining the RTE elasticity score with shear wave propagation.
