Chronic liver disease is a leading cause of death and an increasingly prevalent global health issue affecting quality of life and productivity [1]. Nearly one-third of the world's population has at least one risk factor for chronic liver disease [2]. Irrespective of the underlying cause, chronic liver injury causes inflammation, hepatic necrosis, and fibrosis with resultant gradual and progressive disruption of liver architecture. This process is often subclinical and remains undiagnosed until it manifests as advanced cirrhosis with portal hypertension or the development of liver cancer [3]. Early diagnosis of asymptomatic fibrosis is therefore critical to reduce the mortality and morbidity associated with chronic liver disease.

Assessment of liver stiffness with elastography is increasingly being used to diagnose and stage liver fibrosis in clinical practice. Of the available techniques, MR elastography (MRE) has been shown to have the highest repeatability, reproducibility, and accuracy and the lowest technical failure rate. Establishing a successful MRE service in clinical practice is, however, a multistep process, including access to specialized hardware; a thorough knowledge of setup, configuration, and sequences; and standardized image interpretation and quality control to ensure MRE is performed with consistently high quality.

With this article, the authors provide a comprehensive update addressing numerous practical questions pertaining to MRE. The format makes this review a valuable reference guide on MRE for new adopters as well as current users of this technique. Furthermore, the authors provide unique insights into potential future applications of MRE, including combining MRE with other noninvasive biomarkers, the role of MRE in nonalcoholic steatohepatitis, and the use of 3D vector MRE to optimize clinical care in patients with chronic liver disease.