There were 4,112 studies primarily extracted, with 19 primary studies [7, 18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35] included in this review. Reasons and the number of studies excluded are shown in Fig. 1. The summary of each study and the bias of each study assessed by QUADAS-2 are shown in Table 1, Table S1 and Fig. S1 (SI.2), respectively. Three studies involved multiple hospitals [23, 31, 33]. The smallest number of patients in a study was 37 [35] and the largest was 251 [31]. Ten studies were from Asian countries [7, 19,20,21,22,23, 25, 27, 28, 31] and 7 studies were from European countries [18, 24, 26, 29, 30, 32, 35]. One was from the US [34] and Brazil [33]. All but 3 studies [28, 31, 34] conducted a prospective cohort study. In all studies [7, 18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35], the means or medians of age were middle ages. Most studies had a relatively even gender percentage [7, 19, 20, 23,24,25,26,27,28,29,30,31,32, 34, 35] but some included a higher percentage of men [18] or women [21, 22, 33]. The means or medians of BMI in all studies were above 25 [7, 18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35] and 7 studies were above 30 [20, 24, 30, 32,33,34,35]. Fig. S2 (SI.2) did not show trends between observed accuracy measures and characteristics, such as DM, cirrhosis, non-alcoholic steatohepatitis (NASH), LB needle gauge, LB methods (percutaneous or operation), and fasting before elastographic methods [36]. Seventeen studies conducted TE [7, 18,19,20,21, 24,25,26,27,28,29,30,31,32,33,34,35], 4 studies with pSWE [7, 20, 26, 29] and 2D-SWE [7, 23, 25, 30] and 2 studies with MRE [22, 35]. Ten studies only assessed the diagnostic accuracy of TE [18,