Increased stiffness has been directly associated to fibrosis. Stage 4 fibrosis defines cirrhosis. Can elastometry (transient elastography, acoustic radiation force impulse imaging) be used for a better identification of cirrhosis? The answer is obviously yes, provided hepatologists, radiologists, pathologists, and biologists combine their expertise because severe chronic liver disease is a complex subject. Considering the pathogenesis of cirrhosis, it is likely that factors such as parenchymal extinction (leading to atrophy of the liver mass with approximation of portal tracts and hepatic veins) and exudation (congestion) play a role in liver stiffness not mentioning heart failure, liver necrosis and extrahepatic cholestasis. Neglecting these factors, elastometry will lead too often to a wrong appreciation of the degree and type of liver damage and eventually to wrong medical decision.