Ultrasound elastography (USE) is an imaging technique that assesses tissue stiffness, offering non-invasive evaluation of mechanical properties of tissues. It has been developed to provide qualitative and quantitative information for diagnostic purposes, particularly in assessing liver fibrosis, breast, thyroid, prostate, kidney, and lymph node imaging. USE utilizes different excitation methods, including strain imaging and shear wave imaging, to measure tissue stiffness. Strain imaging applies mechanical compression to measure tissue deformation, while shear wave imaging uses ultrasound-generated shear waves to assess tissue stiffness. The latter method is more widely used due to its ability to provide quantitative data. USE has shown promising results in liver fibrosis assessment, with techniques like 1D-TE, pSWE, and 2D-SWE being used to evaluate fibrosis stages. These methods have demonstrated high accuracy in differentiating between fibrosis stages, although challenges remain in distinguishing between individual stages. The use of USE in liver fibrosis staging is supported by studies showing high AUROCs for differentiating fibrosis stages. However, factors such as liver steatosis, obesity, and physiological variations can affect the accuracy of USE measurements. In breast imaging, USE provides complementary information to conventional ultrasound and mammography, improving the non-invasive characterization of breast lesions. Studies have shown that USE has higher specificity and sensitivity compared to B-mode US and mammography. The incorporation of qualitative USE elasticity measurements into the BI-RADS US lexicon highlights its growing role in breast cancer diagnosis. Despite its potential, USE faces technical limitations, including variability in results due to operator-dependent techniques, differences in commercial systems, and physiological factors affecting measurements. Efforts are ongoing to standardize USE techniques and improve their accuracy through research and clinical validation. Overall, USE is a promising tool in various clinical applications, offering non-invasive assessment of tissue stiffness with ongoing developments to enhance its diagnostic capabilities.Ultrasound elastography (USE) is an imaging technique that assesses tissue stiffness, offering non-invasive evaluation of mechanical properties of tissues. It has been developed to provide qualitative and quantitative information for diagnostic purposes, particularly in assessing liver fibrosis, breast, thyroid, prostate, kidney, and lymph node imaging. USE utilizes different excitation methods, including strain imaging and shear wave imaging, to measure tissue stiffness. Strain imaging applies mechanical compression to measure tissue deformation, while shear wave imaging uses ultrasound-generated shear waves to assess tissue stiffness. The latter method is more widely used due to its ability to provide quantitative data. USE has shown promising results in liver fibrosis assessment, with techniques like 1D-TE, pSWE, and 2D-SWE being used to evaluate fibrosis stages. These methods have demonstrated high accuracy in differentiating between fibrosis stages, although challenges remain in distinguishing between individual stages. The use of USE in liver fibrosis staging is supported by studies showing high AUROCs for differentiating fibrosis stages. However, factors such as liver steatosis, obesity, and physiological variations can affect the accuracy of USE measurements. In breast imaging, USE provides complementary information to conventional ultrasound and mammography, improving the non-invasive characterization of breast lesions. Studies have shown that USE has higher specificity and sensitivity compared to B-mode US and mammography. The incorporation of qualitative USE elasticity measurements into the BI-RADS US lexicon highlights its growing role in breast cancer diagnosis. Despite its potential, USE faces technical limitations, including variability in results due to operator-dependent techniques, differences in commercial systems, and physiological factors affecting measurements. Efforts are ongoing to standardize USE techniques and improve their accuracy through research and clinical validation. Overall, USE is a promising tool in various clinical applications, offering non-invasive assessment of tissue stiffness with ongoing developments to enhance its diagnostic capabilities.