Primary sclerosing cholangitis (PSC) is a chronic liver disease characterized by heterogeneous distribution of increased stiffness in periphery, segmental or lobar pattern. The heterogeneity of liver stiffness has raised concerns for reproducibility of liver stiffness measurement (LSM). We performed interobserver agreement analysis for LSM with two readers drawing manual regions of interest (ROI) and with an automated algorithm. Our study results show that large geographical ROIs including the focal regions of increased liver stiffnesses have excellent agreement between readers and automated method. Therefore large geographical ROIs using either manual or automated methods should be used for LSM in PSC patients.