Measurement of Liver Stiffness with 2D-Shear Wave Elastography (2D-SWE) in Bariatric Surgery Candidates Reveals Acceptable Diagnostic Yield Compared to Liver Biopsy

Background: Obesity is a primary limiting factor in liver stiffness measurement (LSM). The impact of obesity has always been evaluated in terms of body mass index (BMI), without studying the effects of skin-to-liver distance (SLD) on LSM. We studied the impact of SLD on LSM in a cohort of obese patients undergoing bariatric surgery and intra-operatory liver biopsy. Materials and Methods: 299 patients underwent LSM by point-shear wave elastography (ElastPQ protocol), with two different ultrasound machines. SLD was measured as the distance between the skin and the liver capsule, perpendicular to where the region of interest (ROI) was positioned. We used the following arbitrary cut-offs: <5.7 kPa, F0–1; 5.7–7.99 kPa, F2; ≥8 kPa, F3–4. Results: We developed two logistic regression models using elastography–histology agreement (EHA) as the dependent variable and SLD as the independent variable. The model based on the second machine showed strongly more performant discriminative and calibration metrics (AIC 38.5, BIC 44.2, Nagelkerke Pseudo-R2 0.894, AUROC 0.90). The SLD cut-off value of 34.5 mm allowed a correct EHA with a sensitivity of 100%, a specificity of 93%, negative predictive value of 100%, positive predictive value of 87%, an accuracy of 96%, and positive likelihood ratio of 3.56. Conclusion: The impact of SLD is machine-dependent and should be taken into consideration when interpreting LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in obese patients.

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P1322 REAL-TIME SHEAR-WAVE ELASTOGRAPHY (SWE, AIXPLORER™) PERFORMANCES IN CHRONIC HEPATITIS C (CHC) PATIENTS COMPARED TO LIVER STIFFNESS MEASUREMENT (LSM, FIBROSCAN™) AND FIBROTEST™ WITH LIVER BIOPSY (LB) AS REFERENCE

Journal of Hepatology ◽

10.1016/s0168-8278(14)61489-6 ◽

2014 ◽

Vol 60 (1) ◽

pp. S536 ◽

Cited By ~ 1

Author(s):

M. Galushko ◽

I. Bakulin ◽

M. Munteanu ◽

V. Kushnir

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Biopsy ◽

Real Time ◽

Shear Wave ◽

Chronic Hepatitis C ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Liver Stiffness Measurement ◽

Stiffness Measurement

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NON INVASIVE ASSESSMENT OF LIVER FIBROSIS USING ULTRASOUND POINT SHEAR WAVE ELASTOGRAPHY

10.36106/ijar/3402119 ◽

2021 ◽

pp. 1-3

Author(s):

Sunil Patel ◽

Chinmay Kulkarni ◽

Srikanth Moorthy

Keyword(s):

Liver Fibrosis ◽

Liver Biopsy ◽

Shear Wave ◽

Hepatic Fibrosis ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Ultrasound Elastography ◽

Non Invasive ◽

Elevated Liver Enzymes ◽

Clinically Significant

Aim To prospectively determine the sensitivity, specificity and accuracy of point shear wave elastography as a non-invasive method in the diagnosis of clinically significant hepatic fibrosis with various etiologies of liver using liver biopsy as gold standard.To determine the stiffness cut-off values for point shear wave elastography (pSWE) diagnosis of clinically significant hepatic fibrosis. Methods Fifty patients with elevated liver enzymes were examined by point shear wave Elastography and they subsequently underwent percutaneous liver biopsy. Ultrasound Elastography findings were correlated with the histopathology fibrosis staging (METAVIR / Brunt Scoring) Results Liver stiffness value of >7.6 kPa was cut-off for clinically significant fibrosis and had a sensitivity of 92%, a specificity of 78.3% and an accuracy of 86%. Conclusions ElastPQ is a non-invasive and sensitive technique for determining the clinically significant liver fibrosis in patients with various etiologies.

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Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1283-5906 ◽

2020 ◽

Author(s):

Anders Batman Mjelle ◽

Anesa Mulabecirovic ◽

Roald Flesland Havre ◽

Edda Jonina Olafsdottir ◽

Odd Helge Gilja ◽

...

Keyword(s):

Shear Wave ◽

Transient Elastography ◽

Intraclass Correlation ◽

Age Groups ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Healthy Children ◽

Significant Difference ◽

Pediatric Liver Disease ◽

Liver Elastography

Abstract Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

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Noninvasive Assessment of Liver Diseases using 2D Shear Wave Elastography

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.254.lup ◽

2016 ◽

Vol 25 (4) ◽

pp. 525-532 ◽

Cited By ~ 8

Author(s):

Monica Lupșor-Platon ◽

Radu Badea ◽

Mirela Gersak ◽

Anca Maniu ◽

Ioana Rusu ◽

...

Keyword(s):

Shear Wave ◽

Predictive Value ◽

Liver Diseases ◽

Venous Pressure ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Acoustic Radiation Force Impulse ◽

Two Dimensional ◽

Non Invasive ◽

Examination Technique

There has been great interest in the development of non-invasive techniques for the diagnosis of liver fibrosis in chronic liver diseases, including ultrasound elastographic methods. Some of these methods have already been adequately studied for the non-invasive assessment of diffuse liver diseases. Others, however, such as two-dimensional Shear Wave Elastography (SWE), of more recent appearance, have yet to be validated and some aspects are for the moment incompletely elucidated. This review discusses some of the aspects related to two-dimensional SWE: the examination technique, the examination performance indicators, intra and interobserver agreement and clinical applications. Recommendations for a high-quality examination technique are formulated. Key words: – – – Two-dimensional Shear Wave Elastography. Abbreviations: 2D- SWE: Two-dimensional Shear Wave Elastography; 3D- SWE: Three-dimensional Shear Wave Elastography; AUROC: area under the receiver operating characteristic curves; ARFI Acoustic Radiation Force Impulse Elastography; EFSUMB: European Federation of Societies for Ultrasound in Medicine and Biology; HVPG: hepatic venous pressure gradient; LS: liver stiffness; LR: likelihood ratio; NPV: negative predictive value; PPV: positive predictive value; ROI: region of interest; RT-E: Real Time-Elastography; Se: sensitivity; Sp: specificity; TE: Transient Elastography; US: ultrasound; VM: valid measurement; E: Young’s modulus

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