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Quantitative Liver Function

Shear Wave Elasticity (SWE) Unreliable in Detection of Cirrhosis

John Hoefs, M.D
Depts of Medicine, Divs of GI & Hepatology, University of California Irvine, Irvine, California
Hepatology, Liver Specialty Center, Irvine, CA, United States
AASLD The Liver Meeting, 2018.



Shear Wave Elasticity (SWE) by ultrasound (US) is thought to be similar to Fibroscan in the ability to detect cirrhosis and predict Metavir Fibrosis (F0-F4) where F4 is cirrhosis (Rad 276:845). Neither method of estimating cirrhosis measures the functional mass of the liver or quantitative liver function. SWE has recently become a routine measurement during HCC surveillance. We assess the ability of SWE to detect cirrhosis. HYPOTHESIS: SWE correlates with the presence of cirrhosis.


Our initial 193 patients with SWE at US were reviewed for comparison with other clinical factors. Noncirrhotic patients (NC) included 147 with underlying pre-cirrhotic CLD (HBV, HCV, PBC, PSC, ACAH and miscellaneous), non-cirrhotic portal hypertension and acute liver disease with jaundice. Cirrhotic patients (C) included those never having clinical complications (such as ascites, VB and encephalopathy) (C1=16 patients); those with complications in past, but resolved (C2=17); active complications requiring treatment (C3=10) and those on the liver transplant list (C4=3).
All patients had a fasting US (GE LOGIQ E9) with SWE per manufactures instructions: shear wave velocity (SWV) and estimated METAVIR fibrosis score (eMFS: 0-4) were recorded. Surface nodularity, spleen length (SL) (cm) and ascites were recorded. Clinical data was abstracted from the records.


SWE was attempted in 193, but unable in 6 (3%) (NC 3, C 3). The other 187 were included in this analysis. 144 NC were compared with 43 C: nodularity: NC 2/144: C1 8/15; C2 14/15; C3 8/10 and C4 2/3. SL>12 CM: NC 10/144; C1 9/15; C2 6/15; C3 9/10; C4 3/3). Ascites: NC 2/144, C1 0/15; C2 2/15; C3 6/10; C4 3/3. SWV> 1.8: NC 10/144; C1 6/15; C2 7/15; C3 6/10; C4 0/3. eMFS > 2:NC 12/144; C1 8/15; C2 8/15; C3 7/10; C4 0/3. 76.7 % patients with C were < F4. Of the 10 NC with > F2, 3 had severe acute liver disease with jaundice and 2 had fatty liver. The percent of patients with C in each eMFS score was calculated and a good correlation was found with eMFS and % with Cirrhosis (r2=.978) (figure). However, all 3 patients on the liver transplant list (C4) had ascites and had an eMFS <3.


1. eMFS by SWE was unreliable in detecting C with eMFS (range from 0-4),

2. eMFS F4 had a high percent with cirrhosis, but most C had < F4,

3. NC Could have a high eMFS usually associated with severe acute disease.

4. A nodular liver surface correlated with the presence of cirrhosis.

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