ABSTRACT

Background:

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.

Methods:

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.

Results:

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.

Conclusion:

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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