Office Based Shear Wave Elastography. Much More Than Just a Fibrosis Score

Abstract

Introduction: Shear-wave Elastography (SWE) utilizing the SuperSonic Imagine system not only obtains a liver stiffness (fibrosis) score but also, because it is a dedicated US machine obtains 2D/3D, power flow and color doppler images. The uncovering of additonal information beyond just severity of fibrosis in pts seen in everyday clinical practice may have advantages over just obtaining a fibrosis score alone. Methods: Consecutive pts seen in our office over a 15 month period in whom a Supersonic Imagine US with a XC6-L probe was undertaken were stratified into two groups; new pts and fu pts. All pts were entered into a database that prospectively recorded demographic and clinical data. In addition to performing SWE, all ptis had a limited RUQ US along with Doppler interrogation of the portal and hepatic veins. US findings were recorded and only previously unknown/unsuspected pertinent findings were noted. Results: 401 pts are included in the analysis, 205 new and 196 fu. Of the 205 new pt visits, 46 were for chronic hepatitis C tx eval, 3 for chronic hepatitis B, 49 for abnormal LFTs, 41 for abnormal outside imaging of liver, 25 for RUQ/epigastric pain, 23 for NASH screening and 18 for other assorted issues. US imaging findings deemed new/clinically pertinent were seen in 47 pts (23%) and included: gallstone(s) 17, hemangioma 6, right renal abscess 1, liver mass(es) 4, ascites 11, large GB polyp 2, large liver cysts 3, right pleural effusion 3, chronic pancreatitis 1, CBD stone 1, CBD dilation 1, and partial PVT 1. Of the 196 f/u pt visits, 73 were for Cirrhosis surv, 19 NASH, 18 Epi/RUQ pain, 15 abnl LFTs, 24 post Hep C cure, 16 abnormal liver imaging, AutoImmune Hepatitis 11, PBC 4, PSC 2, and other 14, 35 pts (18%) in this group had significant new US findings which included: gallstones (11), liver mass(es) 8, partial PVT 3, ascites 4, PV flow < 15 cm/s 2, new small < 1 cm liver hypoechoic solid nodules 3, dilated CBD 3, CBD stones 1, large GB polyp 1, 3 cm pancreatic cystic lesion 1, and a right pleural effusion 1, Conclusion: Use of Supersonic Imagine US can obtain not only a liver fibrosis score but has the added beneift of uncovering clincially significant hepatobiliary/pancreatic lesions. In our rural outpt clinical practice, 23% of new.pt visits and 18% of pts undergoiing fu of a variety of liver/GI related problems are found to have signifcant findings. Incoporation of in-office US imaging along with elastography appears to have a significant clinical benefit to patient care.