Performance of shear wave elastography: A single centre pilot study of mixed etiology liver disease patients with normal BMI.

Abstract

To assess the performance of shear wave ultrasound elastography (SWE) for non-invasive grading of fibrosis in normal BMI patients with varied aetiology chronic liver disease. Prospective SWE liver and spleen stiffness (LS, SS respectively) of 124 patients (94 men, mean age 45.4±12.4years, mean BMI 19.66±1.49) with CLD of mixed aetiology, who underwent liver biopsy, between January 2019-20 was analysed using receiver operating curve (ROC) and classification analysis regression tree (CART) to determine fibrosis cut-off values and nominal logistical regression to quantify fibrosis. Of 124 patients, 50 (40%) had non-alcoholic steatohepatitis (NASH), 31 (25%) chronic hepatitis B (CHB) and 43 (35%) alcoholic liver disease (ALD) on biopsy. Overall mean LS and SS of the study population was 11.81±5.9 and 16.88±10.8kPa, respectively. LS cut-off value <8kPa was consistent with F0, 9-14kPa for F1-F2 and >14.9kPa for F3-F4 fibrosis on biopsy. On application of CART, LS value < 5.3kPa was discriminative for NASH, 5.32 to <12.64kPa for CHB, >12.64kPa for ALD, SS <15.3kPa was discriminative for NASH, 15.3-30kPa for CHB and >30kPa for ALD in our study population. SWE is a viable non-invasive tool for assessment of liver fibrosis grading in a population of mixed aetiology CLD. LS values in conjunction with SS are promising predictors of F2-F3 fibrosis with potential to discriminate select categories like CHB and NASH in such a population.