ROLE OF SHEAR WAVE ELASTOGRAPHY IN ASSESSING LIVER FIBROSIS IN PATIENTS WITH HEPATIC DISEASES AND ITS CORRELATION WITH SEROLOGICAL INDICES.
Authors: Yogendra M Guru , Sakalecha Anil Kumar 
Published: December 2024

Introduction: Liver fibrosis is a progressive disorder that, if diagnosed early and staged precisely, allows early clinical intervention that may
hinder or slow down the progression to end-stage decompensated cirrhosis. Grading of hepatic fibrosis is essential not only for diagnosis but also
for prognostic evaluation, planning appropriate therapy, and follow-up of patients with chronic hepatitis. Liver biopsy has been considered the gold
standard for grading liver fibrosis. As liver biopsy is invasive and associated with complications, non-invasive serological techniques and
Aminotransferase Platelet Ratio Index (APRI), King's Score, and FIB 4 scores have been spotlighted. Aim: To evaluate patients with liver diseases
using ultrasonography. To perform shear wave elastography and derive cut-off for patients with liver diseases. To correlate ultrasound and shear
wave elastography findings with serological indices in patients with liver disease. Shear wave elast Methods: ography (SWE) was used to assess
the liver stiffness. 2D ultrasound was performed to correlate with the findings of the SWE. Serological values were obtained, and serological
indices were calculated and correlated with the SWE findings. Results: The study reveals that the younger group (< 45 years) has a higher
proportion of liver fibrosis stages, while the older group (> 45 years) has a lower proportion in each stage. Advanced liver fibrosis (ALD) is most
prevalent in advanced stages (92.9% in F4), indicating a severe progression. Hepatitis B and C peak at F3 and drop drastically in F4, while NAFLD
is more common in the early stages (50.0% in F0-F1). Type of liver disease is statistically significantly associated with stages. Patients without
complications were predominant in the early stages but decreased substantially in F4. Patients with complications show a substantial increase in
advanced fibrosis stages, comprising 78.6% of F4 cases. Hematemesis is the most common complication, especially in advanced stages (30.0% in
F3, 39.3% in F4). Increased echogenicity is more common in advanced stages, rising from 65.0% in F0-F1 to 96.4% in F4. Significant changes in
liver size and stiffness with advancing fibrosis are less pronounced. All APRI, FIB 4 and King's scores demonstrate strong correlations with fibrosis
progression, making them valuable for assessing liver fibrosis severity and monitoring disease advancement. The SWE test has high AUC values,
indicating strong discriminatory power when comparing stages (F0-F1) against F2, F3, and F4. It also demonstrates high accuracy in
differentiating between minimal or no fibrosis (F0-F1) and advanced fibrosis (F3), with a sensitivity of 95% and a specificity of 90% at a cut-off
value of ≥ 6.60. It also exhibits outstanding discriminatory ability in distinguishing between minimal or no fibrosis (F0-F1) and severe
fibrosis/cirrhosis (F4), with a sensitivity of 96.4% and a specificity of 91.4% at a cut-off value of ≥7.50. SWE also shows good discriminatory
performance in differentiating between moderate (F2) and advanced fibrosis (F3), with a sensitivity of 95% and a specificity of 77.6% at a cut-off
value of ≥ 8.0. It also shows excellent accuracy in distinguishing between moderate fibrosis (F2) and severe fibrosis/cirrhosis (F4), with a
sensitivity of 92.9% and a specificity of 79.8% at a cut-off value of ≥ 9.0. However, the diagnostic accuracy decreases when distinguishing between
adjacent stages, such as F2 vs. F3 and F3 vs. F4, as indicated by lower AUC values and slightly lower sensitivity and specificity values. The test also
has strong positive correlations with APRI and KING, suggesting that as liver size increases, all APRI, FIB 4, and King's scores tend to increase
significantly. The study found significant associations between liver disease type, stages, complicat Conclusion: ions, echogenicity, liver texture,
liver size, stiffness, portal vein diameter, and spleen size. It also found strong correlations between liver elastography and size, APRI, King's and
FIB 4 scores, and SWE, making them valuable tools for assessing liver fibrosis severity and monitoring disease advancement.