Shear-wave Elastography and Its Correlation with Gray-scale Sonographic Grades of Fatty Liver in Non-alcoholic Fatty Liver Disease Patients: An Observational Study
Shear-wave Elastography and Its Correlation with Gray-scale Sonographic Grades of Fatty Liver in NAFLD Patients
Keywords:
Fatty liver grading, liver stiffness, non-alcoholic fatty liver disease, shear-wave elastography, sonographygeneralAbstract
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Background: Non-alcoholic fatty liver disease (NAFLD) is now one of the most common causes of chronic liver disease worldwide. Early detection and accurate grading are essential to prevent progression to cirrhosis and hepatocellular carcinoma, highlighting the need for reliable, non-invasive diagnostic tools.
Objectives: The objectives are to assess the role of gray-scale sonographic grading and point shear-wave elastography (pSWE) in the evaluation of NAFLD, and to establish quantitative cutoff values for different grades of fatty liver by pSWE.
Materials and Methods: A cross-sectional observational study was conducted on 245 patients referred for ultrasonography at the department of radiodiagnosis, in a tertiary teaching hospital of north India. All patients underwent gray-scale sonography and pSWE using EsoateMyLab Eight eXP with a 1–8 MHz curvilinear transducer. Ten elastographic measurements were obtained from the right lobe of the liver and averaged. Fatty liver was graded sonographically into Grade 1, Grade 2, and Grade 3. Statistical analysis was performed using Statistical Package for the Social Sciences v21.
Results: On gray-scale sonography, 118 patients (48.2%) were classified as Grade 1, 101 (41.2%) as Grade 2, and 26 (10.6%) as Grade 3 fatty liver. Mean liver stiffness values on elastography increased progressively with severity: 4.5 ± 1.3 kilopascals (kPa) (Grade 1), 6.3 ± 1.5 kPa (Grade 2), and 8.9 ± 1.9 kPa (Grade 3). A cutoff value of 5.45 kPa for differentiating between Grade 2 and Grade 1 yielded 93.1% sensitivity and 98.3% specificity, while a cutoff value of 7.45 kPa for differentiating between Grade 3 and Grade 2 yielded 96.2% sensitivity and 94.1% specificity, respectively.
Conclusion: pSWE is a reliable, non-invasive, and quantitative imaging tool for diagnosing and grading NAFLD. Increasing liver stiffness values correlate strongly with higher sonographic grades. Larger, multicentric studies with histopathological confirmation are recommended to validate these cutoff values.
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