ROLE OF SHEAR WAVE ELASTOGRAPHY IN ASSESSING LIVER FIBROSIS IN PATIENTS WITH HEPATIC DISEASES AND ITS CORRELATION WITH SEROLOGICAL INDICES

Abstract

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. 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, noninvasive serological techniques and Aminotransferase Platelet Ratio Index (APRI), King’s Score, and FIB 4 scores have been spotlighted. In this study, we sought to examine the role of SWE in predicting different stages of liver fibrosis and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI), King’s score, and fibrosis-4 index (FIB-4) scores in patients with liver disease. Methodology: This cross-sectional study was conducted at R.L. Jalappa Hospital and Research Center, Kolar, for one year. A total of 91 Patients were included based on criteria such as alcoholic liver disease, non-alcoholic fatty liver disease, deranged liver function tests, and liver diseases due to infective/autoimmune/drug-induced factors. Exclusion criteria included pregnant patients, insufficient breath holding, moderate and gross ascites, and liver tumours. Ultrasound examinations were performed using Philips EPIQ5 and Philips Affinity 70 systems with shear wave point quantification (ELASTPQ). Patients were classified based on sonographic findings and shear wave elastographic evaluation. The study included liver function tests, serological values, and serological indices, which were calculated and xvii correlated with shear wave elastographic 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. Males are more frequently affected across all stages, while females constitute a smaller proportion. 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. xviii 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. Conclusion: The study found significant associations between liver disease type, stages, complications, 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