Ultrasound-guided Shear-Wave Elastography for Liver Fibrosis Staging: A Reliable Technique

This study evaluates the validity and reliability of point-shear wave elastography (pSWE) with ultrasound systems for liver fibrosis staging. pSWE is increasingly considered an alternative to transient elastography, but its use is still limited in clinical practice, largely due to concerns about its accuracy and reliability. To address this, a phantom study was conducted using three ultrasound systems, which assessed pSWE measurements at varying depths (2, 3, and 4 cm) on a phantom with known elasticity values (7 ± 1, 14 ± 2, and 26 ± 3 kPa). The purpose was to determine the validity of pSWE when the measurements were within the uncertainty limits of reference elasticity values and its reliability when the interquartile range (IQR) to median ratio was less than 0.30. The results revealed that pSWE produced valid results for all reference elasticities and depths, except for an overestimation of high reference elasticity at 2 and 4 cm depths for one system. The system measured 41.5 ± 4.3 kPa at 2 cm and 39.0 ± 1.2 kPa at 4 cm for the high reference value (26 ± 3 kPa). Overall, the measurements were reliable, with the IQR/median ratio not exceeding 0.13, far below the guideline threshold of 0.30. These findings support the use of pSWE as a valid and reliable alternative for liver fibrosis staging. The ability to perform both imaging and elastography simultaneously using ultrasound systems from different vendors could enhance clinical workflows, reducing the need for invasive procedures and improving patient outcomes. Thus, pSWE shows promise as an effective tool for non-invasive liver fibrosis assessment, with significant potential for clinical application.