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Reliability of acoustic radiation force impulse shear wave elastography in the evaluation of liver stiffness in morbidly obese patients
Author(s) -
Chauhan Anil,
Shamchi Sara Pourhassan,
Dumon Kristoffel R.,
Williams Noel N.,
Sehgal Chandra M.
Publication year - 2020
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.22837
Subject(s) - medicine , acoustic radiation force , morbidly obese , interquartile range , elastography , nuclear medicine , prospective cohort study , body mass index , ultrasound , radiology , obesity , weight loss
Purpose To evaluate technical and patient‐related factors that can affect the reliability of acoustic radiation force impulse shear wave elastography (ARFI‐SWE) in morbidly obese patients. Methods A prospective single‐center study was performed on 41 patients (32 females, 78%) presenting for preoperative evaluation for bariatric surgery. ARFI‐SWE was performed using a 6 to 1.5 MHz curved (6C1) transducer. Hepatic steatosis was mild, moderate, severe, and absent in 24.4%, 12.2%, 43.9%, and 19.5% of patients, respectively. Interquartile range/median (IQR/M) ranged from 0.05 to 2.07 (0.78 ± 0.56 m/s). Twenty patients (48.7%) had reliable measurements (IQR/M < 0.3). Shear wave velocity (SWV) values were >1.34 m/s (clinically significant fibrosis) in 25 of 41 patients (61%) and >2.2 m/s (advanced fibrosis) in 19 patients (46%). Results Median SWV was correlated with body mass index (BMI; correlation coefficient [CC] = .37; 95% CI, 0.07‐0.61; P ‐value = .03) and skin‐to‐liver capsule distance (SLD) (CC = .38; 95% CI, 0.09‐0.62; P ‐value = .01). IQR/M was higher in patients with BMI > 40 (0.24 ± 0.11 vs 0.39 ± 0.25, P ‐value = .031) and SLD > 3 cm (0.46 ± 0.27 vs 0.23 ± 0.08, P ‐value = .001), and there was higher number of unreliable examinations among patient with SLD > 3 cm (16/23 vs 5/18, P ‐value = .01). Conclusion ARFI‐SWE is technically more challenging among patients with higher BMI and SLD, resulting in a higher number of unreliable studies, which highlights the need for further advancement of ARFI technology.