Application and Diagnostic Performance of Two-Dimensional Shear Wave Elastography and Liver Fibrosis Scores in Adults with Class 3 Obesity

• Published in: Nutrients Vol. 16; no. 1; p. 74
• Main Authors: Chimoriya, Ritesh, Ho, Vincent, Wang, Ziqi Vincent, Chang, Ruby, Boumelhem, Badwi B, Simmons, David, Kormas, Nic, Gorrell, Mark D, Piya, Milan K
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 25.12.2023; MDPI
• Subjects: Adults; Biomarkers; Biopsy; Body mass index; Chronic illnesses; Diabetes; Diagnosis; Electronic health records; Ethylenediaminetetraacetic acid; Fibroblasts; Fibrosis; Gastrointestinal surgery; Liver; Liver cirrhosis; Liver diseases; liver fibrosis; Medical records; metabolic dysfunction-associated fatty liver disease; metabolic dysfunction-associated steatotic liver disease; Metabolism; non-alcoholic fatty liver disease; Obesity; Proteins; two-dimensional (2D) shear wave elastography; Type 2 diabetes; Ultrasonic imaging; Weight control; Australia; liver fibrosis; metabolic dysfunction-associated fatty liver disease; non-alcoholic fatty liver disease; APRI; NAFLD fibrosis score; FIB-4; two-dimensional (2D) shear wave elastography; fibroblast activation protein; metabolic dysfunction-associated steatotic liver disease; obesity
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu16010074

There are no ideal non-invasive tests for assessing the severity of liver fibrosis in people with metabolic dysfunction-associated steatotic liver disease (MASLD) and class 3 obesity, where body habitus often makes imaging technically challenging. This study aimed to assess the applicability and diagnostic performance of two-dimensional shear wave elastography (2D-SWE), alongside several serum-based liver fibrosis scoring methods, in individuals with class 3 obesity. A cross-sectional study was conducted in patients aged ≥18 years and with a body mass index (BMI) ≥ 40 kg/m who were participants in a publicly funded multidisciplinary weight management program in South Western Sydney. The 2D-SWE was performed using the ElastQ Imaging (EQI) procedure with the Phillips EPIQ Elite series ultrasound. An EQI Median value of ≥6.43 kPa was taken as a cutoff score for significant fibrosis, and the scan was considered valid when the liver EQI IQR/Med value was <30%. The Fibrosis-4 (FIB-4) index, AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and circulating fibroblast activation protein index (FAP index) were calculated from fasting blood samples. The participants ( = 116; 67.2% female) were aged 47.2 ± 12.9 years, with BMI 54.5 ± 11.0 kg/m . EQI Median values were obtained for 97.4% (113/116) of the 2D-SWE scans, and 91.4% (106/116) of the scans were considered valid. The EQI Median values exhibited a moderately positive correlation with the FIB-4 index ( = 0.438; < 0.001) and a weakly positive correlation with the APRI = 0.388; < 0.001), NFS ( = 0.210; = 0.036) and FAP index ( = 0.226; = 0.020). All liver fibrosis scores were positively correlated with one another. Among those referred for a liver biopsy based on the 2D-SWE and serum scores, half (11/22) underwent liver biopsy, and their 2D-SWE scores exhibited 72.7% accuracy (sensitivity: 71.4%; specificity: 75%) in detecting significant fibrosis. Our results show that 2D-SWE is a feasible, non-invasive test to assess liver fibrosis among people with class 3 obesity. Further research is needed to assess how 2D-SWE can be used alongside existing serum-based risk scores to reliably detect significant fibrosis, which would potentially reduce the need for invasive liver biopsy.