Prospective comparison of 2D-shearwave elastography in both liver lobes in healthy subjects and in patients with chronic liver disease

Abstract

Background/aims: 2D-shearwave elastography is an established method for liver stiffness measurement (LSM). However, the success rate of LSM using the recommended standard technique in the right lobe is limited by several factors. We aimed to compare LSM in the right and left liver lobe in order to evaluate whether LSM in the left lobe could be an alternative if measurements in the right lobe are not feasible.

Methods: A total of 116 subjects, 58 healthy volunteers and 58 patients with chronic liver disease (CLD), were prospectively included. LSM were performed in the right lobe and in the left lobe, both in neutral and in inspiration position.

Results: LSM in the left lobe (8.39(±4.83)kPa) was significantly (p < .001) higher than LSM in the right lobe (6.27(±2.45)kPa). LSM in inspiration position (8.60(±4.33) kPa) was significantly (p = .009) higher than LSM in neutral position (7.70(±3.01)kPa). LSM in the left lobe overestimated the grade of fibrosis in 50.0% of the patients with CLD. However, correlation between LSM values right and left was strong (r = 0.856) and additional use of LSM in the left lobe increased the success rate from 106/116 (91.4%) to 112/116 (96.6%; p = .098). High skin-to-liver-capsule-distance and presence of ascites were independent risk factors for non-successful LSM.

Conclusions: Despite significantly higher values, LSM in the left lobe may be an alternative if LSM in the right lobe is not feasible, and cirrhosis can be ruled out with high probability if LSM is within the normal range.

Keywords:

• 2D-shearwave elastography
• GE Logiq E9
• liver stiffness
• right liver lobe
• left liver lobe
• chronic liver disease

Ethics approval and consent to participate

This study was approved by the local institutional ethics committee (Ethics committee of the University Medical Center Goettingen, case 22/11/17). All subjects signed an informed consent form in accordance with the Declaration of Helsinki (2013).

Disclosure statement

GE Healthcare has financially supported CEUS workshops at the University Medical Center Goettingen. The study results described in this article were not influenced by such funding.

Author contributions

GP, SK and AN initiated the study. GP and BG collected the data for this study. GP and BG analyzed and interpreted the patient data. GP drafted the manuscript. AN, SK and VE were major contributors in writing the manuscript. SCBB, RFK and RGG substantively revised the manuscript. All authors read and approved the final manuscript.

Data availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.