Focused Shear Wave Elastography to Assess Liver Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease

Liver fibrosis assessment using transient elastography (TE) or 2-dimensional shear wave elastography (2DSWE) exhibits high rates of failure and unreliability in patients with obesity. Novel focused shear wave elastography (fSWE) aims to enhance liver stiffness measurement (LSM) in patients with obesity and MASLD by using shear waves that converge toward the LSM region, rather than diverge as in TE and 2DSWE. The aim of the present study was to demonstrate the feasibility of LSM by fSWE, with comparison to TE and 2DSWE, in a pilot cohort of MASLD patients.

We prospectively enrolled 26 adult subjects at a single clinical site. For each subject, LSM was performed using fSWE, TE, and 2DSWE and baseline clinical characteristics were obtained in a single visit. Fibrosis stage was known in 19 subjects who had prior biopsy or LSM by magnetic resonance elastography.

LSM was obtained in 15 subjects by fSWE, 26 subjects by TE, and 23 subjects by 2DSWE. The correlation between TE and fSWE was 92% and between TE and 2DSWE was 67%. In the subset of subjects with body mass index >35 kg/m² (n = 12), LSM by fSWE was obtained in 7 subjects and had correlation of 87% with TE. The area under the receiver operating characteristic curve in detecting advanced fibrosis was 0.92 for fSWE, compared to 0.89 for TE and 0.74 for 2DSWE.

A novel elastography technique, fSWE, exhibited high concordance with TE and better diagnostic performance than 2DSWE. If confirmed in larger prospective studies, fSWE may represent a promising screening strategy for patients with coexisting MASLD and obesity.