Related Experiment Video
Updated: Aug 5, 2026
Reliability of A Vibration-Based Elastography Protocol For Assessing Achilles Tendon Stiffness Across Multiple Joint Angles In Elite Athletes
Published on: June 16, 2026
EUS-Guided Shear Wave Elastography in a Real-World Cohort: Diagnostic Accuracy and the Impact of Measurement
Umang Arora1, Shivam Khare1, Shrihari Anikhindi1
1Department of Gastroenterology, Institute of Liver Gastroenterology and Pancreatic Sciences (ILGPS), Sir Ganga Ram Hospital, New Delhi, India.
Background:
Liver stiffness measurement (LSM) is a non-invasive surrogate for hepatic fibrosis that informs risk stratification and management. Vibration-controlled transient elastography (VCTE; FibroScan®) is well established. Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) offers the potential to assess LSM during routine EUS; however, its diagnostic performance remains uncertain.
Methods:
In this prospective, single-center diagnostic accuracy study, consecutive adults without biliary obstruction who were undergoing EUS additionally underwent LSM measurement from the right hepatic lobe using EUS-SWE (Olympus ME3) and same-day VCTE. VCTE thresholds defined advanced chronic liver disease (ACLD; > 15 kPa), cirrhosis (> 12 kPa), and advanced fibrosis (> 8 kPa). EUS-SWE performance was evaluated using correlation, Bland-Altman agreement, and area under the receiver-operating characteristic curve (AUROC).
Results:
Among 146 patients (median VCTE-LSM 6.05 kPa, range 3-53.3), 57, 41, and 31 had LSM ≥ 8, ≥ 12, and ≥ 15 kPa, respectively. EUS-SWE showed moderate correlation with VCTE (Spearman ρ = 0.65, p < 0.001) and reported higher values by 34.1% (95% limits of agreement:-64.8% to 133.1%) without proportional bias on Bland-Altman analysis. EUS-SWE showed excellent accuracy for screening relevant VCTE-LSM thresholds with AUROC (95% CI) 0.89 (0.81-0.97) for ACLD, 0.89 (0.82-0.96) for cirrhosis, and 0.85 (0.79-0.92) for advanced fibrosis. Optimal EUS-SWE threshold for VCTE-defined ACLD was 12.9 kPa (sensitivity 93%, specificity 77%), representing the optimal screening cutoff; a regression-derived threshold of 21.4 kPa (sensitivity 67%, specificity 93%) represents the mathematical equivalent EUS-SWE value to VCTE ≥ 15 kPa, appropriate for direct modality comparison. Accuracy for ACLD declined monotonously with increasing variability (IQR/LSM%): AUROC 0.97 (for < 30%), 0.86 (30-45%), 0.83 (45-60%), and 0.78 (≥ 60%).
Conclusion:
EUS-SWE yields LSM values approximately 34% higher than VCTE-LSM; the two modalities are not interchangeable and require modality-specific thresholds. EUS-SWE provides accurate prediction of VCTE-defined fibrosis thresholds, particularly when IQR/LSM% ≤ 45%, and represents a promising adjunct for opportunistic liver stiffness assessment during routine EUS.
