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Shear wave elastography as a screening modality for liver fibrosis in a comprehensive sickle cell disease clinic
Marissa Solow1, Anas Samman2, Dawn Goodyear1,3
1Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada.
Insights
Shear wave elastography (SWE) identified significant liver fibrosis in 8% of sickle cell disease (SCD) patients. This noninvasive ultrasound method may help detect hepatic complications in SCD.
Area of Science:
- Hepatology
- Hematology
- Medical Imaging
Background:
- Sickle cell disease (SCD) patients face risks of liver fibrosis and cirrhosis due to chronic hemolysis, intrahepatic sickling, and iron overload.
- Current screening for liver fibrosis in SCD lacks standardization.
- Shear wave elastography (SWE), a noninvasive ultrasound technique, offers a potential solution for assessing liver stiffness and fibrosis.
Purpose of the Study:
- To determine the prevalence of liver fibrosis in adults with SCD using SWE.
- To explore clinical and laboratory factors associated with SWE-detected fibrosis in SCD patients.
Main Methods:
- A retrospective cohort study involving adults with SCD who underwent SWE between 2021 and 2025.
- Liver fibrosis was staged using METAVIR-equivalent scores (F0-F4), with ≥F2 considered clinically significant.
- Clinical, laboratory, and imaging data were collected within six months of the SWE procedure.
Main Results:
- Out of 219 eligible patients, 153 (70%) underwent SWE.
- Clinically significant fibrosis (≥F2) was detected in 8% (12 patients) of the cohort.
- Abnormal SWE findings correlated with elevated bilirubin, GGT, and ferritin levels.
Conclusions:
- SWE identified significant liver fibrosis in 8% of adults with SCD.
- This noninvasive ultrasound technique shows promise for detecting previously unrecognized hepatic involvement in SCD patients.
- The findings suggest SWE could be a valuable tool for routine screening and management of liver complications in SCD.
Background:
Sickle cell disease (SCD) is associated with hepatobiliary complications including liver fibrosis and cirrhosis, driven by chronic hemolysis, intrahepatic sickling, and transfusion-related iron overload. Standardized screening strategies for liver fibrosis in SCD are lacking. Shear wave elastography (SWE) is a noninvasive ultrasound-based technique that measures liver stiffness and may provide an accessible tool for fibrosis assessment. The objective is to determine the proportion of adults with SCD with liver fibrosis detected using SWE and to explore associated clinical and laboratory characteristics.
Research Design And Methods:
We conducted a retrospective cohort study of adults with SCD who underwent routine outpatient SWE between 2021 and 2025. Findings were categorized using METAVIR-equivalent stages (F0-F4), with ≥F2 defined as clinically significant fibrosis. Clinical, laboratory, and imaging data within six months were collected.
Results:
Of 219 eligible patients, 153 (70%) underwent SWE. Median age was 35.0 years and 59% were female. Most (92%) had no or mild fibrosis, while 12 (8%) had SWE-defined clinically significant fibrosis. Abnormal SWE was associated with higher bilirubin, gamma-glutamyl transferase, and ferritin. Hepatology consultation occurred in seven patients; three required iron chelation.
Conclusions:
SWE-defined fibrosis was identified in 8% of patients, and may provide a feasible noninvasive approach for identifying previously unrecognized hepatic involvement.
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