The diagnosis of liver fibrosis and the assessment of its severity are important to provide appropriate management, to determine the prognosis or the need for surveillance. Currently, for fibrosis staging, liver stiffness measurement (LSM) with shear wave elastography (SWE) techniques is considered a reliable substitute for liver biopsy in several clinical scenarios.
In patients with diffuse liver disease, it is more clinically relevant to determine the likelihood of advanced disease rather than to obtain an exact stage of liver fibrosis using a histologic classification. In this regard, a ‘rule of four’ for LSMs with the acoustic radiation force impulse (ARFI)-based techniques have been proposed. In patients with advanced chronic liver disease (CLD), the risk of liver decompensation increases with increasing liver stiffness value. SWE has been proposed as a tool to predict the risk of death or complications in patients with CLD. However, SWE is very operator dependent and requires a detailed protocol.
This workshop demonstrates a reliable and reproducible liver SWE technique, as well as discussing pitfalls due to technologies, patient factors and technique limitations.