Background: Liver Stiffness (LS) assessed by Sonoelastography (SE), has been demonstrated
as reliable non-invasive indicator of liver fibrosis stage in patients with Chronic Liver Diseases
(CLD). Sonoelastography performs best in ruling-out cirrhosis (F=4) and ruling-in signifficant
fibrosis (F≥2). However, it is insufficiently accurate to replace endoscopy for detection of Esophageal
Varices (EV), being able to only ruling-out large EV. LS ≥ 25 kPa by Transient Elastography (TE)
is considered highly suggestive for the presence of Clinically Significant Portal Hypertension (CSPH).
Higher liver and spleen stiffness have been asociated with adverse clinical outcomes in CLD.
Two-dimensional shear wave elastography (2D-SWE), the latest developed SE method, allows both
visualisation and quantification of liver elasticity in real time superimposed over B-mode ultrasound
Discussion: Meta-analysis of studies with Supersonic Shear Imaging (SSI) revealed comparable
performance of this 2D-SWE to TE in fibrosis staging, with AUROCs 0.85 for F≥2 (LS cut-off 8.04
kPa) and 0.93 for F=4 (LS cut-off 11.12 kPa). Few studies reported very good performance of 2DSWE
(SSI) to rule-in CSPH (AUROCs 0.79-0.95; LS cut-offs 15-25 kPa). While conflicting data
exist with respect to its performance in predicting the presence of EV, prognostic utility of 2D-SWE
(SSI) was demonstrated in a single study that reported 3.4-fold (P=0.026) higher risk of adverse outcome
in patients with baseline LS≥21.5 kPa followed over 28 months.
Conclusion: 2D-SWE (SSI) might be used to stage liver fibrosis in CLD, identify patients with compensated
cirrhosis under risk of adverse outcomes and potentially stratify risk of having CSPH and EV.