Rachita Khot MD, Abstract Co-Author: Nothing to Disclose

Thomas Jose Eluvathingal Muttikkal MD, FRCR, Presenter: Nothing to Disclose

Gia Ann Deangelis MD, Abstract Co-Author: Nothing to Disclose

Stephen Caldwell MD, Abstract Co-Author: Research support, Gilead Sciences, Inc Research support, GENFIT SA Consultant, Vital Therapies, Inc Consultant, Wellstat Diagnostics, LLC Intellectual property, Kimberly-Clark Corporation

Shear Wave Elastography (SWE) has emerged as a non-invasive technique to grade early fibrosis in patients with chronic viral hepatitis and non-alcoholic liver diseases. Recent studies showed good correlation between grading of fibrosis by SWE and histopathology in chronic liver disease. Liver transplant patients have not been studied. The purpose of our study was to evaluate the feasibility of SWE as a screening test in diagnosing clinically significant fibrosis (F2-F4) in patients with liver transplant. 

This study was HIPAA compliant and IRB approved. Shear wave ultrasound was performed in 25 recipients of whole liver transplant (age range 42-67 years; M/F 17/8) on the day of liver biopsy. 12 measurements were obtained from the same segment of the right lobe from which biopsy was planned. Highest and lowest measurements were discarded for calculation of the average liver stiffness. The average liver stiffness was expressed in m/sec. Metavir scoring system was used to grade the fibrosis. The stage of fibrosis derived from the velocity measurements were compared with the histopathological staging of fibrosis.

Eight of 25 biopsies had F2 fibrosis by histopathology (7 were classified as F2 fibrosis and 1 case was classified as F0-F1 by SWE). 1 case of F4 fibrosis by histopathology was classified as F3 by SWE. The remaining 16 cases showed no significant fibrosis (F0, F1) by histopathology (14 cases were classified as without significant fibrosis and 2 were classified as F2 by SWE). The sensitivity for identifying clinically significant fibrosis was 88.9% with NPV of 93.3%. The specificity was 87.5% and PPV was 80%. 

Results from this pilot study shows that SWE can be used to diagnose early stage fibrosis and replace liver biopsy

SWE can be used as non-invasive technique to assess early fibrosis in transplant patients, thereby reducing the morbidity associated with routine protocol biopsy.

Khot, R, Eluvathingal Muttikkal, T, Deangelis, G, Caldwell, S, Evaluation of Liver Fibrosis in Liver Transplant by Shear Wave Elastography - A Pilot Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015657.html