Liver Stiffness Distribution in Pakistani Adults Assessed by Ultrasound Sheer Wave Elastography: A Cross-Sectional Study

Abstract

Objective: To determine the normative percentiles for Liver Stiffness Measurement (LSM) using Shear Wave Elastography in an adult Pakistani population.

Methodology: This cross-sectional study was conducted at PESSI Hospital, Islamabad, from January to December 2023. Individuals aged 20 years and older, comprising both self-referred individuals, referral by plastic surgeon as part of holistic wellness evaluations in patients presenting for body contouring or reconstructive procedures, where liver ultrasound was recommended as a precautionary measure, seeking wellness evaluations and those referred for liver assessments by other medical specialties were included. Liver stiffness measurements (LSM) were obtained using 2D shear wave elastography, with image quality assessed and ten acquisitions recorded per subject. Only measurements with an interquartile range to median (IQR/M) ratio ?30% were deemed reliable.

Results: Most liver assessments (87.69%) revealed a smooth surface. surface with small round bumps or lumps were observed in 5.00% and 4.61% of cases each, while micronodules were present in 4.61%. Irregular surfaces were absent in grade 1 livers but increased in prevalence with higher grades (1.00% in grade 2, 6% in grade 3, 26.24% in grade 4, and 22.68% in grade 5). Nodular surfaces were similarly absent in grades 1 and 2, but were found in 14% of grade 3 livers, 12.20% of grade 4 livers, and 25.46% of grade 5 livers. Micronodules were present in 1.00% of grade 1 and 2 livers and increased significantly in higher grades.

Conclusion: Real-time Shear Wave Elastography is a dependable method for assessing liver stiffness. In generally healthy adults, factors such as male sex, obesity, abnormal tummy shape and hepatic steatosis significantly influence liver stiffness levels.