Non-alcoholic fatty liver disease- correlation between shear wave elastography and nafld fibrosis score: a descriptive single centre study

Afra John, Robert P. Ambooken, Anil A.


Background: Due to the global burden of obesity and type 2 diabetes, prevalence of NAFLD is now increasing, becoming one of the most common cause of chronic liver disease and liver transplantation both for end-stage liver disease and hepatocellular carcinoma. Although traditionally liver biopsy is gold standard for diagnosis of NAFLD, majority of patients can be non-invasively diagnosed with various tools like scoring systems (NAFLD fibrosis score, BARD score), ultrasound and MR elastographic techniques. The primary objective of this study was to assess the liver stiffness measurement by shear wave elastography and assess correlation between LSM by SWE and NAFLD fibrosis score in NAFLD patients.

Methods: This is a descriptive study comprising 75 patients with clinical suspicion of NAFLD, referred from Gastroenterology department from January 2020 to June 2021. All patients had undergone SWE, NAFLD fibrosis score calculated and results analyzed.

Results: Among the 75 patients studied, applying low cut off value of NAFLD fibrosis score (below -1.455), the presence of advanced fibrosis was excluded and by applying the high cut off point (>0.676) majority of subjects had advanced fibrosis. The NAFLD fibrosis score was correlated with E median values of liver stiffness measurement using Pearson correlation test and showed a moderate positive correlation (p=0.0001, =0.685) between both the variables.

Conclusions: Our study showed positive moderate correlation between NAFLD fibrosis score and LSM by 2D SWE. Multistep strategies using liver 2D SWE and NAFLD fibrosis score in combination can be used in the future to accurately diagnose or exclude the presence of advanced fibrosis in NAFLD patients.


Non-alcoholic fatty liver disease, Shear wave elastography, NAFLD fibrosis score

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Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early Detection of Nonalcoholic Steatohepatitis in Patients with Nonalcoholic Fatty Liver Disease by Using MR Elastography. Radiology. 2011;259(3):749-56.

Kim D, Kim WR, Talwalkar JA, Kim HJ, Ehman RL. Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: Noninvasive Assessment with MR Elastography. Radiology.2013;268(2):411-9.

Armstrong MJ, Adams LA, Canbay A, Syn WK. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59(3):1174-97.

Leong WL, Lai LL, Nik Mustapha NR, Vijayananthan A, Rahmat K, Mahadeva S et al. Comparing point shear wave elastography (ElastPQ) and transient elastography for diagnosis of fibrosis stage in non‐alcoholic fatty liver disease. Journal of gastroenterology and hepatology. 2020;35(1):135-41.

Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846-54.

Khov N, Sharma A, Riley TR. Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease. World journal of gastroenterology: WJG. 2014;20(22):6821.

Naganuma H, Ishida H, Uno A, Nagai H, Kuroda H, Ogawa M. Diagnostic problems in two-dimensional shear wave elastography of the liver. World journal of radiology. 2020;12(5):76.

Zheng J, Guo H, Zeng J, Huang Z, Zheng B, Ren J et al. Two-dimensional shear-wave elastography and conventional US: the optimal evaluation of liver fibrosis and cirrhosis. Radiology. 2015;275(1):290-300.

Ekstedt M, Hagström H, Nasr P, Fredrikson M, Stål P, Kechagias S et al. Fibrosis stage is the strongest predictor for disease‐specific mortality in NAFLD after up to 33 years of follow‐up. Hepatology. 2015;61(5):1547-54.

Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30(6):1356-62

Hossain N, Afendy A, Stepanova M, Nader F, Srishord M, Rafiq N et al. Independent predictors of fibrosis in patients with nonalcoholic fatty liver disease. Clinical Gastroenterology and Hepatology. 2009;7(11):1224-9.

Cichoż-Lach H, Celiński K, Prozorow-Król B, Swatek J, Słomka M, Lach T. The BARD score and the NAFLD fibrosis score in the assessment of advanced liver fibrosis in nonalcoholic fatty liver disease. Int Med J Exp Clin Res. 2012;18(12):CR735.

Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57(10):1441-7.

Kirovski G, Schacherer D, Wobser H, Huber H, Niessen C, Beer C et al. Prevalence of ultrasound-diagnosed non-alcoholic fatty liver disease in a hospital cohort and its association with anthropometric, biochemical and sonographic characteristics. Int J Clin Exp Med. 2010;3(3):202.

Khov N, Sharma A, Riley TR. Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease. World journal of gastroenterology: WJG. 2014;20(22):6821.

Silva LD, Oliveira JT, Tochetto S, Oliveira CP, Sigrist R, Chammas MC. Ultrasound elastography in patients with fatty liver disease. Radiologia brasileira. 2019;53:47-55.

Tang A, Cloutier G, Szeverenyi NM, Sirlin CB. Ultrasound elastography and MR elastography for assessing liver fibrosis: part 1, principles and techniques. AJR. American journal of roentgenology. 2015;205(1):22.

Chimoriya R, Piya MK, Simmons D, Ahlenstiel G, Ho V. The use of two-dimensional shear wave elastography in people with obesity for the assessment of liver fibrosis in non-alcoholic fatty liver disease. Journal of Clinical Medicine. 2021;10(1):95.

Suh CH, Kim KW, Park SH, Lee SS, Kim HS, Tirumani SH et al. Shear wave elastography as a quantitative biomarker of clinically significant portal hypertension: a systematic review and meta-analysis. American Journal of Roentgenology. 2018;210(5):W185-95.

Rustogi R, Horowitz J, Harmath C, Wang Y, Chalian H, Ganger DR et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. Journal of Magnetic Resonance Imaging. 2012;35(6):1356-64.

Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84.

Nakahara T, Hyogo H, Yoneda M, Sumida Y, Eguchi Y, Fujii H et al. Type 2 diabetes mellitus is associated with the fibrosis severity in patients with nonalcoholic fatty liver disease in a large retrospective cohort of Japanese patients. Journal of gastroenterology. 2014;49(11):1477-84

Yoneda M, Fujii H, Sumida Y, Hyogo H, Itoh Y, Ono M et al. Platelet count for predicting fibrosis in nonalcoholic fatty liver disease. Journal of gastroenterology. 2011;46(11):1300-6.

Liu F, Zhou H, Cao L, Guo Z, Dong C, Yu L et al. Risk of reduced platelet counts in patients with nonalcoholic fatty liver disease (NAFLD): a prospective cohort study. Lipids in health and disease. 2018;17(1):1-7.

Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Annals of medicine. 2011;43(8):617-49.

Furlan A, Tublin ME, Yu L, Chopra KB, Lippello A, Behari J. Comparison of 2D shear wave elastography, transient elastography, and MR elastography for the diagnosis of fibrosis in patients with nonalcoholic fatty liver disease. American Journal of Roentgenology. 2020;214(1):W20-6.

Lee SM, Lee JM, Kang HJ, Yang HK, Yoon JH, Chang W et al. Liver fibrosis staging with a new 2D-shear wave elastography using comb-push technique: applicability, reproducibility, and diagnostic performance. PLoS One. 2017;12(5):e0177264.