Reliability Of Acoustic Radiation Force Impulse Shear Wave Elastography In The Evaluation Of Liver Stiffness In Morbidly Obese Patients

Purpose To evaluate technical and patient-related factors that can affect the reliability of acoustic radiation force impulse shear wave elastography (ARFI-SWE) in morbidly obese patients.Methods A prospective single-center study was performed on 41 patients (32 females, 78%) presenting for preoperative evaluation for bariatric surgery. ARFI-SWE was performed using a 6 to 1.5 MHz curved (6C1) transducer. Hepatic steatosis was mild, moderate, severe, and absent in 24.4%, 12.2%, 43.9%, and 19.5% of patients, respectively. Interquartile range/median (IQR/M) ranged from 0.05 to 2.07 (0.78 +/- 0.56 m/s). Twenty patients (48.7%) had reliable measurements (IQR/M < 0.3). Shear wave velocity (SWV) values were >1.34 m/s (clinically significant fibrosis) in 25 of 41 patients (61%) and >2.2 m/s (advanced fibrosis) in 19 patients (46%).Results Median SWV was correlated with body mass index (BMI; correlation coefficient [CC] = .37; 95% CI, 0.07-0.61; P-value = .03) and skin-to-liver capsule distance (SLD) (CC = .38; 95% CI, 0.09-0.62; P-value = .01). IQR/M was higher in patients with BMI > 40 (0.24 +/- 0.11 vs 0.39 +/- 0.25, P-value = .031) and SLD > 3 cm (0.46 +/- 0.27 vs 0.23 +/- 0.08, P-value = .001), and there was higher number of unreliable examinations among patient with SLD > 3 cm (16/23 vs 5/18, P-value = .01).Conclusion ARFI-SWE is technically more challenging among patients with higher BMI and SLD, resulting in a higher number of unreliable studies, which highlights the need for further advancement of ARFI technology.