CC BY-NC-ND 4.0 · Ultrasound Int Open 2020; 06(03): E54-E61
DOI: 10.1055/a-1298-9642
Original Article

Point Shear Wave Elastography and the Effect of Physical Exercise, Alcohol Consumption, and Respiration in Healthy Adults

Victoria Taraldsen
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
,
Sunneva Tomasgard
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
,
Margrethe Thune Rudlang
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
,
Odd Helge Gilja
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
2   Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
,
Mette Vesterhus
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
3   Department of Medicine, Haraldsplass Deaconess Hospital Bergen, Norway
4   Norwegian PSC Research Center (NoPSC), Division of Surgery, Inflammatory medicine and transplantation, Oslo Universitetssykehus Rikshospitalet, Oslo, Norway
,
Anders Batman Mjelle
1   Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
5   Department of Clinical Medicine, Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
› Author Affiliations

Abstract

Purpose Ultrasound elastography is a noninvasive method for liver stiffness measurement (LSM) with the aim of reflecting approximate liver fibrosis load. Despite minimal evidence, current guidelines recommend 10 min of rest and breath hold prior to measurements and offer no advice concerning recent alcohol consumption, leading to challenges in clinical practice. We aimed to investigate how LSM in healthy adults is influenced by physical exercise, recent alcohol consumption, and respiration.

Materials and Methods 42 healthy subjects aged 21–36 years were included. LSM using point shear wave elastography (pSWE) was performed in five stages: baseline, after physical activity, after registration of alcohol consumption, and during breath hold compared to free breathing.

Results LSM values were significantly increased following physical exercise compared to baseline values (4.1±0.8 vs. 3.8±0.8 kPa, p=0.01). Alcohol consumption during the last 72 h (0–27 alcohol units) did not significantly affect LSM. There was no significant difference between LSM during breath hold and free breathing.

Conclusion In healthy subjects, LSM increased after recent physical exercise, while alcohol consumption 24–72 h prior to examination did not have a significant impact. There was no clinically significant effect of breath hold on LSM. Our study supports present guidelines recommending rest prior to LSM, while indicating that breath hold may not be mandatory. Recent moderate alcohol exposure may affect LSM to a lesser extent than commonly believed.



Publication History

Received: 28 April 2020
Received: 17 August 2020

Accepted: 26 October 2020

Article published online:
08 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Ferraioli G, Wong VWS, Castera L. et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018; 44: 2419-2440
  • 2 Dietrich CF, Bamber J, Berzigotti A. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version) (vol 38, pg e16, 2017). Ultraschall in Med 2017; 38: E52-E52
  • 3 Karlas T, Pfrepper C, Wiegand J. et al. Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of liver fibrosis: Examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand J Gastroenterol 2011; 46: 1458-1467
  • 4 Arena U, Platon ML, Stasi C. et al. Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis c virus at different stages of fibrotic evolution. Hepatology 2013; 58: 65-72
  • 5 Lebray P, Varnous S, Charlotte F. et al. Liver stiffness is an unreliable marker of liver fibrosis in patients with cardiac insufficiency. Hepatology 2008; 48: 2089-2089
  • 6 Bardou-Jacquet E, Legros L, Soro D. et al. Effect of alcohol consumption on liver stiffness measured by transient elastography. World J Gastroenterol 2013; 19: 516-522
  • 7 Yoon HM, Cho YA, Kim JR. et al. Real-time two-dimensional Shear-wave elastography for liver stiffness in children: Interobserver variation and effect of breathing technique. Eur J Radiol 2017; 97: 53-58
  • 8 Gersak MM, Sorantin E, Windhaber J. et al. The influence of acute physical effort on liver stiffness estimation using Virtual Touch Quantification (VTQ). Preliminary results. Med Ultrason 2016; 18: 151-156
  • 9 Osada T, Iwane H, Katsumura T. et al. Relationship between reduced lower abdominal blood flows and heart rate in recovery following cycling exercise. Acta Physiol 2012; 204: 344-353
  • 10 Tsochatzis EA, Gurusamy KS, Ntaoula S. et al. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracy. J Hepatol 2011; 54: 650-659
  • 11 Trabut JB, Thepot V, Nalpas B. et al. Rapid decline of liver stiffness following alcohol withdrawal in heavy drinkers. Alcohol Clin Exp Res 2012; 36: 1407-1411
  • 12 Kiani A, Brun V, Laine F. et al. Acoustic radiation force impulse imaging for assessing liver fibrosis in alcoholic liver disease. World J Gastroenterol 2016; 22: 4926-4935
  • 13 Lombardi R, Buzzetti E, Roccarina D. et al. Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease. World J Gastroenterol 2015; 21: 11044-11052
  • 14 Thiele M, Detlefsen S, Moller LS. et al. Transient and 2-dimensional shear-wave elastography provide comparable assessment of alcoholic liver fibrosis and cirrhosis. Gastroenterology 2016; 150: 123-133
  • 15 Folkhälsomyndigheten (Public health agency of Sweden). https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/alkohol-narkotika-dopning-tobak-och-spel-andts/alkohol/alkoholkonsumtion/. In
  • 16 Jung C, Groth M, Petersen KU. et al. Hepatic shear wave elastography in children under free-breathing and breath-hold conditions. Eur Radiol 2017; 27: 5337-5343
  • 17 Yun MH, Seo YS, Kang HS. et al. The effect of the respiratory cycle on liver stiffness values as measured by transient elastography. J Viral Hepat 2011; 18: 631-636
  • 18 Hong EK, Choi YH, Cheon JE. et al. Accurate measurements of liver stiffness using shear wave elastography in children and young adults and the role of the stability index. Ultrasonography 2018; 37: 226-232
  • 19 Shin HJ, Kim MJ, Kim HY. et al. Optimal acquisition number for hepatic shear wave velocity measurements in children. Plos One 2016; 11
  • 20 Horster S, Mandel P, Zachoval R. et al. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin Hemorheol Microcirc 2010; 46: 159-168
  • 21 Bailey SS, Youssfi M, Patel M. et al. Shear-wave ultrasound elastography of the liver in normal-weight and obese children. Acta Radiol 2017; 58: 1511-1518
  • 22 Franchi-Abella S, Corno L, Gonzales E. et al. Feasibility and Diagnostic Accuracy of Supersonic Shear-Wave Elastography for the Assessment of Liver Stiffness and Liver Fibrosis in Children: A Pilot Study of 96 Patients. Radiology 2016; 278: 554-562
  • 23 Mjelle AB, Mulabecirovic A, Havre RF. et al. Normal liver stiffness values in children: A comparison of three different elastography methods. J Pediatr Gastroenterol Nutr 2019; 68: 706-712
  • 24 Stigler S. Regression towards the mean, historically considered. Stat Methods Med Res 1997; 6: 103-114