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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 596-602
DOI: 10.1055/s-0044-1782163
Original Article

Distribution of Normative Percentiles of Liver Stiffness Measurement Using Ultrasound Shear Wave Elastography in an Adult Asian Indian Population

Rijo M. Choorakuttil
1   Department of Preventive Radiology and Integrated Diagnostics, AMMA Center for Diagnosis and Preventive Medicine Pvt. Ltd., Kochi, Kerala, India
,
Rajas N. Chaubal
2   Department of Clinical Radiology, Thane Ultrasound Center, Thane, Mumbai, Maharashtra, India
,
Thara Pratap 
3   Department of Clinical Radiology, VPS Lakeshore Hospital & Research Center, Kochi, Kerala
,
Amarnath Chelladurai
4   Department of Radiodiagnosis Stanley Medical College, Chennai, Tamil Nadu, India
,
Praveen K. Nirmalan 
5   Department of Research, AMMA Center for Diagnosis and Preventive Medicine Pvt. Ltd., Kochi, Kerala, India
› Author Affiliations Funding The work was supported in part by a research grant provided by M/s Mindray Medical India Pvt Ltd to the Indian Radiological and Imaging Association. The grant agency did not have any inputs into data collection, analysis, or preparation of the manuscript.
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Abstract

Objective The aim of this study was to determine the normative percentiles for liver stiffness measurement (LSM) using shear wave elastography in an adult Asian Indian population as part of the preventive radiology initiative of the Indian Radiological and Imaging Association (IRIA).

Methods LSMs were ascertained by two-dimensional (2D) shear wave elastography using the Mindray Resona series of ultrasound machines. The image quality was assessed using the motion stability index (M-STB) and reliability (RLB) map. Ten acquisitions were documented, and an interquartile range-to-median (IQR/M) ratio ≤30% kilopascal (kPa) units was considered a good-quality measurement. A subgroup of the study population without comorbidities was chosen to derive the normative percentile distribution of LSM using a generalized least squares multivariable fractional polynomial regression model that adjusted for sex and body mass index (BMI). The effectiveness of the estimated percentiles was assessed on the entire study population using the greater than 90th percentile value of the LSM as the cutoff for abnormality.

Results The study included 852 people who underwent shear wave elastography from June 2022 to July 2023. The magnitude of compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH) was 6.81% (95% confidence interval [CI]: 5.30–8.7) and 4.91% (95% CI: 3.67–6.60), respectively. The normative percentiles were estimated from 282 persons without associated comorbidity and risk factors. The mean age (standard deviation [SD]) of the normal individuals was 40.90 ± 12.92 years, and 210 (71.47%) were males. The mean age (SD) of the 570 persons excluded from the normative percentiles analysis was 47.94 (12.49) years and 72.11% were males. The sex- and BMI-adjusted age-specific 90th percentiles of LSM were 8.76, 8.78, 8.96, 8.97, 9.25, and 9.45 kPa for 18 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, and 61 to 70 years, respectively.

Conclusion The sex- and BMI-adjusted age-specific 90th percentiles for LSM using shear wave elastography in Asian Indian adults are almost similar to the greater than 9 kPa cutoff proposed by the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement guidelines to discriminate cACLD and CSPH from normal individuals.

Keywords

ultrasound elastography - shear wave elastography - liver stiffness - percentiles - chronic liver disease

Note

This work is attributed to Preventive Radiology Program of IRIA, Indian Radiological & Imaging Association, IRIA House, New Delhi, India.




Publication History

Article published online:
25 April 2024

© 2024. Indian Radiological Association. 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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