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
