Search Results (46)

Objectives: Liver fibrosis staging and etiology diagnosis are critical for patient management, but non-invasive methods remain challenging. This study aims to evaluate the performance of radiomics models using 2D shear wave elastography (2D-SWE) of the liver and spleen for liver fibrosis staging and etiology differentiation, comparing them with serum biomarkers and conventional ultrasound. Methods: A retrospective analysis was conducted on 198 patients with liver fibrosis confirmed by biopsy. Radiomics features were extracted from the liver and spleen grayscale and 2D-SWE images. Machine learning (ML) and transfer learning (TL) models were established for fibrosis staging and etiology diagnosis. Model performance was evaluated according to receiver operating characteristic (ROC) curves. Results: For fibrosis staging, 2D-SWE-based models outperformed grayscale and serum biomarkers. The combined liver–spleen TL model achieved exceptional validation performance (AUCs 0.99 for S4, 0.98 for ≥S3, 1.00 for ≥S2). For etiology diagnosis, the liver 2D-SWE TL model and the combined liver–spleen TL model achieved AUCs of 0.97 and 0.94, respectively, significantly outperforming ML models in terms of AUC. Conclusions: Integrating liver and spleen 2D-SWE radiomics with TL significantly improves non-invasive liver fibrosis staging and etiology diagnosis, offering superior accuracy over conventional methods. This approach holds promise for clinical application, though further validation is needed. Full article

Background and Objectives: What led to the development of elastography was the emerging need for a method that could objectively and accurately assess the stiffness of internal structures. As a result, a distinction between normal from pathological tissues becomes possible. Objective: To evaluate non-invasive elastographic techniques, point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE), as methods for differentiating simple liver cysts from liver hemangiomas. Materials and Methods—a total of 63 patients—32 with simple liver cysts and 31 with liver hemangiomas were analyzed. The purpose was to determine the values of the average trend (arithmetic mean or median according to the data distribution) as well as the reference intervals of SWV for both methods in the above-mentioned patients. Final diagnoses were confirmed by contrast-enhanced computed tomography (CECT). Results: The pSWE SWV values (median) for simple hepatic cysts showed an average trend of 1.14 m/s, with an upper limit of 3.33 m/s and a lower limit of 0.35 m/s. For 2D-SWE, the average trend for simple hepatic cysts was 1.00 m/s, with an upper limit of 1.54 m/s and a lower limit of 0.65 m/s. For liver hemangiomas, the average trend in pSWE was 1.36 m/s, with an upper limit of 3.22 m/s and a lower limit of 0.57 m/s. For 2D-SWE, the average trend was 1.34 m/s, with an upper limit of 2.27 m/s and a lower limit of 0.80 m/s. Findings in our work mainly serve as reference values. Conclusions: The accurate diagnosis of liver diseases is of paramount importance when it comes to the approach and treatment of individual benign liver lesions. Early diagnosis of focal liver lesions remains a challenging task. Full article

Background/Objectives: Weight loss is the primary therapy for metabolic dysfunction-associated steatotic liver disease (MASLD). However, the proportion and factors influencing therapeutic changes in the liver condition contrary to weight loss remain unclear. Methods: This observational cohort study spanned between January 2015 and January 2024, with a 48-week lifestyle modification until January 2025. The liver fat content (LFC) determined using MRI-PDFF and liver stiffness measurement (LSM) via 2D-SWE were assessed at baseline and 48 weeks. The weight loss target (WLT) was determined as a reduction of ≥3% in body weight for lean/normal-weight patients and ≥5% for patients who were overweight/obese. Results: Overall, 397 patients with MASLD (30.5% achieving WLT) were included. For participants with WLT, 24.8% presented MRI-PDFF non-response, which was associated with moderate–vigorous physical activity (MVPA) ≥ 150 min/week, indicating a lower likelihood of non-response. Alanine aminotransferase (ALT) non-response occurred in 29.6% of patients and was linked to changes in LFC (ΔLFC, calculated as the baseline minus week 48). LSM non-response was observed in 48.2%, with high free fatty acid (FFA) levels identified as a risk factor. Among individuals without WLT, 29.0% demonstrated an MRI-PDFF response that correlated with greater reductions in low-density lipoprotein cholesterol; 39.4% exhibited an ALT response, which was associated with more significant reductions in LFC. The LSM response was 37.8%, also correlating with a reduction in LFC. Conclusions: Our results identified that MVPA, baseline steatosis degree, FFA, and their responses served as significant markers for treatment response contrary to weight loss in MASLD. Full article

Objective: To determine reference values of liver stiffness during the first week of extrauterine life in healthy newborns, according to gestational age, sex, and birth weight, using three elastography techniques: point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) with convex and linear probes. Materials and Methods: This was a cross-sectional observational study conducted at a single center on a hospital-based cohort of 287 newborns between 24 and 42 weeks of gestation, admitted between January 2023 and May 2024. Cases with liver disease, significant neonatal morbidity, or technically invalid studies were excluded. Hepatic elastography was performed during the first week of life using pSWE and 2D-SWE with both convex and linear probes. Clinical and technical neonatal variables were recorded. Liver stiffness values were analyzed in relation to gestational age, birth weight, and sex. Linear regression models were applied to assess associations, considering p-values < 0.05 as statistically significant. Results: After applying exclusion criteria, valid liver stiffness measurements were obtained in 208 cases with pSWE, 224 with 2D-SWE (convex probe), and 222 with 2D-SWE (linear probe). A statistically significant inverse association between liver stiffness and gestational age (p < 0.03) was observed across all techniques except for 2D-SWE with the linear probe. Only 2D-SWE with the convex probe showed a significant association with birth weight. No significant differences were observed based on neonatal sex. The 2D-SWE technique with the convex probe demonstrated significantly shorter examination times compared to pSWE (p < 0.001). Conclusions: Neonatal liver stiffness measured by pSWE and 2D-SWE with a convex probe shows an inverse correlation with gestational age, potentially reflecting the structural and functional maturation of the liver. These techniques are safe, reliable, and provide useful information for distinguishing normal findings in preterm neonates from early hepatic pathology. The values obtained represent a valuable reference for clinical hepatic assessment in the neonatal period. Full article

Objectives: To compare thresholds and accuracies of FIB-4, vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2D shear wave elastography (2D-SWE), and MR elastography (MRE) for detecting hepatic fibrosis in patients with MASLD. Materials and Methods: Systematic searching of MEDLINE, EMBASE, Cochrane Library, Scopus, and the gray literature from inception to March 2024 was performed. Studies evaluating accuracies of FIB-4, VCTE, 2D-SWE, pSWE, and/or MRE for detecting significant (≥F2) and/or advanced (≥F3) hepatic fibrosis in MASLD patients compared to histology were identified. Full-text review and data extraction were performed independently by two reviewers. Multivariate meta-analysis and subgroup analyses were performed using index test and fibrosis grading. Risk of bias was assessed using QUADAS-2. Results: 207 studies with over 80,000 patient investigations were included. FIB-4 1.3 threshold sensitivity was 71% (95% CI 66–75%) for detecting advanced hepatic fibrosis, which improved to 88% (85–91%) using a <0.75 threshold. FIB-4 specificity using a 2.67 threshold was 96% (94–97%). Sensitivities of 88–91% were achieved using thresholds of 3.2 kPa for pSWE, 4.92 kPa for 2D-SWE, 7.18 kPa for VCTE, and 2.32 kPa for MRE. No significant differences were identified for sensitivities in subgroup analysis with thresholds between 7 and 9 kPa. Most imaging-based studies were high risk of bias for the index test. Conclusions: A FIB-4 threshold of <0.75 and modality-dependent thresholds (VCTE < 7 kPa; pSWE <3 kPa; 2D-SWE <5 kPa; and MRE <2.5 kPa) would achieve sensitivities of around 90% when defining low-risk MASLD in population screening. A modified two-tier algorithm aligning with existing Society of Radiologists in Ultrasound guidelines would improve risk stratification accuracies compared to existing guidelines by European and American liver societies. Full article

Background: Pancreatic neuroendocrine tumors (PanNETs) are relatively rare neoplasms with heterogeneous behavior, ranging from indolent to aggressive disease. The evolution of nuclear medicine has allowed the development of an efficient and advanced toolkit for the diagnosis and treatment of PanNETs. Case: A 45-year-old woman was diagnosed with a grade 1 PanNET and multiple liver metastases. She underwent distal pancreatectomy with splenectomy, extended liver resection, and radiofrequency ablation (RFA). Surgical planning was guided by [^99mTc]Tc-EDDA/HYNIC-TOC SPECT/CT (single-photon emission computed tomography/computed tomography) and preoperative [^99mTc]Tc-mebrofenin-based functional liver volumetry. Functional liver volumetry based on dynamic [^99mTc]Tc-mebrofenin SPECT/CT facilitated precise surgical planning and reliable assessment of the efficacy of parenchymal modulation, thereby aiding in the prevention of post-hepatectomy liver failure. Liver fibrosis was non-invasively evaluated using two-dimensional shear wave elastography (2D-SWE). Tumor progression was monitored using somatostatin receptor scintigraphy, chromogranin A, and contrast-enhanced CT. Recurrent disease was treated with somatostatin analogues (SSAs) and [¹⁷⁷Lu]Lu-DOTA-TATE peptide receptor radionuclide therapy (PRRT). Despite progression to grade 3 disease (Ki-67 from 1% to 30%), the patient remains alive 53 months post-diagnosis, in complete remission, with an ECOG (Eastern Cooperative Oncology Group) status of 0. Conclusions: Functional imaging played a pivotal role in guiding therapeutic decisions throughout the disease course. This case not only underscores the clinical utility of advanced nuclear imaging but also illustrates the dynamic nature of pancreatic neuroendocrine tumors. The transition from low-grade to high-grade disease highlights the need for further studies on tumor progression mechanisms and the potential role of adjuvant therapies in managing PanNETs. Full article

Non-expandable lung (NEL) occurs when the lung fails to fully re-expand after pleural fluid drainage, complicating management and limiting therapeutic options. Diagnosis, based on clinical symptoms, pleural manometry, and traditional imaging, is often delayed to the peri- or post-procedural stages, leading to improper management, complications, and higher healthcare costs. Therefore, early, pre-procedural diagnostic methods are needed. Thoracic ultrasound (TUS) has emerged as a non-invasive tool with the potential to enhance diagnostic accuracy and guide clinical decisions, yet, it remains inadequately studied within the context of NEL. We conducted a non-systematic narrative review using a structured methodology, including a comprehensive database search, predefined inclusion criteria, and QUADAS-2 quality assessment. This approach ensured a rigorous synthesis of evidence on TUS in NEL, with the aim of identifying knowledge gaps and guiding future studies. Non-invasive, real-time, bedside M-mode TUS has demonstrated efficacy in predicting NEL prior to thoracentesis by detecting an absent sinusoidal sign and reduced atelectatic lung movement. Emerging experimental techniques, including 2D shear wave elastography (SWE), speckle tracking imaging (STI) strain analysis, the lung/liver echogenicity (LLE) ratio, TUS assessment of dynamic air bronchograms, and pleural thickening evaluation, show additional potential to enhance pre-procedural NEL detection. However, all these methods have significant limitations that require further comprehensive investigation. Despite their significant promise, TUS modalities for early NEL detection still require rigorous validation and standardization before broad clinical use. A multimodal diagnostic approach, combining clinical manifestations, pleural manometry, radiologic and ultrasonographic findings, along with emerging techniques (once fully validated), may provide the most extensive framework for NEL. Regardless of advancements, patient-centered care and shared decision-making remain essential. Further research is needed to improve outcomes, reduce healthcare costs, and enhance long-term treatment strategies. Full article

Background/Objectives: Esophageal varices (EVs) represent an important portal hypertension complication in patients with compensated advanced chronic liver disease (cACLD). Although upper gastrointestinal endoscopy is currently the gold standard for EV diagnosis, recent guidelines recommend non-invasive approaches to assess EV risk in cACLD patients to reduce unnecessary endoscopies. Our study aims to evaluate spleen stiffness measurement (SSM) using 2D shear-wave elastography (2D-SWE) as a non-invasive predictor of EV presence and severity in patients with cACLD. Methods: We included 73 cACLD patients referred to our liver clinic over one year. SSM and liver stiffness measurement (LSM) were performed using 2D-SWE, with specific cut-off values applied to rule in or rule out clinically significant portal hypertension (CSPH) according to Baveno VII consensus criteria. Upper gastrointestinal endoscopy was performed in all patients to confirm EV presence and grade. Results: Among all patients, 49.3% had no EV, while 50.7% presented with different EV grades (15.1% grade I, 13.7% grade II, 9.6% grade III, and 12.3% grade IV). A strong correlation was observed between elevated SSM values and EV presence, with SSM values > 32.8 kPa highly suggestive of EV (AUROC = 0.95, 95% CI: 0.909–0.995, p < 0.001). SSM values exceeding 40.4 kPa were associated with more advanced EV grades. Combining LSM and SSM improved diagnostic accuracy, effectively stratifying EV risk without invasive procedures. Conclusions: SSM via 2D-SWE is a promising, non-invasive tool for EV prediction in cACLD, aligning with Baveno VII recommendations to minimize unnecessary endoscopies. Further validation is required to refine diagnostic thresholds and expand applicability across different chronic liver disease etiologies. Full article

Background/Objectives: Liver elastography is increasingly used in neonatal intensive care units (NICUs) as a non-invasive, radiation-free, reproducible technique for assessing liver stiffness. This technique demonstrates substantial advantages over conventional ultrasound in diagnosing diffuse liver diseases by providing quantitative measures of tissue elasticity. This article aims to describe the most critical milestones for performing liver elastography ultrasound point-of-care, a tool increasingly used to complement traditional ultrasound in the study of the liver in intensive care units where the population is very susceptible to manipulation. Methods: Techniques such as point-shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have become key in evaluating conditions such as hypoxic-ischemic liver disease, cholestatic diseases, storage and metabolic disorders, or infectious liver conditions. However, despite its usefulness, performing elastography in neonates, particularly in those weighing less than 1000 g or in high-frequency oscillatory ventilation, presents notable challenges, including the extreme sensitivity of neonates to touch, noise, and temperature changes and the difficulty in obtaining accurate measurements due to limited hepatic depth. Results: Key factors for the success of sonoelastography in this population include minimizing contact time, adjusting mechanical and thermal indices to meet biosecurity guidelines, and ensuring patient comfort and stability during the procedure. Despite these challenges, elastography has proven helpful in routine clinical practice. Conclusions: The growing evidence on elastography has provided standardized reference values, further enhancing its clinical applicability in NICU settings. Full article

Background: The aim of this study was to investigate the accuracy in fibrosis staging of a novel shear wave elastography (SWE) device (S-Shearwave Imaging by Samsung) and a previously validated 2D-SWE by Supersonic Imagine (SSI) in patients with biopsy proven metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This prospective study included 75 consecutive patients with MASLD who underwent liver biopsy for suspected MASH. All patients underwent S-Shearwave Imaging by Samsung and 2D-SWE with SSI on the same day of liver biopsy. Fibrosis was histologically assessed using the METAVIR classification system. Agreement between the equipment was assessed with the Pearson coefficient. A receiver operator characteristic curve (ROC) analysis with the Youden index was used to establish thresholds for fibrosis staging. Results: A good correlation was found between S-Shearwave Imaging by Samsung and 2D-SWE with SSI (Pearson’s R = 0.68; p < 0.01). At multivariate regression analysis, S-Shearwave Imaging was associated with advanced fibrosis (≥F3) independently from age, diabetes and platelets (OR 2.94, CI 1.69–5.11, p < 0.01). The fibrosis diagnostic accuracy of both S-Shearwave Imaging and 2D-SWE was good to optimal with AUROCs of 0.81 and 0.70 for significant fibrosis (≥F2), 0.94 and 0.91 for severe fibrosis (≥F3), respectively. The accuracy of S-Shearwave is not significantly different from Fibroscan and Agile3+ (DeLong test p value 0.16 and 0.15, respectively) while is slightly better than 2D-SWE, FIB4 and NFS (DeLong test p value < 0.05). For S-Shearwave Imaging by Samsung, the best cut-off values for diagnosing fibrosis ≥F2, ≥F3 were, respectively, 7.9 kPa (Sens 74.4%, Spec 87.5%) and 8.1 kPa (Sens 95.6%, Spec 78.8%). For 2D-SWE by SSI, the best cut-off values for diagnosing fibrosis ≥F2, ≥F3 were, respectively, 7.2 kPa (Sens 55.8%, Spec 84.4%) and 7.6 kPa (Sens 82.6%, Spec 84.6%). Conclusion: S-Shearwave Imaging is a useful and reliable non-invasive technique for staging liver fibrosis in patients with MASLD. Its diagnostic accuracy is non-inferior to other shear wave elastography techniques (TE and 2D-SWE by SSI). Full article

Background: The accurate staging of liver fibrosis is crucial for managing chronic liver disease (CLD). Although magnetic resonance elastography (MRE) is the reference standard for noninvasive fibrosis assessment, its cost, specialized hardware, and operational demands restrict accessibility. In contrast, two-dimensional shear-wave elastography (2D-SWE) is more affordable, accessible, and widely integrated into routine ultrasound systems. Objective: Our aim was to determine the optimal 2D-SWE cut-offs for detecting significant fibrosis (≥F2) and evaluate its diagnostic performance across fibrosis stages. Methods: In this prospective study, 71 patients with suspected CLD underwent same-day MRE and 2D-SWE. MRE-defined cut-offs categorized fibrosis stages (≥3.5 kPa for significant fibrosis). Sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and likelihood ratios were calculated for various 2D-SWE thresholds. Results: At a 2D-SWE cut-off of 7.0 kPa, sensitivity for detecting ≥F2 fibrosis was 100% with a specificity of 85.7% and a positive likelihood ratio (LR+) of 7.0. Increasing the threshold to 8.0 kPa improved specificity to 91.8% while maintaining a sensitivity of 86.4% and achieving an AUROC of 0.89. For cirrhosis, a cut-off of 11.0 kPa achieved 100% sensitivity and 96.9% specificity. A 5.0 kPa cut-off reliably excluded abnormal stiffness with 89.1% sensitivity. Conclusions: Two-dimensional SWE is a reliable method for staging liver fibrosis. Thresholds of 7.0 kPa for screening significant fibrosis, 8.0 kPa for confirmation, and 11.0 kPa for diagnosing cirrhosis demonstrate high diagnostic accuracy. A 5.0 kPa cut-off effectively excludes abnormal liver stiffness. Full article

Introduction: The non-invasive assessment of disease severity remains pivotal in patients with chronic liver disease (CLD) as it has wide implications in predicting liver-related complications or death. Shear-wave elastography (SWE) is an emerging ultrasound-based method to non-invasively measure liver stiffness. The aim of our study was to evaluate two-dimensional (2D) and point (p) SWE to predict the presence of esophageal varices (EV) or clinically significant portal hypertension (CSPH). Methods: This was a retrospective analysis of a prospectively performed cohort study of patients with CLD treated in the outpatient clinic of the Frankfurt University Hospital. PSWE using the Hitachi HI Vision ASCENDUS system and the Siemens ACUSON S2000^TM system or 2D-SWE using the Toshiba APLIO500 system were analyzed at baseline and during follow-up to predict EV or surrogate parameters of CSPH. ROC curves were calculated for pooled liver stiffness measurements (LSMs) using a bootstrap approach. A combined model of SWE and platelet count was created and a mixed-effect logistic regression analysis using log-transformed values was performed. Results: Overall, 511 patients with CLD and 919 consecutive LSMs were included and 315 patients (61.6%) had signs of CSPH. 2D-SWE performed best to predict EV and CSPH, and the addition of platelet count to the predictive model significantly increased test results for EV (AUC 0.83, 95%-CI: 0.76–0.89; difference in AUC 0.11, 95%-CI: 0.03–0.19, p = 0.004), but only marginally for CSPH (AUC 0.75, 95%-CI: 0.64–0.85; difference in AUC 0.06, 95%-CI: 0.02–0.14, p = 0.150). LSM > 18.5 and >20 kPa were indicative of CSPH and EV, while LSM < 10 kPa and <11 kPa ruled out CSPH and EV, respectively. Conclusions: Our study found that 2D-SWE in combination with platelet count performed best (in comparison to the other SWE methods) to predict EV or CSPH in patients with CLD. Future prospective trials are needed to validate our results. Full article

Background: Transient Elastography (TE) is widely regarded as the most reliable non-invasive method for evaluating liver fibrosis. Recently, new techniques such as 2D Shear Wave Elastography (2D-SWE) have been developed. This study aimed to evaluate the correlation between TE and 2D-SWE in patients with HCV-related chronic liver disease and to redefine the cut-off values of 2D-SWE for predicting different stages of fibrosis based on our results. Methods: Both TE (Fibroscan, Echosens, Paris, France) and 2D-SWE (SuperSonic Imagine) were performed simultaneously in 170 patients, including those with active and eradicated HCV infection. Spearman’s rank correlation coefficient was used to assess the correlation between the two measurements, and the concordance between the assigned METAVIR classes was calculated using Cohen’s kappa coefficient. ROC curves were constructed to determine the optimal cut-off values for 2D-SWE. Results: Ten patients were excluded for invalid measurements. In the remaining 160 patients, TE and 2D-SWE demonstrated a high correlation (ρ = 0.83, p < 0.0001) and good agreement in METAVIR classification (k = 0.74). The optimal cut-off values identified for 2D-SWE were as follows: ≥ 7 kPa for F ≥ 2, ≥ 8.3 kPa for F ≥ 3, and ≥ 9.4 kPa for F4. Conclusions: 2D-SWE is a viable alternative to TE for patients with HCV-related chronic liver disease. Our data suggest that the currently accepted 2D-SWE cut-off values for cirrhosis (F4) should be reconsidered and potentially lowered. Full article

Transient elastography (TE), recommended by the WHO, is an established method for characterizing liver fibrosis via liver stiffness measurement (LSM). However, technical barriers remain towards point-of-care application, as conventional TE requires wired connections, possesses a bulky size, and lacks adequate imaging guidance for precise liver localization. In this work, we report the design, phantom validation, and clinical evaluation of a palm-sized TE system that enables simultaneous B-mode imaging and LSM. The performance of this system was validated experimentally using tissue-equivalent reference phantoms (1.45–75 kPa). Comparative studies against other liver elastography techniques, including conventional TE and two-dimensional shear wave elastography (2D-SWE), were performed to evaluate its reliability and validity in adults with various chronic liver diseases. Intra- and inter-operator reliability of LSM were established by an elastography expert and a novice. A good agreement was observed between the Young’s modulus reported by the phantom manufacturer and this system (bias: 1.1–8.6%). Among 121 patients, liver stiffness measured by this system and conventional TE were highly correlated (r = 0.975) and strongly agreed with each other (mean difference: −0.77 kPa). Inter-correlation of this system with conventional TE and 2D-SWE was observed. Excellent-to-good operator reliability was demonstrated in 60 patients (ICCs: 0.824–0.913). We demonstrated the feasibility of employing a fully integrated phased array probe for reliable and valid LSM, guided by real-time B-mode imaging of liver anatomy. This system represents the first technical advancement toward point-of-care liver fibrosis assessment. Its small footprint, along with B-mode guidance capability, improves examination efficiency and scales up screening for liver fibrosis. Full article

There are no ideal non-invasive tests for assessing the severity of liver fibrosis in people with metabolic dysfunction-associated steatotic liver disease (MASLD) and class 3 obesity, where body habitus often makes imaging technically challenging. This study aimed to assess the applicability and diagnostic performance of two-dimensional shear wave elastography (2D-SWE), alongside several serum-based liver fibrosis scoring methods, in individuals with class 3 obesity. A cross-sectional study was conducted in patients aged ≥18 years and with a body mass index (BMI) ≥ 40 kg/m² who were participants in a publicly funded multidisciplinary weight management program in South Western Sydney. The 2D-SWE was performed using the ElastQ Imaging (EQI) procedure with the Phillips EPIQ Elite series ultrasound. An EQI Median value of ≥6.43 kPa was taken as a cutoff score for significant fibrosis, and the scan was considered valid when the liver EQI IQR/Med value was <30%. The Fibrosis-4 (FIB-4) index, AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and circulating fibroblast activation protein index (FAP index) were calculated from fasting blood samples. The participants (n = 116; 67.2% female) were aged 47.2 ± 12.9 years, with BMI 54.5 ± 11.0 kg/m². EQI Median values were obtained for 97.4% (113/116) of the 2D-SWE scans, and 91.4% (106/116) of the scans were considered valid. The EQI Median values exhibited a moderately positive correlation with the FIB-4 index (r = 0.438; p < 0.001) and a weakly positive correlation with the APRI (r = 0.388; p < 0.001), NFS (r = 0.210; p = 0.036) and FAP index (r = 0.226; p = 0.020). All liver fibrosis scores were positively correlated with one another. Among those referred for a liver biopsy based on the 2D-SWE and serum scores, half (11/22) underwent liver biopsy, and their 2D-SWE scores exhibited 72.7% accuracy (sensitivity: 71.4%; specificity: 75%) in detecting significant fibrosis. Our results show that 2D-SWE is a feasible, non-invasive test to assess liver fibrosis among people with class 3 obesity. Further research is needed to assess how 2D-SWE can be used alongside existing serum-based risk scores to reliably detect significant fibrosis, which would potentially reduce the need for invasive liver biopsy. Full article