Longitudinal Assessment of Ultrasound Liver Service Performance: Insights at 18 Months
Sadie Ridley, Benenden Hospital
Introduction:
This longitudinal review evaluates the performance of a newly established liver assessment service over an 18-month period, utilising Siemens ACUSON Sequoia ultrasound systems with advanced Liver Software, including Shear Wave Elastography (SWE) and Ultrasound Derived Fat Fraction (UDFF). The service offers non-invasive, quantitative analysis of liver stiffness and fatty infiltration, enabling early detection and proactive management of diffuse liver disease. The advantages of elastography are visual placement of measurements to avoid vessels, liver capsule and so forth, ensuring accuracy, reproducibility, and best practice for optimum results; Non-invasive, quantitative /assessment of tissue stiffness, overcoming complications and limitations of biopsy.
Method:
A total of 275 referrals were received (111 in 2024 and 164 in 2025), encompassing a range of indications including suspected steatosis, abnormal liver function tests, alcohol-related liver concerns, hepatic trauma, portal vein thrombosis and lifestyle-associated risks. Notably, public awareness increased following a 2024 documentary, prompting younger adults, especially females, to seek assessment.
Results:
Challenges included inadequate fasting compliance, breathing/breath-hold difficulties and a high non-attendance rate (DNA) amongst NHS patients. Results for fat fraction distribution are demonstrated in Figure 1, liver stiffness scores in Figure 2; correlation between UDFF and fibrosis score > 9kPa (Figure 3), and liver stiffness in patients with UDFF >20% (Figure 4).
Conclusion:
Challenges were identified and addressed through improved communication, patient instructions, and operational protocols. These interventions enhanced service reliability and uptake, leading referrers to favour ultrasound-based elastography over Fibroscan. The impending launch of self-referral options, with consultant oversight, marks a further step toward widening access and empowering individuals seeking proactive liver health assessment. No consistent correlation was found between fat fraction and liver stiffness, highlighting the risk of late diagnosis of fibrosis and underscoring the importance of measuring both parameters independently.