SETTING UP A COMPREHENSIVE LIVER ASSESSMENT SERVICE USING ULTRASOUND AND ELASTOGRAPHY
By Sadie Ridley, Benenden Hospital
The objective was to introduce an accurate, quantitative method of measuring liver stiffness and fatty infiltration, allowing early detection of diffuse liver disease. Early intervention and treatment of liver disease greatly improves prognosis (1-3).
Liver disease is prevalent in Western society due to lifestyle, diet, alcohol consumption and some medication (4, 5).
The risk of non-alcoholic Fatty Liver Disease (NAFLD) is greater for patients with existing or potential health issues (figure 1). 20-30% progress to non-alcoholic steatohepatitis (NASH), which can lead to advanced fibrosis, cirrhosis, primary liver tumour, portal vein thrombosis or liver failure.
Liver disease can often progress without symptoms, complicating early identification and delaying potentially life-saving treatment. The first-ever relevant parliamentary debate in 2023 described liver disease as a “silent killer”, as many people are diagnosed too late for effective treatment.
Shear Wave Elastography (SWE) delivers a simple and comprehensive liver assessment through quantification of liver tissue stiffness and hepatic fat to help streamline patient care pathways, and potentially avoid invasive intervention.
‘Fibroscan’ machines (6) (figure 2), the current gold standard, use elastography to measure liver stiffness with no visual guide for data collection.
A proposal was presented to relevant hospital boards for approval and funding, and several ultrasound systems were trialled. Two Siemens ACUSON Sequoia ultrasound systems were acquired in December 2023 with the Liver Software Package incorporating SWE to measure liver stiffness and ultrasound derived fat fraction (UDFF)(figure 3). The advantages of this for liver assessment are visual placement of measurements to avoid vessels, liver capsule and so forth ensuring accuracy, reproducibility, and best practice for optimum results (figure 4); non-invasive, quantitative assessment of tissue stiffness overcoming complications and limitations of biopsy.
Patients are referred through GI consultants, privately through GPs and self-pay.
In the first three months we have scanned 35 patients.