Shear wave elastography to predict liver failure in patients undergoing hepatectomy for malignant liver lesions. Can we avoid liver biopsy in the remnant liver?

Sunday, March 30, 2025

4:12 PM – 4:21 PM CT

Location: Music City Center, 208 AB

Presenting Author(s)

Varun Yadav, MD, MBBS

Assistant Professor, Intervention Radiology
Homi Bhabha Cancer Hospital and Research Centre, New Chandigarh, India, India

Author/Co-author(s)

Kunal Gala, MD, MBBS

Professor
Tata Memorial Hospital, India
Suyash Sureshchandra Kulkarni, MD, MBBS (he/him/his)

PROFESSOR AND HEAD OF DEPARTMENT
TATA MEMORIAL HOSPITAL, India
NS

Nitin Shetty, MD, MBBS

PROFESSOR
TATA MEMORIAL HOSPITAL, India
Ai

Anagha ingle, MD

Resident
MBBS, India
MG

Monish G K, MD

Fellow
TMH, India

Purpose: Hepatic resection is one of the curative treatments for liver lesions, but patients with chronic liver disease or cirrhosis are at increased risk of post-hepatectomy liver failure (PHLF). So, effective preoperative assessment of liver function is crucial to mitigate this risk. Shear Wave Elastography (SWE), a non-invasive imaging technique, has shown potential in assessing liver stiffness. In this abstract, we will

assess whether liver stiffness measured by SWE can accurately predict post-hepatectomy liver failure in patients undergoing hepatectomy.

Materials and Methods: This retrospective study included 37 patients with malignant liver lesions who underwent hepatectomy for the same. The patients included had liver stiffness measurements using 2D shear wave elastographic evaluation done prior to the surgery. Post-operative liver function tests, serum bilirubin, AST, ALT and INR were recorded in the patients beyond postoperative day 5, and a persistent elevation beyond postoperative day 5 was categorized into the Post-hepatectomy liver failure (PHLF) group. The fibrosis grading obtained by SWE was compared with the histological grade obtained in the surgical specimen.

Results: SWE demonstrated a sensitivity of 85.71% and a negative predictive value of 94.44%, making it highly effective in ruling out PHLF. However, its specificity was moderate at 58.62%, with an overall accuracy of 63.89%. A positive likelihood ratio of 2.07 suggests that patients with positive SWE results are over twice as likely to develop PHLF.

There is moderate agreement between the fibrosis grade measured by SWE and the histological grade obtained from a histopathological sample of liver parenchyma obtained in the surgical specimen, with an Intraclass Correlation Coefficient (ICC) of 0.735 and a Kappa value of 0.491.
Despite some variability, especially in lower fibrosis stages, SWE showed moderate agreement with histology, reinforcing its role as a non-invasive alternative to liver biopsy.

Conclusion:

SWE is a valuable tool for preoperative evaluation, helping identify patients at higher risk of PHLF. Its ability to assess liver fibrosis non-invasively reduces the need for invasive procedures like biopsies, improves clinical decision-making, and enhances patient outcomes, making it a promising approach for safer hepatectomy planning.