Novel noninvasive technique for liver fibrosis evaluation using spatiotemporal analysis of strain elastography.

Abstract

Purpose: Strain elastography is often limited by its relative nature and failure to capture temporal changes. This study aimed to establish a novel quantitative strain index (Q-SI) integrating spatiotemporal analysis and evaluate its utility for assessing liver fibrosis.

Methods: This prospective study included patients with chronic liver disease (CLD) or chronic heart failure (CHF) between June 2020 and March 2022. The Q-SI was established by applying Q-Analysis to spatiotemporal strain map data, averaging values over 5-10 cardiac cycles. Correlations with two-dimensional shear wave elastography (2D-SWE) and vibration-controlled transient elastography (VCTE) were assessed. Diagnostic performance in histological fibrosis staging was compared using areas under the curve (AUC).

Results: A total of 201 participants (194 CLD, 7 CHF) were evaluated. In the CLD cohort, Q-SI showed a significant negative correlation with 2D-SWE (r = -  0.51, P <0.001) and VCTE (r = -  0.53, P <0.001). Q-SI also decreased significantly with advancing histological fibrosis stage. Diagnostic accuracy (AUC: ≥ F2, 0.74; ≥ F3, 0.73; F4, 0.84) was comparable to that of 2D-SWE (0.73, 0.76, and 0.76) and that of VCTE (0.77, 0.83, and 0.88). Unlike 2D-SWE and VCTE, Q-SI was not affected by high alanine aminotransferase levels. In the CHF cohort, the Q-SI correlated strongly with right atrial reservoir strain (r = 0.90, P < 0.01), an indicator of right atrial pressure, but not with left ventricular ejection fraction.

Conclusion: Q-SI provides a strain-based assessment of liver fibrosis comparable to that of shear wave-based techniques, with potential resilience to inflammation and independence from left ventricular function.