Shear-Wave Dispersion Slope: Do We Have the Tool for Detecting Necroinflammation?

HomeRadiologyVol. 294, No. 2 PreviousNext CommunicationsFree AccessLetters to the EditorShear-Wave Dispersion Slope: Do We Have the Tool for Detecting Necroinflammation?João Marcello de Araujo Neto João Marcello de Araujo Neto Author AffiliationsDepartment of Internal Medicine/Hepatology, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255, Sala 09E16, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, BrazilNational Institute of Cancer, Rio de Janeiro, Brazile-mail: [email protected]João Marcello de Araujo Neto Published Online:Dec 31 2019https://doi.org/10.1148/radiol.2019192326MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Editor:I read with interest the article by Dr Lee and colleagues (1) in the November 2019 issue of Radiology about the usefulness of the shear-wave dispersion slope (SWDS) for assessing allograft damage after liver transplantation. The results suggest that the SWDS is superior to liver stiffness in identifying allograft damage. Based on previous animal models data, it is hypothesized that the advantage is due to the ability of the SWDS to help detect necroinflammation (2).It has been reported that SWDS directly correlates with liver fibrosis (3,4). In the study by Dr Lee and colleagues (1), the rate of histologic fibrosis was higher in participants with allograft damage than in those without allograft damage (20% vs 2%, respectively). Furthermore, the number of participants with significant (grade ≥F2) and severe (grade ≥F3) fibrosis in the entire cohort was low (9.6% and 0.9%, respectively). The higher performance of SWDS with respect to liver stiffness in identifying participants with allograft damage may be due to confounding factors on liver stiffness assessment (5). On the other hand, the analysis of the entire patient cohort based on the presence and/or absence of necroinflammation would be of great interest for better understanding the role of SWDS. In fact, the SWDS may have a potentially great impact in the diagnostic work-up of patients if the ability to assess viscosity is confirmed. This is an exciting research field, but few and not encouraging data are available so far (2,3).The study by Dr Lee and colleagues (1) enriches the literature and prompts a future practical application of the SWDS in transplant recipients. However, the correlation of SWDS with necroinflammation and fibrosis must be assessed differently. As pointed out by the authors, transplant recipients are a very heterogeneous population (1). Inflammation and necrosis can occur for different causes of liver disease, and different histologic patterns (acute cellular rejection, cholangitis, recurrent viral hepatitis, steatohepatitis, etc) can affect the shear-wave measurement as well as the SWDS values. Thus, another source of variability could be the authors’ methodology for liver stiffness assessment (liver stiffness values were obtained by placing the measurement box in three different areas on a single image). Current guidelines have recommended that five measurements should be obtained from five independent images (5).Disclosures of Conflicts of Interest: disclosed no relevant relationships.References1. Lee DH, Lee JY, Bae JS, et al. Shear-Wave Dispersion Slope from US Shear-Wave Elastography: Detection of Allograft Damage after Liver Transplantation. Radiology 2019;293(2):327–333. Link, Google Scholar2. Sugimoto K, Moriyasu F, Oshiro H, et al. Viscoelasticity Measurement in Rat Livers Using Shear-Wave US Elastography. Ultrasound Med Biol 2018;44(9):2018–2024. Crossref, Medline, Google Scholar3. Deffieux T, Gennisson JL, Bousquet L, et al. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015;62(2):317–324. Crossref, Medline, Google Scholar4. Chen S, Sanchez W, Callstrom MR, et al. Assessment of liver viscoelasticity by using shear waves induced by ultrasound radiation force. Radiology 2013;266(3):964–970. Link, Google Scholar5. Ferraioli G, Wong VW, Castera L, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018;44(12):2419–2440. Crossref, Medline, Google ScholarReferences1. Lee DH, Lee JY, Bae JS, et al. Shear-Wave Dispersion Slope from US Shear-Wave Elastography: Detection of Allograft Damage after Liver Transplantation. Radiology 2019;293(2):327–333. Link, Google Scholar2. Chen S, Sanchez W, Callstrom MR, et al. Assessment of liver viscoelasticity by using shear waves induced by ultrasound radiation force. Radiology 2013;266(3):964–970. Link, Google Scholar3. Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med 2017;38(4):e16–e47. Crossref, Medline, Google Scholar4. Ferraioli G, Wong VW, Castera L, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018;44(12):2419–2440. Crossref, Medline, Google ScholarReferences1. Lee DH, Lee JY, Bae JS, et al. Shear-Wave Dispersion Slope from US Shear-Wave Elastography: Detection of Allograft Damage after Liver Transplantation. Radiology 2019;293(2):327–333. Link, Google Scholar2. Sugimoto K, Moriyasu F, Oshiro H, et al. Viscoelasticity Measurement in Rat Livers Using Shear-Wave US Elastography. Ultrasound Med Biol 2018;44(9):2018–2024. Crossref, Medline, Google Scholar3. Deffieux T, Gennisson JL, Bousquet L, et al. Investigating liver stiffness and viscosity for fibrosis, steatosis and activity staging using shear wave elastography. J Hepatol 2015;62(2):317–324. Crossref, Medline, Google Scholar4. Chen S, Sanchez W, Callstrom MR, et al. Assessment of liver viscoelasticity by using shear waves induced by ultrasound radiation force. Radiology 2013;266(3):964–970. Link, Google Scholar5. Ferraioli G, Wong VW, Castera L, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018;44(12):2419–2440. Crossref, Medline, Google ScholarResponseDong Ho Lee*, Jae Young Lee*,† Dong Ho Lee*, Jae Young Lee*,† Author AffiliationsDepartment of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea*Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea†e-mail: [email protected]We would like to reply to Dr de Araujo Neto’s comments regarding our recent study about the usefulness of the SWDS in the detection of allograft damage after liver transplantation (1). Dr de Araujo Neto expresses concerns about the confounding effect of liver fibrosis on SWDS measurement. We did additional analysis on subgroups of participants without fibrosis based on the presence or absence of necroinflammation. The SWDS in participants with necroinflammation was higher than that in participants without necroinflammation (12.6 [m/sec]/kHz vs 9.8 [m/sec]/kHz, respectively; P = .03), further indicating the potential of SWDS to reflect necroinflammation. Indeed, at multivariable analysis, both necroinflammatory grade and liver fibrosis stage were determinant factors for SWDS.Although Chen et al (2) previously reported that elasticity and viscosity measured using shear-wave dispersion ultrasound vibrometry are correlated with the liver fibrosis stage, our results indicate that SWDS reflects necroinflammatory activity, at least for patients without substantial fibrosis. As pointed out, heterogeneous histopathologic findings in our transplant recipients was a limitation, as different causes of liver disease would have different patterns of necroinflammation and different patterns of necroinflammation may affect the result of SWDS measurement. Further studies including patients with different causes of liver disease are warranted to accurately define the clinical role of SWDS with regard to the measurement of liver stiffness.With regard to our methods, we performed three measurements of shear-wave propagation. This is consistent with European Federation of Societies for Ultrasound in Medicine and Biology guidelines stating that three measurements of two-dimensional shear-wave elastography are sufficient to obtain consistent results (3). Recently updated World Federation of Societies for Ultrasound in Medicine and Biology guidelines also suggest three or five measurements (4). As of this time, there are no consensus guidelines regarding repeated measurement for SWDS. Disclosures of Conflicts of Interest: D.H.L. disclosed no relevant relationships. J.Y.L. disclosed no relevant relationships.References1. Lee DH, Lee JY, Bae JS, et al. Shear-Wave Dispersion Slope from US Shear-Wave Elastography: Detection of Allograft Damage after Liver Transplantation. Radiology 2019;293(2):327–333. Link, Google Scholar2. Chen S, Sanchez W, Callstrom MR, et al. Assessment of liver viscoelasticity by using shear waves induced by ultrasound radiation force. Radiology 2013;266(3):964–970. Link, Google Scholar3. Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med 2017;38(4):e16–e47. Crossref, Medline, Google Scholar4. Ferraioli G, Wong VW, Castera L, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol 2018;44(12):2419–2440. Crossref, Medline, Google ScholarArticle HistoryPublished online: Dec 31 2019Published in print: Feb 2020 FiguresReferencesRelatedDetailsCited ByUS Quantification of Liver Fat: Past, Present, and FutureDavid T. Fetzer, Theodore T. Pierce, Michelle L. Robbin, Guy Cloutier, Arjmand Mufti, Timothy J. 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