Assessment of Point Shear Wave Elastography as a Diagnostic Tool in Comparison to Biochemical Indices in patients with Alcohol Associated Acute Pancreatitis

Background

The gold standard for assessing liver fibrosis is liver biopsy, which is a painful, invasive technique. Point Shear Wave Elastography (P-SWE) imaging is an advanced and new promising ultrasound based diagnostic method that analyses the wave propagation speed and helps in the assessment of tissue stiffness. Our study is first study from North India wherein we have tried to assess the liver stiffness (P-SWE using Esaote MyLab9 Exp Ultrasound) in patients with alcohol associated acute pancreatitis (AA-AP), and therein tried to evaluate the diagnostic performance of P-SWE against biochemical index (APRI index).

Objective

The objective of this study was to assess the effectiveness of P-SWE as a diagnostic tool, in comparison to biochemical indices in patients with AA-AP.

Material and Method

73 patients with alcohol related acute pancreatitis (cases) and 67 patients with non-alcohol related acute pancreatitis (controls) was recruited in this study. P-SWE was done in all 140 patients and utilized for grading of liver fibrosis.

Observation and Result

Mean P-SWE measurement in cases was 1.68 ± 0.17 m/s, and controls was 1.30 ± 0.14 m/s. Cut off value of 1.4 m/s had sensitivity of 93.2%, specificity of 88.1%, positive predictive value of 89.5%, negative predictive value of 92.2%, diagnostic accuracy of 90.7% and area under ROC curve = 0.911. There was positive correlation between amount of alcohol intake (g/day) and P-SWE (m/s). P-SWE positively correlated [Pearson correlation (r): +0.76] with APRI results in our study.

Conclusion

P-SWE can provide valuable information about liver stiffness in patients with AA-AP and help to predict the stage of liver fibrosis. Ultimately, early diagnosis plays a crucial role in patient management, since there is high chance of regression or reversal of liver fibrosis in early stage. The available cut off values of P-SWE was also validated in this study with high diagnostic performance for significant fibrosis (F2), severe/advanced fibrosis (F3) and cirrhosis (F4).