Integration of 2D Shear Wave Elastography, Doppler Hemodynamics, and Clinical Scores for Noninvasive Assessment of Liver Fibrosis in Chronic Liver Disease

Abstract

Purpose: Chronic liver disease (CLD) is a major global health burden with increasing prevalence in India due to rising alcohol use and non-alcoholic fatty liver disease (NAFLD). Non-invasive tools such as shear wave elastography (SWE) and Doppler ultrasound are gaining importance in evaluating liver fibrosis and associated hemodynamic changes.
Methods: This cross-sectional observational study included 60 patients with CLD and 20 healthy controls who underwent 2D-SWE and Doppler ultrasound. Liver stiffness (LS) was graded according to SRU 2020 criteria. Hemodynamic parameters - spleen index (SI), portal vein velocity (PVV), portal vein width (PVW), splenoportal index (SPI), and hepatic vein waveform - were analyzed in relation to LS. Additionally, correlations were assessed with clinical fibrosis scores including AST/ALT ratio, APRI, and FIB-4.
Results: The majority of CLD patients (51.66%) had advanced fibrosis (F4). LS showed strong positive correlations with SI, PVW, and SPI, and a significant negative correlation with PVV (p<0.001). Altered hepatic vein waveforms were also associated with higher LS. Non-invasive fibrosis scores were significantly elevated in CLD patients and showed strong correlation with LS and inverse correlation with PVV.
Conclusion: SWE and Doppler ultrasound offer complementary, non-invasive evaluation of liver fibrosis and portal hemodynamics. Their integration with clinical scores enhances diagnostic accuracy and may reduce dependence on liver biopsy in CLD assessment.