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Background: Traditionally, liver biopsy has been the gold standard for fibrosis staging. However, it is an invasive, expensive and uncomfortable procedure that is associated with the risk of complications. Thus, non-invasive methods such as shear wave elastography (SWE) have been developed as potential alternatives to liver biopsy. The aim of this study is to evaluate the diagnostic performance of SWE in pediatric patients with liver fibrosis, specifically in a group of Algerian children and to determine whether this method can be a reliable alternative to liver biopsy. Methods: This prospective, descriptive, monocentric study evaluated the non-invasive diagnostic performance of 2D-SWE in assessing liver fibrosis in pediatric patients. The assessment was carried out using various statistical methods, including Spearman's correlation coefficient, Kappa concordance coefficients, regression analysis, as well as the calculation of area under the receiver operating characteristic (AUROC) values and corresponding cut-off points based on the receiver operating characteristic (ROC) curve. Results: Our study found that 2D-SWE is strongly correlated with liver biopsy in estimating liver fibrosis in children, with a correlation coefficient greater than 0.8. Furthermore, the Kappa correlation coefficients exceeded 0.8, indicating a strong agreement between 2D-SWE and liver biopsy results. The AUROC value was not less than 0.9 for significant fibrosis and above (≥ F2), indicating that it has satisfactory diagnostic performance in detecting liver fibrosis in children. Conclusion: 2D-SWE shows promise as a non-invasive method for evaluating liver fibrosis in children, offering a potential alternative to liver biopsy. Larger studies are needed to substantiate the findings of this study and to confirm the accuracy and reliability of 2D-SWE for assessing liver fibrosis in children. [ABSTRACT FROM AUTHOR]

Nowadays ultrasound-based non-invasive techniques for the evaluation of tissue elasticity are becoming increasingly popular. A key determinant for the adequate treatment of focal liver lesions is on establishment of accurate diagnosis. Contemporary imaging modalities, particularly ultrasonographic, are widely accepted for assessing the elasticity of focal liver lesions but the investigation of their accuracy and differentiation potential is still ongoing. Aim: To compare the values of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for liver metastases from colorectal cancer. Materials and Methods: A total of 31 adult patients with liver metastases from colorectal cancer (CRC) were included from the Department of Gastroenterology of University Hospital Kaspela, Plovdiv, Bulgaria, in the period June 2022 to November 2022. The men/women ratio of the participants was respectively 11 women and 20 men. For all of them point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) were performed to evaluate the stiffness of liver metastases, by measuring the shear wave velocity (SWV) in a region of interest (ROI). Prior histological confirmation of colorectal cancer through diagnostic lower endoscopy was a prerequisite for inclusion in the study. Contrast-enhanced computer tomography (CECT) was used as a reference imaging modality to confirm the presence of lesions in the liver. All the images were evaluated by a radiologist with long-standing experience in liver imaging. Results: For point shear wave elastography (pSWE), the lower limit was found to be 1.80 m/s (90% CI: 1.39 to 2.32) and the upper limit was 4.21 m/s (90% CI: 3.69 to 4.60). For two-dimensional shear wave elastography (2D-SWE), the lower limit was determined to be 1.87 m/s (90% CI: 1.54 to 2.25) and the upper limit was 3.65 m/s (90% CI: 3.26 to 3.97). Conclusions: Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) could bring additional information about the stiffness of liver metastases from colorectal cancer but they are not to be considered a method to substitute biopsy of colorectal cancer during lower endoscopy.

Abstract Background Two‐dimensional shear wave elastography (2D‐SWE) provides information on hepatic elastic modulus as shear wave velocity (SWV). Hypothesis/Objectives To assess SWV using 2D‐SWE in dogs with induced volume overload, investigate the relationship between this information and right atrial pressure (RAP) measured by invasive right heart catheterization, and also evaluate the difference in SWV before and after diuretic administration. Animals Six healthy beagles. Methods Prospective experimental study. Right heart catheterization and 2D‐SWE were performed in 6 anesthetized beagles at baseline and after the induction of volume overload. Volume overload was induced by IV hydroxyethyl starch 70/0.5 infusion (100 mL/kg/h). Furosemide (4‐6 mg/kg, IV) was administered, and the SWVs were measured. Results Shear wave velocity showed a significant gradual increase during acute volume overload compared to baseline. SWV was significantly positively correlated with RAP (P 10, >15, and >20 mm Hg was 0.9896 (95% confidence interval [95% CI], 0.9690‐1.000), 0.9907 (95% CI, 0.9701‐1.000), and 0.9722 (95% CI, 0.9280‐1.000), respectively. The SWV after diuretic use decreased significantly. Conclusions and Clinical Importance Two‐dimensional shear wave elastography might be useful for noninvasive and reliable estimation of RAP in dogs with acute volume overload and has potential as a quantitative biomarker for evaluating therapeutic response in dogs with right sided congestive heart failure.

Currently, most primary hospitals cannot routinely perform liver stiffness measurements (LSMs) and spleen stiffness measurements (SSMs), which are recommended by guidelines to exclude high-risk varices (HRVs). We tried to find more convenient indicators for HRV screening. We enrolled 213 cirrhosis patients as the training cohort (TC) and 65 primary biliary cirrhosis patients as the validation cohort (VC). We included indicators such as SSM by two-dimensional shear wave elastography, LSM by transient elastography, and other imaging and laboratory tests. Variable analysis revealed SSM, platelets (PLT), and spleen thickness (ST) as independent risk indicators for HRV. In TC, ST+PLT (ST < 42.2 mm and PLT > 113.5 × 109/L) could avoid 35.7% of the esophagogastroduodenoscopies (EGDs), with a 2.4% missed HRV rate. Although the proportion of EGDs spared by ST+PLT was less than SSM+PLT (SSM < 29.89 kPa + PLT > 113.5 × 109/L) (35.7% vs. 44.1%), it was higher than that of the Baveno VI criteria (B6) (35.7% vs. 28.2%). We did not validate SSM+PLT in VC considering our aims. ST+PLT safely spared 24.6% of EGDs in VC, identical to B6. Conclusions: The ability of ST+PLT to exclude HRVs was superior to B6 but slightly inferior to SSM+PLT. When SSM cannot be routinely performed, ST+PLT provides an extra option for patients to exclude HRVs as a more convenient model. [ABSTRACT FROM AUTHOR]

Nowadays ultrasound-based non-invasive techniques for the evaluation of tissue elasticity are becoming increasingly popular. A key determinant for the adequate treatment of focal liver lesions is on establishment of accurate diagnosis. Contemporary imaging modalities, particularly ultrasonographic, are widely accepted for assessing the elasticity of focal liver lesions but the investigation of their accuracy and differentiation potential is still ongoing. Aim: To compare the values of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for liver metastases from colorectal cancer. Materials and Methods: A total of 31 adult patients with liver metastases from colorectal cancer (CRC) were included from the Department of Gastroenterology of University Hospital Kaspela, Plovdiv, Bulgaria, in the period June 2022 to November 2022. The men/women ratio of the participants was respectively 11 women and 20 men. For all of them point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) were performed to evaluate the stiffness of liver metastases, by measuring the shear wave velocity (SWV) in a region of interest (ROI). Prior histological confirmation of colorectal cancer through diagnostic lower endoscopy was a prerequisite for inclusion in the study. Contrast-enhanced computer tomography (CECT) was used as a reference imaging modality to confirm the presence of lesions in the liver. All the images were evaluated by a radiologist with long-standing experience in liver imaging. Results: For point shear wave elastography (pSWE), the lower limit was found to be 1.80 m/s (90% CI: 1.39 to 2.32) and the upper limit was 4.21 m/s (90% CI: 3.69 to 4.60). For two-dimensional shear wave elastography (2D-SWE), the lower limit was determined to be 1.87 m/s (90% CI: 1.54 to 2.25) and the upper limit was 3.65 m/s (90% CI: 3.26 to 3.97). Conclusions: Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) could bring additional information about the stiffness of liver metastases from colorectal cancer but they are not to be considered a method to substitute biopsy of colorectal cancer during lower endoscopy. [ABSTRACT FROM AUTHOR]

Two‐dimensional shear wave elastography (2D‐SWE) is widely used as a noninvasive method to quantify liver stiffness. In humans, liver stiffness approximates histologic hepatic fibrosis. While histology is the gold standard for diagnosing liver disease, 2D‐SWE may be a minimally invasive alternative to biopsy in feline patients. The objectives of this prospective, observational, crossover study were trifold: (1) to assess the feasibility of performing 2D‐SWE in awake cats, (2) to determine whether anesthesia altered shear wave velocity (SWV) measurements, and (3) to correlate hepatic stiffness with histologically quantified hepatic fibrosis. Eleven healthy, purpose‐bred cats underwent 2D‐SWE in awake and anesthetized states. SWV measurements were compared with histologic fibrosis measurements obtained from liver biopsies during the anesthetic period. The mean velocities were not significantly different between awake (1.47 ± 0.18 m/s) and anesthetized (1.47 ± 0.24 m/s) cats. Premedication and anesthetic drugs did not impact mean SWV. There was a higher variability in the SWV values in the awake group. The data points were reliably replicated, with an interquartile range of 0.24 and 0.32 in anesthetized and awake groups, respectively. There was moderate agreement between observers (intraclass correlation coefficient = 0.66). All cats had clinically insignificant fibrosis. There was no correlation between the SWV measurements and the histological fibrosis values. This study demonstrates that 2D‐SWE is feasible in awake cats and that the anesthetic protocol employed did not significantly alter mean SWV. This work is the first to histologically validate normal SWV values in cats and show that 2D‐SWE cannot differentiate minimal differences in feline hepatic fibrosis. [ABSTRACT FROM AUTHOR]

Differentiating between thyroid and parathyroid lesions by means of ultrasound can be a challenge in some cases. This study explores the diagnostic efficacy of bidimensional shear wave elastography planewave ultrasound (2D SWE PLUS) as an auxiliary technique in distinguishing these superficial structures. We evaluated 86 cases, presenting with concurrent thyroid nodules and hyperparathyroidism, through conventional ultrasound and 2D SWE PLUS, employing an Aixplorer Supersonic Mach30 with a 5-18 MHz linear probe. Statistically significant differences were observed for the elasticity index (EI) between parathyroid and normal thyroid tissue (p<0.0001, U=291), and between parathyroid lesions and thyroid nodules (p<0.0001, U=248.5). An area under the curve (AUC) of 0.961, with an optimal cut-off value of =8.9 kPa, was established to effectively distinguish parathyroid tissue from normal thyroid tissue (sensitivity of 91.9%; specificity of 97.5%). Furthermore, an AUC of 0.963 and an optimal cut-off of 9.24 kPa (sensitivity of 94.2%, specificity of 91.1%) were determined for parathyroid vs thyroid lesions. Elasticity values were significantly elevated in the cancer group compared to benign thyroid nodules (p<0.0001). Our findings suggest that 2D SWE PLUS is an effective tool in differentiating between thyroid nodules and parathyroid lesions, enhancing diagnostic performance in neck ultrasonography. [ABSTRACT FROM AUTHOR]

Background: Staging of liver fibrosis traditionally relied on liver histology; however, transient elastography (TE) and more recently two‐dimensional shear wave elastography (2D‐SWE) evolved to noninvasive alternatives. Hence, we evaluated the diagnostic accuracy of 2D‐SWE assessed by the Canon Aplio i800 ultrasound system using liver biopsy as reference and compared the performance to TE. Methods: In total, 108 adult patients with chronic liver disease undergoing liver biopsy, 2D‐SWE and TE were enrolled prospectively at the University Hospital Zurich. Diagnostic accuracies were evaluated using the area under the receiver operating characteristic (AUROC) analysis, and optimal cut‐off values by Youden's index. Results: Diagnostic accuracy of 2D‐SWE was good for significant (≥F2; AUROC 85.2%, 95% confidence interval (95%CI):76.2–91.2%) as well as severe fibrosis (≥F3; AUROC 86.8%, 95%CI: 78.1–92.4%) and excellent for cirrhosis (AUROC 95.6%, 95%CI: 89.9–98.1%), compared to histology. TE performed equally well (significant fibrosis: 87.5%, 95%CI: 77.7–93.3%; severe fibrosis: 89.7%, 95%CI: 82.0–94.3%; cirrhosis: 96%, 95%CI: 90.4–98.4%), and accuracy was not statistically different to 2D‐SWE. 2D‐SWE optimal cut‐off values were 6.5, 9.8 and 13.1 kPa for significant fibrosis, severe fibrosis and cirrhosis, respectively. Conclusions: Performance of 2D‐SWE was good to excellent and well comparable with TE, supporting the application of this 2D‐SWE system in the diagnostic workup of chronic liver disease. [ABSTRACT FROM AUTHOR]

Background: Two‐dimensional shear wave elastography (2D‐SWE) provides information on hepatic elastic modulus as shear wave velocity (SWV). Hypothesis/Objectives: To assess SWV using 2D‐SWE in dogs with induced volume overload, investigate the relationship between this information and right atrial pressure (RAP) measured by invasive right heart catheterization, and also evaluate the difference in SWV before and after diuretic administration. Animals: Six healthy beagles. Methods: Prospective experimental study. Right heart catheterization and 2D‐SWE were performed in 6 anesthetized beagles at baseline and after the induction of volume overload. Volume overload was induced by IV hydroxyethyl starch 70/0.5 infusion (100 mL/kg/h). Furosemide (4‐6 mg/kg, IV) was administered, and the SWVs were measured. Results: Shear wave velocity showed a significant gradual increase during acute volume overload compared to baseline. SWV was significantly positively correlated with RAP (P <.0001, ρ = 0.9729). The area under the curve of SWV to predict RAP at >10, >15, and >20 mm Hg was 0.9896 (95% confidence interval [95% CI], 0.9690‐1.000), 0.9907 (95% CI, 0.9701‐1.000), and 0.9722 (95% CI, 0.9280‐1.000), respectively. The SWV after diuretic use decreased significantly. Conclusions and Clinical Importance: Two‐dimensional shear wave elastography might be useful for noninvasive and reliable estimation of RAP in dogs with acute volume overload and has potential as a quantitative biomarker for evaluating therapeutic response in dogs with right sided congestive heart failure. [ABSTRACT FROM AUTHOR]

Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.

Portal hypertension (PH) and esophageal varices (EVs) are a matter of extensive research. According to current Baveno VII guidelines, in patients with compensated advanced chronic liver disease (cACLD), liver stiffness measurement (LSM) < 15 kPa and PLT count > 150 × 109/L, upper endoscopy (UE) is not mandatory, and the emphasis should be set on non-invasive methods for evaluation of clinically significant portal hypertension (CSPH). The aim of this study is to establish whether liver stiffness (LS) measured by 2D-SWE could be used as a predictor for the presence and severity of EVs in cirrhotic patients. In total, 86 patients of whom 32 with compensated liver cirrhosis (cLC) and 54 with decompensated liver cirrhosis (dLC) were examined in the Gastroenterology clinic of University hospital "Kaspela", Plovdiv, Bulgaria. Each patient underwent LS assessment by 2D-SWE and EVs grading by UE. EVs were detected in 47 (54.7%) patients, 23 (49%) of them were stage 4-high-risk EVs (HREV). The cut-off value for LS that differentiates HREV from the rest was set at 2.49 m/s with 100% sensitivity and 100% specificity (AUC 1.000, CI 0.925). Conclusions: 2D-SWE can be used as a non-invasive method in the assessment of only high-grade esophageal varices. For the other grades, upper endoscopy remains the method of choice. [ABSTRACT FROM AUTHOR]

Differentiating between thyroid and parathyroid lesions by means of ultrasound can be a challenge in some cases. This study explores the diagnostic efficacy of bidimensional shear wave elastography planewave ultrasound (2D SWE PLUS) as an auxiliary technique in distinguishing these superficial structures. We evaluated 86 cases, presenting with concurrent thyroid nodules and hyperparathyroidism, through conventional ultrasound and 2D SWE PLUS, employing an Aixplorer Supersonic Mach30 with a 5-18 MHz linear probe. Statistically significant differences were observed for the elasticity index (EI) between parathyroid and normal thyroid tissue (p

Currently, most primary hospitals cannot routinely perform liver stiffness measurements (LSMs) and spleen stiffness measurements (SSMs), which are recommended by guidelines to exclude high-risk varices (HRVs). We tried to find more convenient indicators for HRV screening. We enrolled 213 cirrhosis patients as the training cohort (TC) and 65 primary biliary cirrhosis patients as the validation cohort (VC). We included indicators such as SSM by two-dimensional shear wave elastography, LSM by transient elastography, and other imaging and laboratory tests. Variable analysis revealed SSM, platelets (PLT), and spleen thickness (ST) as independent risk indicators for HRV. In TC, ST+PLT (ST < 42.2 mm and PLT > 113.5 × 109/L) could avoid 35.7% of the esophagogastroduodenoscopies (EGDs), with a 2.4% missed HRV rate. Although the proportion of EGDs spared by ST+PLT was less than SSM+PLT (SSM < 29.89 kPa + PLT > 113.5 × 109/L) (35.7% vs. 44.1%), it was higher than that of the Baveno VI criteria (B6) (35.7% vs. 28.2%). We did not validate SSM+PLT in VC considering our aims. ST+PLT safely spared 24.6% of EGDs in VC, identical to B6. Conclusions: The ability of ST+PLT to exclude HRVs was superior to B6 but slightly inferior to SSM+PLT. When SSM cannot be routinely performed, ST+PLT provides an extra option for patients to exclude HRVs as a more convenient model.

Calibrating physically based hydrological models manually is time-consuming and challenging. Automatic calibration tools have become prevalent in these models; however, its effective use requires not only a deep knowledge of the calibration procedure itself, but also understanding the structure of the model input and output files. In this study, we introduce Iber-PEST, a novel framework combining the parameter estimation and uncertainty analysis package, PEST, with Iber, a 2D model based on the shallow water equations. We demonstrate its capabilities by successfully calibrating eight storm events in northwestern Spain's basins, achieving promising results (mean NSE equal to 0.84). Furthermore, by applying the iterative ensemble smoother included in PEST, we demonstrate the feasibility to use the calibration data generated by Iber-PEST with alternative PEST algorithms not directly integrated in the Iber-PEST framework. This work successfully addresses the significant implementation barrier associated with the automatic calibration of Iber hydrological models with PEST. • Iber-PEST simplifies calibration, linking PEST and Iber, for hydrological modelling. • Successful application in 8 storm events in two different watersheds. • Iber-PEST generates an inverse problem compatible with the whole PEST suite. [ABSTRACT FROM AUTHOR]

The growing concern about natural hazards, such as snow avalanches, has led to the development of ad hoc numerical models as a support tool for their analysis and evaluation. Existing models for avalanche simulation are based on the conservation of mass and the momentum, which are similar equations to the Saint Venant equations for water with differences only in terms of friction (rheological model). This document shows the possibilities of these equations to simulate dense-slab avalanches and the numerical treatment carried out in Iber. A new methodology has been used to balance the source term and the flow vector to avoid spurious oscillations and unreal movements, modifying the bottom slope based on the fluid parameters and thus stop its movement. The tool has been tested in two case studies to analyse the behaviour of the fluid depending on the parameters of the rheological model.

Portal hypertension (PH) and esophageal varices (EVs) are a matter of extensive research. According to current Baveno VII guidelines, in patients with compensated advanced chronic liver disease (cACLD), liver stiffness measurement (LSM) < 15 kPa and PLT count > 150 × 109/L, upper endoscopy (UE) is not mandatory, and the emphasis should be set on non-invasive methods for evaluation of clinically significant portal hypertension (CSPH). The aim of this study is to establish whether liver stiffness (LS) measured by 2D-SWE could be used as a predictor for the presence and severity of EVs in cirrhotic patients. In total, 86 patients of whom 32 with compensated liver cirrhosis (cLC) and 54 with decompensated liver cirrhosis (dLC) were examined in the Gastroenterology clinic of University hospital “Kaspela”, Plovdiv, Bulgaria. Each patient underwent LS assessment by 2D-SWE and EVs grading by UE. EVs were detected in 47 (54.7%) patients, 23 (49%) of them were stage 4-high-risk EVs (HREV). The cut-off value for LS that differentiates HREV from the rest was set at 2.49 m/s with 100% sensitivity and 100% specificity (AUC 1.000, CI 0.925). Conclusions: 2D-SWE can be used as a non-invasive method in the assessment of only high-grade esophageal varices. For the other grades, upper endoscopy remains the method of choice.

Aims: We aimed to compare the diagnostic performance of two 2D-Shear Wave Elastography (2D-SWE) techniques for the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C virus (HCV) infection using Transient Elas-tography (TE) as reference.Material and Methods: We enrolled 208 consecutive patients with chronic HCV infection, in which liver stiffness (LS) was evaluated in the same session using two 2D-SWE techniques: 2D-SWE.GE and 2D-SWE.SSI using TE as the method of reference. LS measurements were considered failures when no value was obtained after 10 attempts.Results: Valid LSMs were obtained in 95.6% (199/208) of cases by 2D-SWE.GE, 92.7% (193/208) of cases by 2D-SWE.SSI, and in 94.7% (197/208) of cases by TE (p>0.05). The mean LS values by 2D-SWE.GE were significantly lower than those obtained by 2D-SWE.SSI: 10.3±3.8 kPa vs. 15±10.4 kPa (p<0.0001). 2D-SWE.GE LSMs correlated better with TE than 2D-SWE.SSI (r=0.75, p<0.0001 vs. r=0.57, p<0.0001, z test p=0.0012). Linear regression analysis showed a moderate correlation between LSMs obtained by 2D-SWE.GE and 2D-SWE.SSI (r=0.63, R2=0.4, P<0.0001). Pairwise comparison of receiver operating characteristics curves (ROC) found no significant differences between 2D-SWE.GE and 2D-SWE.SSI in identifying F≥2 fibrosis (0.97 vs. 0.96, P = 0.5650), F≥3 (0.97 vs. 0.95, P = 0.2935), or F=4 (0.97 vs. 0.96, p = 0.6914).Conclusions: Both 2D-SWE techniques had good feasibility for the noninvasive assessment of liver fibrosis. LS values obtained by 2D-SWE.GE were significantly lower than those obtained by 2D-SWE.SSI. No significant differences were found between both methods in staging liver fibrosis in patients with chronic HCV. [ABSTRACT FROM AUTHOR]

Abstract Background Two‐dimensional shear wave elastography (2D‐SWE) can noninvasively evaluate hepatic elastic modulus as shear wave velocity (SWV). Additionally, it may predict the presence of clinical relevant hepatic fibrosis (≥F2) in dogs with hepatic disease. Objectives To investigate whether SWV measured by 2D‐SWE can differentiate between dogs with (≥F2) and without (F0‐1) clinically relevant hepatic fibrosis. Animals Twenty‐eight client‐owned dogs with hepatic disease and 8 normal healthy Beagle dogs were enrolled. Methods In this cross‐sectional prospective study, SWVs were measured using 2D‐SWE in all dogs. Hepatic fibrosis stages and necroinflammatory activity grades were histopathologically evaluated using a histological scoring scheme that was adapted from the Ishak schema used in human medicine. Results Median SWVs were significantly higher in dogs with clinically relevant hepatic fibrosis (2.04 m/s; range, 1.81‐2.26 m/s) than in healthy dogs (1.51 m/s; range, 1.44‐1.66 m/s; P = .007), and dogs without clinically relevant hepatic fibrosis (1.56 m/s; range, 1.37‐1.67 m/s; P

Introducción: la elastografía en tiempo real, 2D-SWE (Supersonic), es una prueba no invasiva que se utiliza para determinar la elasticidad del hígado y, de esa forma, calcular el grado de fibrosis hepática. En Colombia, la prueba se introdujo en 2016 y no existen hasta el momento estudios del comportamiento de la prueba en todos los pacientes hepáticos, solo se han publicado en pacientes sanos y cirróticos. Objetivo: analizar la experiencia de la aplicación de la elastografía en tiempo real, en sujetos atendidos en el centro de enfermedades hepáticas y digestivas de Bogotá, Colombia. Materiales y métodos: estudio descriptivo retrospectivo de una cohorte de sujetos atendidos entre marzo de 2016 y julio de 2017. Se realizó una historia clínica completa y una prueba de elastografía en tiempo real (Supersonic). Resultados: se incluyeron 654 sujetos, con una mediana de edad de 55 años (rango intercuartílico [RIC]: 45-64). La mediana de valores de fibrosis expresada en kilopascales (kPs) fue de 8,3, con un promedio de 5 mediciones. Se observó una diferencia significativa en el grado de fibrosis entre los grupos de edad y en relación con el diagnóstico final, donde se evidenció una mayor fibrosis en el grupo de enfermedades colestásicas (autoinmune, colangitis biliar primaria [CBP] y superposición autoinmune-CBP). La tasa global de fracaso fue menor al 1 %. Conclusiones: es la primera descripción del comportamiento de la prueba a nivel nacional. Los valores de rigidez hepática observados en los diferentes estadios demuestran la utilidad de la prueba para la determinación de la fibrosis hepática en pacientes con diferentes patologías.

Introduction: Real-time two-dimensional shear wave elastography (2D-SWE) (Supersonic Imagine SA), is a non-invasive test used to determine liver elasticity and calculate the degree of liver fibrosis. In Colombia, this test was introduced in 2016 and, to date, no study has tested its behavior in all liver patients, only in healthy and cirrhotic patients. Objective: To analyze the experience of real-time elastography implementation in subjects treated at the Centro de Enfermedades Hepáticas y Digestivas in Bogotá, Colombia. Materials and methods: This is a retrospective descriptive study of a cohort of subjects treated between March 2016 and July 2017. A complete medical report and a real-time elastography (Supersonic) test were performed. Results: 654 subjects were included, with a median age of 55 years (interquartile range [IQR]: 45-64). The median fibrosis values expressed in kilopascals (kPs) were 8.3, with an average of 5 measurements. There was a significant difference in the degree of fibrosis between the age groups and in relation to the final diagnosis, where there was a greater fibrosis in the cholestatic disease group (autoimmune, primary biliary cholangitis [PBC], and overlap). The overall failure rate was less than 1 %. Conclusions: This is the first description of this test behavior in the country. Hepatic stiffness values observed in the different stages demonstrate the usefulness of the test to establish the degree of liver fibrosis in patients with multiple diseases. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility of two elastographic methods, point Shear Wave Elastography (pSWE) and two dimensional Shear Wave Elastography (2D-SWE), integrated in the same ultrasound machine, for liver fibrosis (LF) assessment, using Transient Elastography (TE) as the reference method.Material and Methods: We included in the study 115 subjects in which LF was evaluated in the same session by TE (FibroScan, EchoSens), pSWE and 2D-SWE (Samsung-Medison RS85). Reliable liver stiffness (LS) measurements were defined: for TE the median value of 10 measurements with interquartile range (IQR/M)≤30%,while for pSWE and 2D-SWE the median value of 10 measurements, with a reliability measurement index (RMI)≥0.5 and IQR/M≤30%. For classification of LF severity we used TE as the reference method with the following cut-offs: F2≥7kPa, F3≥9.5kPa and F4≥12kPa.Results: Reliable measurements by TE were obtained in 98.2% of cases (113/115), by pSWE in 93.9% of cases (108/115) and by 2D-SWE in 92.1% of cases (106/115), so the final analysis included 101 patients. We divided the cohort into 3 groups: fibrosis 5.9 kPa [AUROC=0.95, 95%CI(0.89;0.98), p<0.0001, Se=94.1%, Sp=89.5%, PPV=82.1%, NPV=96.8%]; F4 LS >8 kPa [AUROC=0.98, 95%CI(0.94;0.99), p<0.0001, Se=94.4%, Sp=95.1%, PPV=81%, NPV=98.7%], while for 2D-SWE they were: F≥2 LS >6.1 kPa [AUROC=0.93, 95%CI(0.86;0.97), p<0.0001, Se=91.1%, Sp=80.6%, PPV=70.5%, NPV=94.7%]; F4 LS >7.6 kPa [AUROC=0.98, 95%CI(0.93;0.99), p<0.0001, Se=100%, Sp=91.5%, PPV=72%, NPV=100%]. We observed strong correlations between LS values obtained by TE and 2D-SWE (r=0.85), between TE and pSWE (r=0.88) and between pSWE and 2D-SWE (r=0.90) (p=0.37), respectively. There were no significant differences between the mean values obtained by pSWE and 2D-SWE (p=0.96).Conclusion: The pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results. [ABSTRACT FROM AUTHOR]

There is hope that the development of 2D shear wave elastography (2D‐SWE) technology will enhance clinical assessment of muscles. In addition to structural information obtained from traditional sonography, knowledge of muscle biomechanical properties may add diagnostic value in the investigation of pathological processes and functions of the musculoskeletal system. 2D‐SWE offers benefits over traditional biomechanical testing tools and may be adapted to assess muscle at rest, or in contracted or lengthened states. To date, disparate research methodologies and proprietary technological differences limit comparison of research findings. Consensus guidelines exist for clinical utilisation of elastography in fields such as liver, breast and thyroid imaging. Presently, no such consensus has been reached for 2D‐SWE muscle utilisation. This paper explores the current literature to describe the technical considerations and challenges of 2D‐SWE in the assessment of skeletal muscle. [ABSTRACT FROM AUTHOR]

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The aim of this study was to predict the presence of esophageal varices (EVs) by noninvasive tools combined with 2-dimensional shear wave elastography (2D-SWE), and to compare the diagnostic capabilities of 2D-SWE with those of transient elastography (TE). Between January 2015 and December 2017, 289 patients with compensated advanced chronic liver disease (cACLD) who underwent consecutive 2D-SWE and EGD were enrolled. Capabilities for predicting the presence of EVs of 2D-SWE and models combining 2D-SWE with other noninvasive tools (modified LS-spleen-diameter-to-platelet-ratio score [mLSPS], platelet-spleen ratio score) were compared. A subgroup analysis was performed on 177 patients who also underwent simultaneous TE. The area under receiver operating characteristics (AUROCs) for detecting EVs for 2D-SWE alone vs. mLSPS, which included 2D-SWE, were 0.757 (95% confidence interval [CI], 0.701–0.810) and 0.813 (95% CI, 0.763–.857), respectively. The AUROCs for predicting varices needing treatment (VNT) for 2D-SWE and mLSPS were 0.712 (95% CI, 0.621–0.738) and 0.834 (95% CI, 0.785–0.875), respectively. For the 195 patients who underwent simultaneous TE and 2D-SWE, no differences in diagnostic performance were observed. The diagnostic performance of 2D-SWE is similar to that of TE for predicting the presence of EVs. The mLSPS, which includes 2D-SWE, seemed to be useful for predicting EVs. [ABSTRACT FROM AUTHOR]

The present study evaluates the performance of Baveno VI criteria, using liver stiffness (LS) assessed with a 2D-SWE elastography technique, for predicting high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD). A secondary aim was to determine whether the use of spleen stiffness measurements (SSMs), as additional criteria, increases the performance of the 2D-SWE Baveno VI criteria. Data were collected from 208 subjects with cACLD, who underwent abdominal ultrasound, liver and spleen stiffness measurements, and upper digestive endoscopy. HRV were defined as grade 1 esophageal varices (EV) with red wale marks, grade 2/3 EV, and gastric varices. A total of 35.6% (74/208) of the included subjects had HRV. The optimal LS cut-off value for predicting HRV was 12 kPa (AUROC-0.80). Using both LS cut-off value < 12 kPa and a platelet cut-off value > 150 × 109 cells/L as criteria to exclude HRV, 52/208 (25%) subjects were selected, 88.5% (46/52) were without EV, 9.6% (5/52) had grade 1 EV, and 1.9% (1/52) had HRV. Thus 98% of the subjects were correctly classified as having or not having HRV and 25% of the surveillance endoscopies could have been avoided. Using SS < 13.2 kPa and a platelet cut-off value > 150 × 109 cells/L as additional criteria for the patients that were outside the initial ones, 32.7% of the surveillance endoscopies could have been avoided.

Aim: To evaluate the ultrasound (US) modifications [grey scale, Doppler, 2D-share wave elastography (2D-SWE)] ofsalivary (parotid and submandibular) and lacrimal glands in healthy people and patients with diabetes mellitus and/or obesity, with or without sialosis.Material and Methods: We evaluated 170 patients (1020 glands, 1700 grey scale and Doppler images), split in two groups (group 1- healthy people, group 2- obese and/or diabetes patients, with or without sialosis). For each patient we assessed the parotid, submandibular and lacrimal glands in grey scale US (echogenicity, homogeneity, glandular contour, posterior border, lymph nodes), color Doppler US and 2D-SWE. All images were analyzed by two examiners blinded to each other or to patients.Results: The interobserver agreement was strong or moderate for all parameters. In group 2, the salivary glands had increased echogenicity, homogeneous aspect and invisible posterior border (all p<0.001). There was no significant variation of elasticity modulus in the groups analyzed (5.46±1.57 vs 5.67±1.81 in parotid, 8.63±1.84 vs 8.55±1.94 in submandibular and 9.47±2.1 vs 9.53±2.23 in lacrimal glands, all p>0.05) or according to the body mass index (BMI), sex, patient age, the aspect in grey scale/Doppler US or the presence of sialosis (all p>0.05).Conclusion: The main US differences between healthy people and patients with diabetes mellitus and/or obesity are suggested by the echogenicity, homogeneity, posterior border and the size of glandular area. No significant differences of elasticity modulus were found between the analyzed groups or related to BMI, sex, patient age or other grey scale/Doppler US items analyzed. [ABSTRACT FROM AUTHOR]

Background: Two‐dimensional shear wave elastography (2D‐SWE) can noninvasively evaluate hepatic elastic modulus as shear wave velocity (SWV). Additionally, it may predict the presence of clinical relevant hepatic fibrosis (≥F2) in dogs with hepatic disease. Objectives: To investigate whether SWV measured by 2D‐SWE can differentiate between dogs with (≥F2) and without (F0‐1) clinically relevant hepatic fibrosis. Animals: Twenty‐eight client‐owned dogs with hepatic disease and 8 normal healthy Beagle dogs were enrolled. Methods: In this cross‐sectional prospective study, SWVs were measured using 2D‐SWE in all dogs. Hepatic fibrosis stages and necroinflammatory activity grades were histopathologically evaluated using a histological scoring scheme that was adapted from the Ishak schema used in human medicine. Results: Median SWVs were significantly higher in dogs with clinically relevant hepatic fibrosis (2.04 m/s; range, 1.81‐2.26 m/s) than in healthy dogs (1.51 m/s; range, 1.44‐1.66 m/s; P =.007), and dogs without clinically relevant hepatic fibrosis (1.56 m/s; range, 1.37‐1.67 m/s; P < .001). However, no significant difference was found in the SWVs between dogs without clinically relevant hepatic fibrosis and healthy dogs (P =.99). Furthermore, median SWVs were not significantly different among dogs with necroinflammatory activity, those without necroinflammatory activity, and healthy dogs (Kruskal‐Wallis test, P =.12). Conclusions and Clinical Importance: The 2D‐SWE may be useful for predicting the presence of hepatic fibrosis in dogs with hepatic disease. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver disease (NAFLD) is common among severely obese patients. Two-dimensional shear wave elastography (2D-SWE) has been validated as a noninvasive diagnostic tool for liver stiffness measurement. However, the technical feasibility and accuracy of this method in severely obese patients are still under debate. Objective: We aimed to assess the diagnostic accuracy of 2D-SWE in bariatric surgery candidates in comparison with the gold standard liver biopsy. Methods: Ninety severely obese candidates for bariatric surgery were included. Liver stiffness was measured using 2D-SWE 14 days before liver biopsy. Liver biopsy was taken on the day of surgery. The area under the receiver operating curve (AUROC) was calculated for the staging of liver fibrosis. Results: 2D-SWE was performed in 97.3% of patients successfully. Histologic stages of fibrosis (F0-F4) were detected in 34.2%, 36%, 6.3%, 3.6%, and 0.9% of patients, respectively. The AUROC for 2D-SWE was 0.77 for F1, 0.72 for F2, 0.77 for F3, and 0.70 for F4. In univariate analysis, 2D-SWE values were correlated with BMI, waist circumference, NAFLD activity score (NAS), and steatosis, whereas these components did not affect liver stiffness in multivariate analysis. Conclusion: Two-dimensional shear wave elastography of the liver can be feasible and has good accuracy in severely obese candidates for bariatric surgery. Therefore, 2D-SWE may be a good option for assessing liver fibrosis, especially in the early stages of fibrosis to lessen complications of surgery in this population. However, this method should be applied on a larger scale for late stage of fibrosis. [ABSTRACT FROM AUTHOR]

In recent years, several non-invasive methods have been developed for staging liver fibrosis in patients with chronic hepatitis C. A 2D-Shear wave elastography (SWE) technique has been recently introduced on the EPIQ 7 US system (ElastQ), but its accuracy has not been validated in patients with chronic hepatitis C virus (HCV) infection. We enrolled 178 HCV patients to assess their liver fibrosis stage with ElastQ software using transient elastography as a reference standard. The best cut-off values to diagnose ≥ F2, ≥ F3, and F4 were 8.15, 10.31, and 12.65 KPa, respectively. Liver stiffness values had a positive correlation with transient elastography (r = 0.57; p < 0.001). The area under the receiver operating characteristics (AUROC) was 0.899 for ≥ F2 (moderate fibrosis), 0.900 for ≥ F3 (severe fibrosis), and 0.899 for cirrhosis. 2D-SWE has excellent accuracy in assessing liver fibrosis in patients with chronic hepatitis C and an excellent correlation with transient elastography.

The main objective of this study was to evaluate the diagnostic value of elastography methods and to provide a head-to-head comparison of real-time strain elastography (RTE) and 2D shear-wave elastography (2D-SWE) techniques in predicting the risk of malignancy of thyroid nodules. Ninety-four thyroid nodules were evaluated using conventional US of the neck, followed by elastography examination with 2 different techniques: RTE with a Hitachi Preirus machine (Hitachi Inc., Japan) and consecutively 2D-SWE with a SuperSonic Mach30 equipment (Supersonic Imagine, France). For RTE, the qualitative Asteria score and the strain ratio (SR) were determined, while for 2D-SWE, the mean (Mean SWE) and maximum (Max SWE) elasticity index (kPa) and the nodule-to-parenchyma SWE ratio were determined. The mean of the 5 measurements was considered in the analysis and the results were compared in all cases to the pathology reports. Out of the 94 nodules, 29 (30.9%) were malignant. The SWE parameters performed as follows: for an optimal cut-off value of 30.5 kPa, the Mean SWE predicts malignancy with a sensitivity of 79.3%, specificity of 95.38%, NPV of 91.2% and PPV of 88.5% (AUROC: 0.912); for the Max SWE, a value above 40.3 kPa has sensitivity of 86.2% and specificity of 81.5% (AUROC 0.877); for a cut-off value of 2.8, the SWE ratio also represents a good parameter, with very good specificity of 92.3% (AUROC 0.851) in detecting thyroid malignancy. The performance of the RTE parameters was for the strain ratio: cutoff >3.9; sensitivity 82.7%; specificity 92.3%, AUROC 0.905 and for the qualitative score: cut-off >2; sensitivity 89.6%; specificity 69.2%; 0.848. Five thyroid cancers were missed by RTE and six malignancies by the SWE evaluation. RTE generated five false positives and SWE, three. Both methods showed great predictions for predicting the malignancy risk. The best elastography parameters were the strain ratio (SR) for RTE was the strain ratio and the mean elasticity index for the 2D-SWE technique. We concluded that elastography adds diagnostic value in predicting malignancy, both when Hitachi RTE or SuperSonic 2D-SWE were used. [ABSTRACT FROM AUTHOR]

Elastography comes as a useful noninvasive tool for the assessment of renal transplant recipients, but there is however a great heterogeneity between the studies performed with different elastographic methods. 2D-shear wave elastography (SWE) PLUS emerges as a novel technique that promises to offer improved renal stiffness measurements due to improved processing algorithms. We performed a cross-sectional study of 35 kidney transplanted patients (13 women, 22 men, with a mean age of 49.4±13 and a mean duration after transplant 10.1±5 years). In every patient, we obtained 5 valid measurements of renal stiffness (obtained from 5 different frames in the cortex of the renal graft), and also tissue viscosity (Viscosity Plane-wave Ultrasound-VI-Plus), with a C6-1X convex transducer using the Ultra-Fast™ software available on the Aixplorer Mach 30 ultrasound system (Supersonic Imagine, Aix-en-Provence, France). The median value of elastographic measurements has been correlated with the demographic and clinical parameters of the patients. We obtained a cut-off value of renal cortical stiffness of <27.3kPa for detection of estimated glomerular filtration rate(eGFR)<60ml/min/1.73m2 with 80% sensitivity and 75% specificity (AUC=0.777, P=0.0001), a cut-off value of <26.9kPa for detection of eGFR<45ml/min/1.73m2 with 70.33% sensitivity and 70% specificity (AUC=0.718, P=0.014) and a cut-off value of <23kPa for detection of eGFR<30ml/min/1.73m2 with 85.7% sensitivity and 75% specificity (AUC=0.837, P<0.001). We found a positive correlation coefficient of renal cortical stiffness and the eGFR (r=0.4855, P=0.0031, 95% CI for r 0.1817 to 0.7048), also with viscosity (r=0.4640, P=0050, 95% CI for r 0.1546 to 0.6905), and a negative correlation with measurement depth (r=-0.3388, P=0.0465, 95% CI for r -0.6038 to -0.0061). No statistically significant correlations were found between mean measures of cortical stiffness and age, hypertension, diabetes, previous glomerular disease, or if the kidney was attained from a living related or a deceased donor or between C reactive protein and viscosity. Renal stiffness in transplanted patients shows a major statistical correlation with renal function, thus kidneys with reduced renal function show significantly decreased stiffness values. More research is needed to validate this technique for it to be used in regular clinical practice. [ABSTRACT FROM AUTHOR]

Background & Aim: This is a prospective study for evaluation of 2D-shear wave elastography (2D-SWE) for characterisation and differentiation of benign und malignant focal liver lesions (FLLs). Methods: The patients referred to our ultrasound unit were prospectively included. B-mode ultrasound and 2D-SWE (Aixplorer® France) were performed for one FLL in each patient. Liver histology and/or contrastenhanced imaging were used as a reference method. Results: 140 patients with FLL were included. SWE acquisitions failed in 24% of them. Therefore, 106 patients with FLL could be analysed, 42/106 with benign and 64/106 with malignant FLLs. The median stiffness for benign FLLs was 16.4 (2.1-71.9) kPa: 16.55 kPa for 18 focal nodular hyperplasia (FNH), 16.35 kPa for 18 hemangioma, 9.8 kPa for 3 focal fatty sparings (FFS), 8.9 kPa for 1 adenoma, 20 kPa for one regenerative node and 29 kPa for one cholangiofibroma, and for the malignant FLLs 36 (4.1-142.9) kPa: 44.8 kPa for 16 hepatocellular carcinoma (HCC), 70.7 kPa for 7 cholangiocarcinoma (CCC) and 29.5 kPa for the 41 metastasis (p<0.001). Malignant FLLs were significantly stiffer than benign FLLs (p<0.0001). Cholangiocarcinomas were the stiffest malignant FFLs with significantly higher values as compared to HCCs and metastases (p=0.033 and p=0.0079, respectively). No significant difference in stiffness could be observed between the different benign FLL entities. No significant difference was observed whether 2D-SWE included the whole FLL, the periphery or only the hardest area of the FLL. Conclusions: 2D-SWE provides further characterising information for interpretation of FLLs and may be useful at least in differentiation of CCCs and HCCs. [ABSTRACT FROM AUTHOR]

OBJECTIVES AND BACKGROUND To evaluate the performance of 2D share wave elastography from General Electric (2D-SWE.GE) for the noninvasive assessment of liver fibrosis and to identify liver stiffness (LS) cut-off values for predicting different stages of fibrosis, using Transient Elastography (TE) as the reference method. MATERIALS AND METHODS The study group included 331 consecutive subjects with or without chronic hepatopathies in whom liver stiffness (LS) was evaluated in the same session by means of 2 elastographic techniques: TE (FibroScan, EchoSens, Paris, France, M or XL probes) and 2D-SWE.GE (LOGIQ E9, GE Healthcare, Chalfont St Giles, United Kingdom, C1-6-D convex probe). Reliable LS measurements were defined as follows: for TE – the median value of 10 measurements with a success rate of ≥60% and an interquartile range

Liver fibrosis is a progressive process leading to liver cirrhosis. Several non-invasive elastography techniques were developed in order to perform liver stiffness measurements (LS). The aim of this study was to evaluate the performance and feasibility of 2D-Shear Wave Elastography (2D-SWE) for liver fibrosis (LF) assessment using Transient Elastography (TE) as the reference method. 67 subjects were included, 65% (44/67) male, mean age 55.6 ± 13.2, in which LS was evaluated in the same session by TE (FibroScan Compact M 530) and 2D-SWE (Samsung-Medison RS85). Reliable LS measurements were defined for TE the median value of 10 measurements with an IQR/M≤30%, while for 2D-SWE the median value of 10 measurements, with a reliability measurement index (RMI)≥ 0.5 and IQR/M ≤30%. For classification of LF severity we used TE as reference method with cut-off value ≥ 7 kPa for at least significant liver fibrosis [1]. Reliable measurements by TE and 2D-SWE were obtained in all 67 cases. A strong correlation was found between 2D-SWE and TE, r=0.83. The best cut-off value for 2D-SWE in identifying at least significant fibrosis (F≥2) was >7 kPa [AUROC=0.91, 95% CI (0.82;0.97), p<0.0001, Se=81.8%, Sp=80.0%, PPV=66.7%, NPV=90.0%]. 2D-SWE is a feasible method for assessing liver fibrosis, that strongly correlates with TE results. [ABSTRACT FROM AUTHOR]

Two-dimensional shear wave elastography (2D-SWE) is an accurate method for the non-invasive evaluation of liver fibrosis. We aimed to determine the reliability criteria and the number of necessary reliable measurements for 2D-SWE. 788 patients with chronic liver disease underwent liver biopsy and 2D-SWE examination in three centers. The 4277 2D-SWE measurements performed were 2:1 randomly divided into derivation (n = 2851) and validation (n = 1426) sets. Reliability criteria for a 2D-SWE measurement were defined in the derivation set from the intrinsic characteristics given by the device (mean liver stiffness, standard deviation, diameter of the region of interest), with further evaluation in the validation set. In the whole population of 4277 measurements, AUROC for bridging fibrosis was 0.825 ± 0.006 and AUROC for cirrhosis was 0.880 ± 0.006. Mean stiffness and coefficient of variation (CV) were independent predictors of bridging fibrosis or cirrhosis. From these two parameters, new criteria were derived to define a reliable 2D-SWE measurement: stiffness <8.8 kPa, or stiffness between 8.8-11.9 kPa with CV <0.25, or stiffness ≥12.0 kPa with CV <0.10. In the validation set, AUROC for bridging fibrosis was 0.830 ± 0.013 in reliable measurements vs 0.667 ± 0.031 in unreliable measurements (P <.001). AUROC for cirrhosis was 0.918±0.014 vs 0.714 ± 0.027, respectively (P <.001). The best diagnostic accuracy for a 2D-SWE examination was achieved from three reliable measurements. Reliability of a 2D-SWE measurement relies on the coefficient of variation and the liver stiffness level. A 2D-SWE examination should include three reliable measurements according to our new criteria. [Display omitted] [ABSTRACT FROM AUTHOR]