Advances in endoscopic ultrasound-guided shear wave elastography: A comprehensive review of its clinical applications

Table 2 Endoscopic ultrasound-guided shear wave elastography in liver diseases

Ref.	Design	Population	Techniques	Reference standard	Results
AbiMansour et al[27]	Prospective, single-center	Patients undergoing EUS for various indications; subset analyzed for liver disease staging	EUS-SWE performed in the left lobe of the liver during EUS	VCTE and clinical diagnosis of advanced liver disease	Patients with advanced liver disease showed higher values of EUS-SWE compared to healthy control: LHL 17.6 kPa vs 12.7 kPa (P < 0.001); RHL 24.8 kPa vs 11.0 kPa (P < 0.001)
Yousaf et al[45]	Prospective + retrospective, single-center	25 patients with suspected chronic liver disease	EUS-SWE (right lobe), EUS-PPG, and concomitant EUS-liver biopsy	Histology (METAVIR), clinical/radiologic criteria	Mean EUS-SWE 24.1 kPa. Significant fibrosis (F2-F4) associated with higher PPG (5.9 mmHg vs 2.5 mmHg, P = 0.003) and higher stiffness (30.0 kPa vs 15.6 kPa, P = 0.02). Advanced fibrosis (F3-F4) vs non-advanced: PPG 6.0 mmHg vs 3.4 mmHg (P = 0.01), EUS-SWE 32.0 kPa vs 18.8 kPa (P = 0.04)
Del Valle et al[40]	Single-center, cross-sectional diagnostic trial (case-control)	59 patients: 29 cirrhosis, 30 controls	EUS-SWE (ROI 10 mm, ≥ 10 measurements in both lobes) vs VCTE	Gold standard: 2-lobe EUS-guided liver biopsy (Kleiner/METAVIR)	Cirrhosis 27 kPa (RHL)/25 kPa (LHL) vs controls 5.6/6.5 kPa (P < 0.001). Accuracy: AUROC 0.97 (RHL), 0.98 (LHL), 0.95 (VCTE). Performance: Se 966% (both lobes), Sp 90% (RHL), 96.7% (LHL). Cut-offs: 10.7 kPa (RHL), 14 kPa (LHL). Agreement: Higher with LHL-EUS-SWE (96.6%) vs RHL (93.2%) and VCTE (91.5%)
Diehl et al[36]	Prospective pilot cohort	52 patients undergoing EUS-guided liver biopsy for abnormal liver function tests or fibrosis staging	EUS-SWE (10 measurements per lobe, VsN > 60% reliable); compared with VCTE	Bilobar EUS-guided liver biopsy (histology, Kleiner/METAVIR)	Correlation with histology: RHL SWE r = 0.57 (P < 0.0001), LHL r = 0.37 (P = 0.0079). Accuracy: AUROC advanced fibrosis F3-4: 0.98 (RHL), 0.95 (LHL), 0.99 (VCTE), no significant differences. Cut-offs: RHL 25.5 kPa (Se 60%, Sp 98%), LHL 22.5 kPa (Se 60%, Sp 83%). Reproducibility: Variance 35 × higher in LHL vs RHL; RHL more reliable
Wang et al[37]	Multicenter, cross-sectional (prospective data)	62 obese patients (BMI ≥ 30) with suspected MASLD/MASH undergoing liver biopsy	EUS-SWE (ROI < 2 cm from transducer, 10 measurements, ROI ≤ 1.5 cm; minimal probe pressure)	Liver biopsy (Brunt criteria); subset comparison with VCTE (n = 19) and FIB-4	Stiffness increased with fibrosis stage (Kruskal-Wallis P < 0.0001). Accuracy (AUROC): F ≥ 20.87, F ≥ 30.93, F4 0.95. Cutoffs (90% Se/90% Sp): F ≥ 27.50/9.82 kPa (PPV/NPV 0.74/0.89 at Se-prioritized; 0.91/0.78 at Spprioritized); F ≥ 38.48/10.20 kPa (PPV/NPV 0.73/0.94; 0.80/0.88); F4 11.30/14.60 kPa (PPV/NPV 0.56/1.00; 0.67/0.98). Comparators: EUSSWE superior to FIB4 for F ≥ 2 and F ≥ 3 (AUROC 0.87 vs 0.61, P = 0.0048; 0.93 vs 0.63, P < 0.0001); vs VCTE in reliable subgroup (n = 19): EUSSWE AUROC 0.93/0.89/0.93 (F ≥ 2/F ≥ 3/F4) vs VCTE 0.84/0.61/0.60 with superiority for F ≥ 3 (P = 0.0067) and F4 (P = 0.0022). Feasibility/safety: No adverse events; IQR/M > 30% in 29%, VsN < 50% in 12.9% (accuracy unchanged in Se analyses)
AbiMansour et al[51]	Prospective, single-center	142 patients undergoing clinically indicated EUS; 13 (9.2%) with CSPH	EUS-SWE of spleen (ROI 1-1.5 cm from probe, ≥ 10 reliable readings, VsN > 60%)	Clinical and radiologic criteria for CSPH	Mean spleen stiffness significantly higher in CSPH vs non-CSPH (37.6 ± 8.5 kPa vs 29.1 ± 9.9 kPa; P = 0.003). AUROC 0.74 for CSPH detection; optimal cut-off 37.6 kPa (Se 692%, Sp 79.8%). Spleen stiffness correlated with liver stiffness measured by EUS-SWE (P = 0.001) and MRE (P = 0.003)
Kohli et al[44]	Single-center, prospective tandem study	42 patients undergoing liver biopsy	EUS-SWE (left and right lobes separately) vs VCTE	Liver biopsy (histology, fibrosis staging)	AUROC for advanced fibrosis: VCTE 0.87, EUS-SWE left lobe 080, right lobe 078. AUROC for cirrhosis: VCTE 0.90, EUS-SWE left lobe 096, right lobe 090. VCTE unreliable in 8 patients who all had successful EUS-SWE

EUS: Endoscopic ultrasound; BMI: Body mass index; MASLD: Metabolic dysfunction-associated steatotic liver disease; MASH: Metabolic dysfunction-associated steatohepatitis; CSPH: Clinically significant portal hypertension; SWE: Shear wave elastography; PPG: Portal pressure gradient; ROI: Region of interest; VCTE: Vibration-controlled transient elastography; VsN: Net effective shear wave velocity; FIB-4: Fibrosis-4 index; RHL: Right hepatic lobe; LHL: Left hepatic lobe; AUROC: Area under the receiver operating characteristic; Se: Sensitivity; Sp: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; IQR/M: Interquartile range-to-median ratio; MRE: Magnetic resonance elastography.