Background: Metabolic-associated fatty liver disease (MAFLD) is common among patients with class 3 obesity, and weight loss may result in reduction in this stiffness. Two-dimensional shear wave elastography (2D-SWE) is a non-invasive diagnostic tool using ultrasonography and shear wave velocity for measuring liver stiffness. The aim of this study was to compare the liver fibrosis scores using 2D-SWE in patients with class 3 obesity at baseline and after 12 months in a medical weight management program (WMP).
Methods: Prospective cohort study conducted in a publicly funded multidisciplinary (WMP) in Sydney. Participants were ≥18 years, BMI ≥40 kg/m2, and had at least one obesity-related comorbidity. 2D-SWE was performed using the ElastQ Imaging (EQI) procedure with the Phillips EPIQ Elite series for all participants at baseline and 12 months. A reliable reading was considered when the EQI interquartile range divided by EQI Median was <30%, and an EQI Median value (of 10 readings) of ≥6.43 kPa was considered significant fibrosis (≥F2), as per the validated literature and manufacturer instructions.
Results: Participants (n=31; 61.3% female; 67.7% Caucasians; 54.8% T2DM) were aged 51.8±14.8 (Mean±SD) years, with baseline mean weight 145.4±32.5kg, and BMI 52.7±10.9kg/m². Reliable EQI Median values were obtained from 100% of the 2D SWE scans at baseline and 12 months. After 12 months in the WMP, weight loss was significant at 10.1±13.9kg (6.7±8.5% body weight) p=<0.001, with a significant drop in EQI Median score (5.3±1.7 to 4.5±1.1, p=0.009) and the percentage with significant fibrosis dropped from baseline to 12 months from 16.1% (5/31) to 3.2% (1/31), p=0.01.
Conclusions: Reliable EQI median values were obtained from 2D-SWE in all patients despite the high baseline BMI, with a significant improvement in liver fibrosis scores with 2D-SWE assessment following moderate weight loss at 12 months in a medical WMP.