Case discussion
01Clinical context
A patient with known chronic hepatitis B underwent quantitative liver ultrasound to assess hepatic steatosis and fibrosis using shear-wave elastography and multiparametric fat quantification.
02Key imaging findings
Shear-wave elastography showed elevated liver stiffness with a median of 11.5 kPa and median shear-wave velocity of 1.93 m/s, consistent with concern for hepatic fibrosis. Multiparametric fat quantification parameters (USAT, HRI+, LTI) did not indicate significant hepatic steatosis. Laboratory tests showed normal liver enzymes and preserved platelet count at the time of imaging.
03Diagnostic reasoning
The diagnosis was reached using multiparametric quantitative liver ultrasound, including shear-wave tissue stiffness quantification (STQ) to measure liver stiffness and shear-wave velocity. Multiple regions of interest were sampled to ensure measurement reliability. Quantitative parameters for hepatic fat (USAT, HRI+, LTI) were also obtained to assess steatosis. The combination of elevated stiffness with normal fat quantification and reassuring laboratory values guided the interpretation towards hepatic fibrosis without significant steatosis.
04Questions for clinical practice
What is the significance of the elevated liver stiffness? Elevated stiffness suggests hepatic fibrosis, which requires further evaluation to determine severity and guide management. How reliable is shear-wave elastography alone for fibrosis staging? It provides useful information but cannot definitively stage fibrosis; additional tests like transient elastography are recommended. Does the absence of significant steatosis affect management? Yes, it helps focus treatment on fibrosis and underlying hepatitis rather than fatty liver disease. When should follow-up imaging or biopsy be considered? Follow-up depends on clinical context and hepatology consultation; biopsy may be reserved for uncertain or advanced cases.
05Teaching point
Shear-wave elastography provides a reliable non-invasive measure of liver stiffness, useful for detecting hepatic fibrosis in chronic hepatitis B. However, elastography alone cannot definitively stage fibrosis; further non-invasive tests like transient elastography (FibroScan) are recommended for comprehensive assessment. Multiparametric ultrasound fat quantification helps exclude significant steatosis, aiding clinical management.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.