How to order an abdominal ultrasound (US) with elastography?

From the Guidelines

To order an abdominal US with elastography, specifically request "abdominal ultrasound with shear wave elastography" and include relevant clinical information, such as chronic liver disease or suspected cirrhosis, to ensure accurate assessment of liver fibrosis and stiffness. When contacting the radiology department, it is essential to clearly indicate the need for elastography in addition to the standard abdominal ultrasound, as this technique extends the capabilities of conventional US by assessing tissue deformation in response to high-intensity US pulses and the generation of shear waves, from which deductions about tissue stiffness can be made 1.

Key Considerations for Ordering Abdominal US with Elastography

• Include relevant clinical information, such as diagnosis, laboratory values, and specific clinical questions, to ensure accurate assessment and interpretation of results
• Patients should fast for 4-6 hours before the examination to reduce bowel gas and improve image quality
• Elastography is particularly useful for non-invasively assessing liver fibrosis and stiffness, potentially avoiding the need for liver biopsy, with a reported area under the receiver operating characteristic curves of 0.88 for predicting advanced stages of fibrosis and 0.91 for cirrhosis 1
• The procedure measures the speed of shear waves through liver tissue—faster waves indicate stiffer tissue and more advanced fibrosis
• The entire examination typically takes 30-45 minutes and provides quantitative measurements of tissue stiffness that can be tracked over time

Clinical Applications and Benefits

• Abdominal US with elastography is useful for assessing chronic liver disease, suspected cirrhosis, and viral hepatitis
• This technique can help avoid the need for liver biopsy and provide a non-invasive assessment of liver fibrosis and stiffness
• The results can be used to track changes in tissue stiffness over time, allowing for monitoring of disease progression and response to treatment 1

From the Research

Ordering an Abdominal US with Elastography

To order an abdominal US with elastography, consider the following steps:

• Identify the clinical indication for the exam, such as liver fibrosis assessment or chronic liver disease evaluation 2, 3, 4, 5, 6
• Choose the appropriate ultrasound-based elastography technique, including strain elastography, two-dimensional shear wave elastography (2D-SWE), point shear wave elastography (pSWE), or vibration-controlled transient elastography (VCTE) 3, 5
• Consider the technical and biological factors that may affect the results of US elastography, such as liver stiffness measurement (LSM) and estimated Young's modulus (eYM) 2, 4, 6
• Ensure that the clinician performing the exam is aware of the factors that can affect the results and is trained to interpret the elastography images 2, 5

Clinical Applications of Elastography

Elastography has various clinical applications, including:

• Liver fibrosis assessment and staging 3, 4, 5, 6
• Detection of advanced liver fibrosis and cirrhosis 3, 6
• Liver decompensation prediction and differentiation of non-alcoholic steatohepatitis (NASH) from simple steatosis (SS) 3
• Monitoring treatment response and guiding treatment strategy 4, 6