How many times should we repeat measuring liver stiffness using shear wave elastography? 5-repetition versus 10-repetition protocols

The purpose of this study is to evaluate whether a 5-repetition liver stiffness (LS) measurement as the standard protocol of shear wave elastography (SWE) is comparable to a conventional 10-repetition measurement protocol and to identify factors that influence the reliability of the 5-repetition protocol. A total of 346 patients (mean, 48.0 years; range, 15–81 years, M:F = 192:154) who underwent SWE were enrolled. The median, first quartile, third quartile, and interquartile range divided by the median (IQR/M) of LS measurement were calculated and compared between 5-repetition and 10-repetition protocols. Subgroup analyses were also performed to identify factors associated with measurement reliability. The overall mean LS from the 10-repetition protocol was 7.97 kPa, which was not significantly different from the mean LS of the 5-repetition protocol (7.91 kPa; p = 0.192). However, the third quartile and IQR/M values of the two groups were significantly different from each other (p = 0.003 and <0.001). Subgroup analysis revealed that the 5-repetition results were significantly different from the 10-repetition results in the fatty liver and high LS subgroups. Therefore, the 5-repetition SWE measurement protocol can replace the conventional 10-repetition protocol, with the exception of patients with fatty liver disease or an LS value higher than 10 kPa.