Shear wave elastography and fibrosis-4 index for assessing liver fibrosis after hepatectomy in cirrhotic patients

Abstract

BACKGROUND

Noninvasive assessment of residual liver fibrosis after hepatectomy in patients with cirrhosis remains challenging. While shear wave elastography (SWE) and the fibrosis-4 (FIB-4) index can both be used individually for fibrosis assessment, their combined value in predicting post-hepatectomy fibrosis has not been established. We hypothesize that combining preoperative SWE with FIB-4 may more accurately predict significant postoperative liver fibrosis compared to using either method alone.

AIM

To assess whether preoperative SWE plus FIB-4 can predict significant liver fibrosis after hepatectomy in patients with cirrhosis.

METHODS

This retrospective study included 128 patients with cirrhosis who underwent hepatectomy at a tertiary hospital from January 2023 to October 2025. Postoperative histopathology divided patients into two groups: 85 patients with significant postoperative fibrosis (Scheuer ≥ S2) and 43 patients without significant postoperative fibrosis. Preoperative shear wave SWE, FIB-4, and laboratory indicators were collected. Multivariate logistic regression and receiver operating characteristic curve analysis were used, and the area under the curve (AUC) was calculated to assess predictive performance.

RESULTS

Multivariable analysis identified total bilirubin [odds ratio (OR) = 1.543, 95% confidence interval (CI): 1.038-2.294, P = 0.032], FIB-4 (OR = 4.716, 95%CI: 2.026-10.977, P < 0.001), and SWE (OR = 1.659, 95%CI: 1.211-2.273, P = 0.002) as independent predictors. Receiver operating characteristic curve analysis showed that both FIB-4 (AUC = 0.952) and SWE (AUC = 0.870) exhibited good predictive performance. When FIB-4 and SWE were used together, the AUC value reached 0.979, which was better than using either indicator alone.

CONCLUSION

Preoperative SWE combined with FIB-4 index has high predictive accuracy for significant fibrosis after liver resection in patients with cirrhosis, and is helpful for preoperative risk stratification.

Keywords: Shear wave elastography; Fibrosis-4 index; Liver cirrhosis; Hepatectomy; Liver fibrosis; Non-invasive assessment; Preoperative risk stratification

Core Tip: This study demonstrates that combining preoperative shear wave elastography with the fibrosis-4 index significantly improves the predictive accuracy of significant liver fibrosis after hepatectomy in patients with cirrhosis. The combined model achieved an area under the curve of 0.979, superior to either index alone. This non-invasive and easy-to-implement strategy facilitates more accurate preoperative risk stratification and individualized surgical planning, potentially improving patient outcomes.