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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Shear wave elastography in healthy patients: Pancreatic stiffness is less reliable than liver and spleen measurements
Nicholas Viceconti, Mattia Paratore, Fabio Del Zompo, Maria Assunta Zocco, Maria Elena Ainora, Giorgio Esposto, Antonio Gasbarrini, Maurizio Pompili, Laura Riccardi, Matteo Garcovich
Nicholas Viceconti, Mattia Paratore, Laura Riccardi, Matteo Garcovich, Diagnostic and Interventional Ultrasound Unit, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Fabio Del Zompo, Maria Assunta Zocco, Maria Elena Ainora, Giorgio Esposto, Antonio Gasbarrini, Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Gemelli IRCCS, Rome 00168, Italy
Maria Assunta Zocco, Antonio Gasbarrini, Maurizio Pompili, Translational Medicine and Surgery Department, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome 00168, Italy
Maurizio Pompili, Internal Medicine and Liver Transplantation Unit, Fondazione Policlinico Universitario Gemelli IRCCS, Rome 00168, Italy
Author contributions: Viceconti N, Garcovich M, Del Zompo F, Riccardi L, and Garcovich M contributed to conceptualization, investigation, and editing; Viceconti N and Garcovich M contributed to study design, supervision, writing the first draft, and review; Paratore M, Riccardi L, and Garcovich M contributed to acquisition, analysis, and interpretation of data; all authors revised the manuscript critically for intellectual content and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Comitato Etico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, No. 3584.
Informed consent statement: Each patient agreed to participate in the study by written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All participants’ personal data were anonymized before analysis, and data handling fully complied with the General Data Protection Regulation (EU) 2016/679 (GDPR) and applicable national privacy laws. The authors can provide datasets upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mattia Paratore, MD, Diagnostic and Interventional Ultrasound Unit, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
mattia.paratore@guest.policlinicogemelli.it
Received: July 8, 2025
Revised: September 15, 2025
Accepted: November 6, 2025
Published online: November 28, 2025
Processing time: 142 Days and 11.4 Hours
BACKGROUND
Shear wave elastography (SWE) is a non-invasive ultrasound-based technique used to assess tissue stiffness, which reflects underlying pathological changes. While SWE has been widely applied for liver fibrosis evaluation, its application to other abdominal organs, such as the spleen and pancreas, is gaining interest. However, normal stiffness values and inter-system agreement remain poorly defined.
AIM
To assess the feasibility and agreement of liver, spleen, and pancreas stiffness using three SWE methods.
METHODS
This single-center observational study enrolled 50 healthy adult volunteers. Liver, spleen, and pancreas stiffness were assessed using three SWE methods: Point-SWE (p-QElaXto) and 2-Dimensional-SWE (2D-QElaXto) with Esaote MyLab 9, and 2D-SWE with SuperSonic Imagine. Feasibility, inter-operator reproducibility, and concordance among systems were evaluated. Stiffness was expressed as median kPa values, and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds.
RESULTS
Liver and spleen stiffness assessment was feasible in > 98% of patients, while pancreas stiffness was measurable in 84%-88% depending on the SWE technique. Mean liver stiffness ranged between 3.9-4.7 kPa across techniques, spleen stiffness ranged from 19.4-23.0 kPa, and pancreas stiffness from 5.2-7.6 kPa. Inter-operator agreement was excellent for liver (intraclass correlation coefficient > 0.90) and good to moderate for spleen and pancreas (intraclass correlation coefficient from 0.43 to 0.90). Bland-Altman analysis confirmed good correlation but also systematic differences among devices, especially in pancreas measurements.
CONCLUSION
This is the first study to establish normal liver, spleen, and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine, with acceptable inter-technique agreement. Liver and spleen values matched existing guidelines; pancreas SWE showed more variability and reduced reproducibility.
Core Tip: In the literature, normal stiffness values for liver, spleen, and pancreas in healthy individuals are not well established. This is partly due to differences in equipment and cut-off values used, and partly due to inter-operator variability. In this study, we evaluated these parameters in 50 healthy individuals using three different methods (two of which were integrated into the same scan) to assess their correlation with clinical and technical features.
