Imaging, QoL and Patient-Reported Outcome and Supportive Care

Category: Imaging, QoL and Patient-Reported Outcome and Supportive Care

Diagnostic potential of shear wave elastography for liver involvement in AL amyloidosis

(PA-155) Diagnostic Potential of Shear Wave Elastography for Liver Involvement in AL Amyloidosis

Friday, September 19, 2025

Ryohei Sumitani, MD

Assistant professor
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences

Introduction: Liver involvement is frequently observed in patients with systemic immunoglobulin light-chain (AL) amyloidosis. Although liver biopsy remains the gold standard for diagnosis, it is invasive and associated with a risk of bleeding. In clinical practice, liver involvement is assessed using total liver span and serum alkaline phosphatase (ALP) levels; however, hepatomegaly and elevated serum ALP levels may also occur with different pathologic conditions, including drug-induced liver disease or chronic liver disease. Therefore, a non-invasive and accurate diagnostic approach is needed. Shear wave elastography (SWE) is a non-invasive and repeatable radiation-free technique for the quantitative measurement of tissue elasticity and is currently applied to evaluate liver stiffness. This study was undertaken to evaluate the diagnostic potential of SWE for liver involvement in AL amyloidosis.

Methods:   We retrospectively analyzed 25 patients with biopsy-proven AL amyloidosis who underwent SWE at Tokushima University Hospital between September 2019 and February 2025. Liver involvement was defined according to the current consensus criteria: hepatomegaly (total liver span ≥15 cm) or serum ALP levels >1.5 times the institutional upper limit of normal. Patients with significant ascites, alcohol use, congestive heart failure, or chronic liver disease were excluded. Ultrasound hepatic shear wave velocity (SWV) was measured from the right intercostal space using the C1-6 convex probe on a high-end ultrasound system, Logiq E10. (GE Healthcare, Japan). We also assessed the value of biochemical markers as complementary indicators of liver involvement, including γ-GTP, ALP, AST, ALT, total bilirubin (T-Bil.), albumin (ALB), and prothrombin time (PT).

Results:   Among the 25 patients (median age: 67 years, range: 51–86), 8 had liver involvement. The mean hepatic SWV was significantly higher in patients with liver involvement than those without (1.93 ± 0.39 vs 1.36 ± 0.11 m/s, p=0.00099). Similarly, γ-GTP levels were elevated in the liver involvement group (165 ± 131 vs 36 ± 28 U/L, p=0.00222). Both SWV and γ-GTP showed positive correlations with serum ALP levels and total liver span. No significant differences were observed in AST, ALT, T-Bil., ALB, or PT between the groups. Receiver operating characteristic (ROC) curve analysis yielded an area under the curve (AUC) of 0.915 for SWV and 0.886 for γ-GTP. The cut-off value for SWV was 1.62 m/s (sensitivity 1.000, specificity 0.875), and for γ-GTP was 68 U/L (sensitivity 0.882, specificity 0.750), respectively.

Conclusions:   SWE represents an accurate, non-invasive imaging modality for detecting liver involvement in AL amyloidosis. γ-GTP also could have the diagnostic potential alongside conventional criteria. Further multicenter, prospective studies are warranted to validate the clinical applicability of SWE and to explore the pathological basis of increased liver stiffness in patients with AL amyloidosis.