Ultrasonography.  2026 Jan;45(1):69-79. 10.14366/usg.25161.

Fully automated frame selection and region-of-interest placement in 2D shear wave elastography: reduced examination time with comparable reproducibility in diffuse liver disease

• Kang HJ
• Yoon JH
• Lee JM

• KMID: 2575158
• DOI: http://doi.org/10.14366/usg.25161

Abstract

Purpose
This study evaluated the clinical utility of a fully automated two-dimensional shear wave elastography (2D-SWE) method incorporating automated frame selection and region-of-interest (ROI) placement algorithms in participants with diffuse liver disease. The analysis assessed examination time and reproducibility compared with semi-automated and manual methods.
Methods
This prospective study included 40 participants who underwent liver stiffness measurements with a Samsung Medison ultrasound system using three methods: fully automated (automated frame selection via a reliability indicator derived from elasticity uniformity and the reliability measurement index, with automated ROI placement); semi-automated (automated frame selection with manual ROI placement); and manual (fully operator-controlled). Examination time and inter-method (n=40), intra-observer (n=21), and inter-observer (n=15) variabilities were analyzed using analysis of variance, paired t-tests, and intraclass correlation coefficients (ICCs). All participants underwent comparative measurements with a Canon i800 system for cross-platform analysis.
Results
One technical failure each occurred during the intra-observer and cross-platform measurement sessions. Fully automated measurement significantly reduced total examination time (14.38±5.01 seconds) compared to semi-automated (30.46±7.11 seconds, P<0.001) and manual (33.05±7.10 seconds, P<0.001) measurements. No significant differences in liver stiffness were observed among methods (P=0.556). Inter-method agreement was excellent (ICC, 0.997). Intra-observer and inter-observer agreements were also excellent with the fully automated method (ICCs, 0.971 and 0.984, respectively). Good cross-platform agreement with the Canon system was observed (ICC, 0.833).
Conclusion
Fully automated 2D-SWE markedly reduces examination time while maintaining high reproducibility in liver stiffness assessment.

Keyword

Shear wave elastography; Liver cirrhosis; Automated imaging; Reproducibility; Observer variability