CHICAGO - COVID-19 patients who underwent ultrasound shear-wave elastography showed increased liver stiffness up to 10 months after infection, according to research presented December 1 at RSNA 2022.
Dr. Firouzeh Heidari. Image courtesy of the RSNA.The study adds to emerging evidence that COVID-19 infection may lead to liver injury that lasts well after the acute illness, said presenter Dr. Firouzeh Heidari of the Massachusetts General Hospital in Boston.
"We don't yet know if elevated liver stiffness observed after COVID-19 infection will lead to adverse patient outcomes," Heidari noted in an RSNA statement.
Liver stiffness is a marker of liver damage, such as fibrosis, which is the buildup of scar tissue in the liver. Over time, as healthy liver tissue diminishes, the liver can no longer function properly, and this can lead to liver failure.
Heidari and colleagues studied liver stiffness in 131 patients who underwent shear-wave elastography at Massachusetts General between 2019 and 2022. Patients were split into three groups based on when they underwent elastography and whether they tested positive for COVID-19.
One COVID-19-positive group included 31 patients who had a positive COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test result at least 12 weeks before the elastography exam. Two control groups consisted of a random sample of 50 patients who underwent elastography during the COVID-19 pandemic and had a history of only negative COVID-19 PCR test results and a cohort of 50 patients who underwent an elastography exam prior to the COVID-19 pandemic.
In the COVID-positive group, elastography exams were performed an average of 44 weeks after a positive PCR test result.
After controlling for age, sex, and time period, a comparison of the elastography results among the groups showed that COVID-positive patients had a statistically significant higher liver stiffness than the control patients, and higher median liver stiffness (7.68 kPa) than pandemic control patients (5.99 kPa).
Additional research is warranted, Heidari said.
"We hope to enrich our existing database with additional patient data and a broader scope of co-variates to better understand the post-acute effects of COVID-19 within the liver," she stated.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
