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Shear Wave Elastography: non-invasive liver fibrosis assessment

Clinical Need

It is estimated that 500 million people are affected by chronic viral hepatitis worldwide, of which 1 million people will die of their illness every year, primarily from cirrhosis or hepatocellular carcinoma as a result of their infection. Histological analysis of the liver is still considered the reference standard in the assessment of liver fibrosis despite the intra- and inter-observer variation in staging and some morbidity and mortality risks. Thus, noninvasive methods for assessing liver fibrosis are of great clinical interest. Ultrasound-based techniques to estimate the stage of liver fibrosis have become commercially available. They all have the capability to noninvasively evaluate differences in the elastic properties of soft tissues by measuring tissue behavior when a mechanical stress is applied. Shear wave elastography relies on the generation of shear waves determined by the displacement of tissues induced by the force of a focused ultrasound beam or by an external push.


QElaXto is Esaote’s innovative approach to point shear wave elastography. The shear waves are lateral waves, with a motion perpendicular to the direction of the force that has generated them. They travel slowly (between 1 and 10 m/s) and are rapidly attenuated by tissue. The propagation velocity of the shear waves correlates with the elasticity of tissue; that is, it increases with increasing stiffness of the examined tissues.

How does it work?

QElaXto delivers a quantitative measure of tissue stiffness (expressed in shear wave propagation velocity or deduced Young’s modulus in KPa) for a small tissue sample. QElaXto is based on a perturbation and a reading phase, and the system has a set value of measurement rejection, which skips the values outside the accepted range.

3D eWave

3D eWave is the three-dimensional representation of the shear wave generated with QElaXto. It provides feedback about the quality of the shear wave produced.

Esaote pSWE Advantages

  • Non-invasive solution for evaluating fibrosis
  • An alternative to the gold standard (biopsy)
  • Significantly less expensive than magnetic resonance elastography (MRE)
  • Indication of shock and gate locations: allows the operator to select suitable measurement areas
  • 3D eWave shear wave quality graph for immediate feedback about measurement quality
  • Automatic reliability tool for performed measurements based on statistical analysis of acquired RF signals: accept or skip measurement
  • Workflow in line with clinical needs (developed together with multiple expert clinical sites)


QElaXto offers multiple Indexes and Measurements available in m/s and KPa with selection possible in real-time.


QElaXto embeds an Esaote patent-pending technology for innovative motion artifact correction plus advanced SW for motion correction algorithm for smart selection of reliable measurements.


QElaXto user interface optimized for productivity and fully customizable:

  • Ergonomics and productivity workflow: palm distance controls
  • Auto-unfreeze after the cooling cycle
  • Audio feedback when cooling ends
  • Clearing of info window when measurement protocol completed
  • ROI depth indication
  • Quick cooling pause for improved productivity and faster examinations
  • Cooling indication (snowflake) directly at the measurement site for immediate feedback
  • Automatic saving of images with each measurement
  • Freedom of measurement selection/deletion and real-time updating of related statistics
  • Complete report and worksheet


Virtual Navigator

Esaote QElaXto pSWE is available also with Virtual Navigator Real-time Multimodality Fusion Imaging and Virtual Biopsy with Measurements available in m/s and KPa (selection possible in real-time).



Technology and features are system/configuration dependent. Specifications subject to change without notice. Information might refer to products or modalities not yet approved in all countries. Product images are for illustrative purposes only. For further details, please contact your Esaote sales representative.