The Two-Dimensional Shear Wave Elastography (2D-SWE) in Assessing Abdominal Aortic Wall Stiffness

ORIGINAL ARTICLE
Salahaden R. Sultan, Lojain Alsayegh, Hajer B. Almsaari, Mohammad Khalil, Abrar Alfatni, Reham Kaifi, Mohammed Alkharaiji, Adel Alzahrani, Mohammed Aslam

 
For citation: Sultan SR, Alsayegh L, Almsaari HB, Khalil M, Alfatni A, Kaifi R, Alkharaiji M, Alzahrani A, Aslam M. The Two-Dimensional Shear Wave Elastography (2D-SWE) in Assessing Abdominal Aortic Wall Stiffness. International Journal of Biomedicine. 2025;15(4):690-694. doi:10.21103/Article15(4)_OA7
 
Originally published December 5, 2025

Abstract: 

Background: Ultrasound elastography, a non-invasive imaging modality, holds promise for assessing tissue stiffness, offering potential applications in the evaluation of cardiovascular disease. This study aimed to quantify local stiffness of the abdominal aortic wall using two-dimensional shear wave elastography (2D-SWE) in adults without underlying medical conditions, and to evaluate its reproducibility.
Methods and Results:2D-SWE measurements of infra-renal posterior wall of the abdominal aorta (PWoAA) were obtained from 50 subjects. For intra- and inter-observer reproducibility, five 2D-SWE measurements of PWoAA were averaged, and the measurements were performed two times by observer A and once by observer B (n=750). Intraclass correlation coefficient (ICC) and Bland-Altman plot were used to establish bias and limit of agreement (LoA) between PWoAA elasticity measurements.
Ultrasound 2D-SWE of PWoAA was 3.87±0.99 kPa. Intra-observer agreement of PWoAA ultrasound 2D-SWE elasticity measurements was moderate with an ICC value of 0.69 (95% CI: 0.56 – 0.82, P<0.001). Bias in intra-observer measurements was 0.18±0.92 kPa (95% LoA: -1.62 – 1.99). Similarly, inter-observer agreement was moderate with an ICC value of 0.56 (95% CI: 0.22 – 0.75, P=0.002). Bias in inter-observer measurements was -0.02±1.09 kPa (95% LoA: -2.16 – 2.11). There was no significant difference in the 2D-SWE measurements of the aortic walls, both within the same observer (mean difference [MD] 0.17, 95% CI: 0.07–0.44, P=0.16)) and between two different observers (MD=0.02, 95% CI: 0.33–0.28, P=0.86).
Conclusion: Our findings demonstrated moderate reproducibility of ultrasound 2D-SWE in assessing abdominal aortic wall elasticity, with no significant differences within or between observers. Further research is warranted to optimize the clinical application of this method for assessing arterial wall stiffness, particularly in patients with cardiovascular disease, including those with abdominal aortic aneurysms.

Keywords: 
ultrasound elastography • 2D-SWE • aortic stiffness
References: 
  1. Sethi S, Rivera O, Oliveros R, Chilton R. Aortic stiffness: pathophysiology, clinical implications, and approach to treatment. Integr Blood Press Control. 2014 May 23;7:29-34. doi: 10.2147/IBPC.S59535. PMID: 24910511; PMCID: PMC4046515.
  2. Angoff R, Mosarla RC, Tsao CW. Aortic Stiffness: Epidemiology, Risk Factors, and Relevant Biomarkers. Front Cardiovasc Med. 2021 Nov 8;8:709396. doi: 10.3389/fcvm.2021.709396. PMID: 34820427; PMCID: PMC8606645.
  3. Karlsson J, Stålhand J, Carlhäll CJ, Länne T, Engvall J. Abdominal Aortic Wall Cross-coupled Stiffness Could Potentially Contribute to Aortic Length Remodeling. Artery Res. 2022;28(4):113–27.
  4. Salvi P, Scalise F, Rovina M, Moretti F, Salvi L, Grillo A, Gao L, Baldi C, Faini A, Furlanis G, Sorropago A, Millasseau SC, Sorropago G, Carretta R, Avolio AP, Parati G. Noninvasive Estimation of Aortic Stiffness Through Different Approaches. Hypertension. 2019 Jul;74(1):117-129. doi: 10.1161/HYPERTENSIONAHA.119.12853. Epub 2019 May 28. PMID: 31132954.
  5. Parr S, Scheuermann B, Hammond S, Ade CJ. Abstract TP99: Non-invasive Aortic Pulse Wave Velocity Is Related To Gold Standard Carotid-femoral Pulse Wave Velocity: Implications For Monitoring Large Artery Stiffness In The Clinic. Stroke. 2023;54.
  6. Calabia J, Torguet P, Garcia M, Garcia I, Martin N, Guasch B, Faur D, Vallés M. Doppler ultrasound in the measurement of pulse wave velocity: agreement with the Complior method. Cardiovasc Ultrasound. 2011 Apr 15;9:13. doi: 10.1186/1476-7120-9-13. PMID: 21496271; PMCID: PMC3098145.
  7. Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics. 2017 Mar 7;7(5):1303-1329. doi: 10.7150/thno.18650. PMID: 28435467; PMCID: PMC5399595.
  8. Popescu A, Sirli R, Sporea I. 2D Shear Wave Elastography for Liver Fibrosis Evaluation. IntechOpen. 2020.
  9. Weiher M, Richtering FG, Dörffel Y, Müller HP. Simplification of 2D shear wave elastography by enlarged SWE box and multiple regions of interest in one acquisition. PLoS One. 2022 Sep 9;17(9):e0273769. doi: 10.1371/journal.pone.0273769. PMID: 36084083; PMCID: PMC9462759.
  10. Favero G, Paganelli C, Buffoli B, Rodella LF, Rezzani R. Endothelium and its alterations in cardiovascular diseases: life style intervention. Biomed Res Int. 2014;2014:801896. doi: 10.1155/2014/801896. Epub 2014 Feb 26. PMID: 24719887; PMCID: PMC3955677.
  11. Schaafs LA, Tzschätzsch H, Figiel C, van der Giet M, Reshetnik A, Hamm B, Sack I, Elgeti T. Quantitative Time-Harmonic Ultrasound Elastography of the Abdominal Aorta and Inferior Vena Cava. Ultrasound Med Biol. 2019 Sep;45(9):2349-2355. doi: 10.1016/j.ultrasmedbio.2019.05.021. Epub 2019 Jun 11. PMID: 31201021.
  12. Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, Garra B, Myers RP, Wilson SR, Rubens D, Levine D. Elastography Assessment of Liver Fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2015 Sep;276(3):845-61. doi: 10.1148/radiol.2015150619. Epub 2015 Jun 16. PMID: 26079489.
  13. Elgeti T, Fröhlich M, Wismayer KK, Tzschätzsch H, Hamm B, Sack I, Schaafs LA. The effect of smoking on quantification of aortic stiffness by ultrasound time-harmonic elastography. Sci Rep. 2022 Oct 22;12(1):17759. doi: 10.1038/s41598-022-22638-7. PMID: 36273020; PMCID: PMC9588008.
  14. Schaafs LA, Tzschätzsch H, van der Giet M, Reshetnik A, Steffen IG, Hamm B, Braun J, Sack I, Elgeti T. Time-Harmonic Ultrasound elastography of the Descending Abdominal Aorta: Initial Results. Ultrasound Med Biol. 2017 Nov;43(11):2550-2557. doi: 10.1016/j.ultrasmedbio.2017.07.001. Epub 2017 Aug 14. PMID: 28818306.
  15. Collette M, Humeau A, Chevalier C, Hamel JF, Leftheriotis G. Assessment of aortic stiffness by local and regional methods. Hypertens Res. 2011 May;34(5):578-83. doi: 10.1038/hr.2010.280. Epub 2011 Jan 27. PMID: 21270814.
  16. Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol. 2011 Apr 5;57(14):1511-22. doi: 10.1016/j.jacc.2010.12.017. PMID: 21453829.
  17. Wang J, Jing C, Hu X, Cui J, Tang Q, Tu L, Zhao S, Huang J, Guo D, Li Y, Xu J. Assessment of aortic to peripheral vascular stiffness and gradient by segmented upper limb PWV in healthy and hypertensive individuals. Sci Rep. 2023 Nov 13;13(1):19859. doi: 10.1038/s41598-023-46932-0. PMID: 37963909; PMCID: PMC10645764.
  18. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, Ferraioli G, Friedrich-Rust M, Gilja OH, Goertz RS, Karlas T, de Knegt R, de Ledinghen V, Piscaglia F, Procopet B, Saftoiu A, Sidhu PS, Sporea I, Thiele M. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med. 2017 Aug;38(4):e48. English. doi: 10.1055/a-0641-0076. Epub 2018 Sep 3. Erratum for: Ultraschall Med. 2017 Aug;38(4):e16-e47. doi: 10.1055/s-0043-103952. PMID: 30176678.
  19. Pruijssen JT, de Korte CL, Voss I, Hansen HHG. Vascular Shear Wave Elastography in Atherosclerotic Arteries: A Systematic Review. Ultrasound Med Biol. 2020 Sep;46(9):2145-2163. doi: 10.1016/j.ultrasmedbio.2020.05.013. Epub 2020 Jul 1. PMID: 32620385.
  20. Sultan SR, Alghamdi A, Abdeen R, Almutairi F. Evaluation of ultrasound point shear wave elastography reliability in an elasticity phantom. Ultrasonography. 2022 Apr;41(2):291-297. doi: 10.14366/usg.21114. Epub 2021 Jul 31. PMID: 35316890; PMCID: PMC8942736.
  21. Marais L, Pernot M, Khettab H, Tanter M, Messas E, Zidi M, Laurent S, Boutouyrie P. Arterial Stiffness Assessment by Shear Wave Elastography and Ultrafast Pulse Wave Imaging: Comparison with Reference Techniques in Normotensives and Hypertensives. Ultrasound Med Biol. 2019 Mar;45(3):758-772. doi: 10.1016/j.ultrasmedbio.2018.10.032. Epub 2019 Jan 12. PMID: 30642659.
  22. Couade M, Pernot M, Prada C, Messas E, Emmerich J, Bruneval P, Criton A, Fink M, Tanter M. Quantitative assessment of arterial wall biomechanical properties using shear wave imaging. Ultrasound Med Biol. 2010 Oct;36(10):1662-76. doi: 10.1016/j.ultrasmedbio.2010.07.004. PMID: 20800942.

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Received August 6, 2025.
Accepted September 18, 2025.
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