ORIGINAL CONTRIBUTIONS Measurement of Liver Stiffness with 2D-Shear Wave Elastography (2D-SWE) in Bariatric Surgery Candidates Reveals Acceptable Diagnostic Yield Compared to Liver Biopsy Tannaz Jamialahmadi 1 & Mohsen Nematy 2 & Ali Jangjoo 3 & Ladan Goshayeshi 4,5 & Reza Rezvani 2 & Kamran Ghaffarzadegan 6 & Mehdi Jabbari Nooghabi 7 & Payman Shalchian 8 & Mahtab Zangui 5 & Zeinab Javid 1 & Saeid Doaei 9 & Farnood Rajabzadeh 10 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Nonalcoholic fatty liver disease (NAFLD) is common among severely obese patients. Two-dimensional shear wave elastography (2D-SWE) has been validated as a noninvasive diagnostic tool for liver stiffness measurement. However, the technical feasibility and accuracy of this method in severely obese patients are still under debate. Objective We aimed to assess the diagnostic accuracy of 2D-SWE in bariatric surgery candidates in comparison with the gold standard liver biopsy. Methods Ninety severely obese candidates for bariatric surgery were included. Liver stiffness was measured using 2D-SWE 14 days before liver biopsy. Liver biopsy was taken on the day of surgery. The area under the receiver operating curve (AUROC) was calculated for the staging of liver fibrosis. Results 2D-SWE was performed in 97.3% of patients successfully. Histologic stages of fibrosis (F0-F4) were detected in 34.2%, 36%, 6.3%, 3.6%, and 0.9% of patients, respectively. The AUROC for 2D-SWE was 0.77 for F1, 0.72 for F2, 0.77 for F3, and 0.70 for F4. In univariate analysis, 2D-SWE values were correlated with BMI, waist circumference, NAFLD activity score (NAS), and steatosis, whereas these components did not affect liver stiffness in multivariate analysis. Conclusion Two-dimensional shear wave elastography of the liver can be feasible and has good accuracy in severely obese candidates for bariatric surgery. Therefore, 2D-SWE may be a good option for assessing liver fibrosis, especially in the early stages of fibrosis to lessen complications of surgery in this population. However, this method should be applied on a larger scale for late stage of fibrosis. Keywords Bariatric surgery . Liver stiffness . Severe obesity . Elastography . 2D-SWE Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-019-03889-2) contains supplementary material, which is available to authorized users. * Farnood Rajabzadeh Farnood@yahoo.com 1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran 2 Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran 3 Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran 4 Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 5 Gastroenterology and Hepatology Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran 6 Pathology Department, Education and Research Department, Razavi Hospital, Mashhad 9177948564, Iran 7 Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad 9177948944, Iran 8 Hazrat Zahra Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 9 Research Center of Health and Environment, Guilan University of Medical Sciences, Rasht 1313973476, Iran 10 Department of Radiology, Faculty of Medicine, Islamic Azad University-Mashhad Branch, Mashhad 9137714639, Iran Obesity Surgery https://doi.org/10.1007/s11695-019-03889-2