Ultrasound Elastography Improves Diagnosis of Liver DiseaseAn Indian Institute Found a Way That Can Give Patients an Alternative to Biopsy

The Asian Institute of Gastroenterology in Hyderabad

March 11, 2014 | The Asian Institute of Gastroenterology in Hyderabad uses the high-end Siemens ACUSON S2000 ultrasound system for affordable, reliable, non-invasive diagnosis and assessment of liver diseases. This can save patients from undergoing an interventional biopsy.


Text: Archis Mohan

Photos: Bhairavi Parikh


Liver diseases are highly prevalent in India. Surgical biopsy is the most common diagnostic tool to detect liver fibrosis and potential cirrhosis. Yet, surgical biopsy has several disadvantages. It is expensive and requires hospitalization. Since most Indians do not have health insurance, few can afford it. Moreover, biopsy is not always error-free and cannot be repeated at short intervals.
Ultrasound elastography has revolutionized the diagnosis of liver conditions. The technology is non-invasive, very reliable, and costs a tenth of surgical biopsy. The Asian Institute of Gastroenterology in Hyderabad (AIG) invested in a Siemens ACUSON S2000 ultrasound system in 2009. With its acquisition, the hospital has reduced unnecessary biopsies by 40 percent.

M.A. Mateen, MD, uses non-invasive diagnosis of liver disease.
M. A. Mateen, MD, Chief Radiologist, Asian Institute of Gastroenterology

It is 10 in the morning and M. A. Mateen, MD, 55, Chief Radiologist at the Asian Institute of Gastroenterology (AIG) in Hyderabad, India, is already on his 50th ultrasound elastography examination of the day. His patient is a 52-year-old clerk from Jorhat, a small town in Assam in north-east India, who has travelled 2,700 kilometers to the highly regarded AIG to undergo liver elastography – a procedure that helps assess his liver disease.
Elastography is a non-invasive method that measures the stiffness of the tissue using ultrasound to help in the assessment of liver disease. It is performed with a Siemens ACUSON™ S2000 ultrasound system. Ten minutes is all it takes for the investigation.


Avoiding invasive biopsy and saving money at the same time
Under less favorable circumstances, the patient from Jorhat would have needed to undergo an invasive biopsy, which involves cutting out a 2-millimeter thick and 6-millimeter long piece from his liver to assess its condition. This patient not only saves on the discomfort of the biopsy procedure, but also on costs. While a liver biopsy costs INR 22,000 to INR 25,000 (US $ 342 to US$ 390), an ultrasound exam with elastography costs just INR 3,000 (US$ 47).


Improve Diagnosis of Liver Disease through Ultrasound Elastography.
Ultrasound Elastography saves people from interventional biopsy.

A Boon for Diagnosing Liver Disease in India
Since 1994, Dr. Mateen and his team along with Dr. D. Nageshwar Reddy – Mateen’s mentor and founder of the AIG – have built a reputation for specializing in treating liver, pancreatic, and gall bladder diseases. The hospital acquired an ACUSON S2000 ultrasound system in early 2009, within months of its launch.
According to WHO statistics, liver disease accounts for 200,000 deaths in India every year, and according to Mateen, one in four Indians, or approximately 300 million of the 1.25 billion people, needs a liver check for various diseases. Like Mateen’s patient, most Indians do not have health insurance and cannot afford diagnostic methods such as surgical biopsy.


Ultrasound Elastography’s Advantages
In such a scenario, elastography is a boon. "Biopsy is considered the gold standard for diagnosing liver fibrosis, which is a scarring process caused by chronic liver diseases. But elastography is much more patient-friendly than biopsy as it is not only non-invasive, but also very accurate," says the radiologist of over 25 years.
In a biopsy, the sample may not be representative, and there may be errors in reading the slide. "Add to that the expense involved for a patient, hospitalization, trauma, and the fact that it cannot be repeated at will,” says Mateen, “and biopsy becomes even more unattractive.” In contrast, elastography is not limited in scope like biopsy as it covers the entire affected area. Plus, it can be repeated as often as needed.


The Lobby of the Asian Institute of Gastroenterology in Hyderabad
The Asian Institute of Gastroenterology’s Lobby

A Good Reputation
Technology together with Mateen's expertise in handling liver diseases is a potent combination at the AIG. Every day, Mateen and his team conduct elastography measurements on near to 250 people.
Due to its high-end equipment and the good reputation of its doctors, patients come to the AIG from all corners of India as well as from neighboring countries such as Bangladesh, Sri Lanka, Nepal, and Afghanistan – but also from the Middle East and East Africa.


Reducing Biopsies by 40 Percent
"The most common liver conditions that we see are alcoholic liver disease and viral liver disease,” says Mateen. “Today, due to the rising consumption of fast food, many people below the age of 20 also suffer from liver diseases. Estimates suggest that by 2050, over 50 percent of urban Indians will suffer from non-alcoholic fatty liver disease.”
Unfortunately, liver fibrosis is a 'silent killer'. It can be cured only if detected at an early stage, but does not typically exhibit any symptoms that conventional ultrasound could catch. Generally, it is too late by the time an invasive method like a biopsy is employed, says Mateen.


  • Liver diseases kill 200,000 people every year
  • Liver disease is one of the top ten causes of death
  • About 12 million people suffer from Hepatitis C
  • 17 out of 100,000 people die from liver cirrhosis (as of 2004), caused by alcoholism1
  • Up to 32 percent of the population are believed to suffer from liver problems2

1 Source: http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index4.html5
2 Source: Indian Council of Medical Research (ICMR)


Elastography can give patients an alternative to biopsy.

Establishing the Non-Invasive Technique
The ACUSON S2000 system has helped Mateen and his team to detect the presence of fibrosis even in deep, hard-to-access liver tissue. It has helped the hospital's Department of Interventional Radiology to devise its own protocols to make assessment of liver disease both fast and affordable.
In recent years, his team has helped prevent many medical errors. "This is the reason the whole world is looking at this non-invasive technique as it establishes itself as an alternative to conventional procedures," says Mateen. The AIG has reduced biopsies by 40 percent since 2009.


Mateen and his team have successfully explored elastography for early diagnosis of other diseases such as pancreatitis and gall bladder tumors. Due to the rise in the number of patients, the AIG plans to build a separate radiology facility on the periphery of the city and equip it with advanced elastography ultrasound systems.


Archis Mohan is a New Delhi-based freelance journalist. He writes on a range of issues for both Indian and foreign publications. He has worked as a correspondent for leading print and television media outlets, including Hindustan Times, The Telegraph, NDTV, and Times Now.