Background The present study aims to investigate the changes in liver function and liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) before and after ablation in patients with hepatocellular carcinoma (HCC), and to explore the feasibility of using LS before and after ablation as a means to assess and predict liver function, gaining a better understanding of the impact of ablation on liver function and LS’s potential as a prognostic tool for HCC patients.

Methods From March 2022 to December 2023, 101 patients with treatment-naïve HCC and undergoing ablation were prospectively enrolled and followed up for one year. Data, including LS and indicators of liver function, were collected at the pre-operative period and post-operative 1 month, 3 months, 6 months, and 12 months, respectively. Statistical analysis was conducted to explore the correlation between LS and liver function during the follow-up.

Results Among the enrolled patients, 69 (68.3%) underwent percutaneous radiofrequency ablation, 23 (22.8%) underwent percutaneous microwave ablation, and 9 (8.9%) cases underwent other methods of ablation (such as laparoscopic ablation). Using pre-operative LS as the baseline, paired t-test showed that LS slightly increased at 1 month post-operatively and then decreased (all p<0.050). This trend was similar to the changes in liver function before and after ablation. There was a significant correlation between pre-operative LS and liver function (represented by Child-Pugh and ALBI scores) at pre-operative period and post-operative 1, 3, 6, and 12 months (all p<0.050). Additionally, LS at 1, 3, and 6 months post-operatively was significantly correlated with the immediate post-operative liver function (all p<0.050).

Conclusions LS is expected to become a powerful tool for assessing and predicting liver function in HCC ablation patients, which could help alleviate the burden of follow-up examinations to some extent.