[Value of transient elastography in noninvasive assessment in children's hepatic fibrosis].
OBJECTIVE
Transient elastography (FibroScan) is a novel, noninvasive, rapid bedside method to assess liver fibrosis by measuring liver stiffness. This study aimed to determine the feasibility and reliability of liver stiffness measurement in children with liver diseases.


METHODS
Liver stiffness measurements were carried out on 72 children, from 4 to 18 years of age, with potential hepatic fibrosis disease. The clinical, biological, ultrasonographic, and endoscopic parameters were noted to identify children with portal hypertension syndrome. The APRI (ASAT-to-platelet ratio index) test was calculated according to the standard formula. An APRI test score higher than 1.5 indicates significant hepatic fibrosis. METAVIR scoring from 14 liver biopsies was compared to the liver stiffness using the Kappa statistic.


RESULTS
Twenty-eight patients had viral hepatitis, 20 cystic fibrosis, 16 chronic liver cholestasis, 5 autoimmune hepatitis, and 3 patients had liver fibrosis with uncertain etiology. FibroScan measurements were available in all children. There was good agreement between FibroScan and pathological studies (weighted kappa=0.814). Only 9 children had portal hypertension syndrome with an average measurement of liver stiffness significantly higher than children without portal hypertension (26.5kPa vs 6.4kPa; p<0.01). The APRI test for 6 out of 9 patients scored higher than 1.5.


CONCLUSIONS
These results indicate that liver stiffness measurement is feasible in children and seems to be related to liver fibrosis. Larger prospective studies are needed to validate this FibroScan method.
Breton
E
E
Unité des nourrissons et explorations fonctionnelles digestives, pôle médicochirurgical de pédiatrie et de génétique clinique, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France. estelle.breton@chu-rennes.fr
Bridoux-Henno
L
L
Guyader
D
D
Daniélou
H
H
Jouan
H
H
Beuchée
A
A
Nousbaum
J B
JB
Dabadie
A
A
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000473:pathology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D010976:Platelet Count; D011517:Prothrombin Time; D012680:Sensitivity and Specificity; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase