title: Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease.
abstract: BACKGROUND
  Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error, and risks including bleeding. The aim of the present study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort.
  
  
  METHODS
  Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepatohistopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared with biopsy score.
  
  
  RESULTS
  During the study period, 104 children (62 boys) were enrolled (median age 13.6 years). Diagnosis was autoimmune liver disease in 27; nonalcoholic fatty liver disease in 37; posttransplant in 16; hepatitis B/C in 8; Wilson disease in 5; and the remainder, miscellaneous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (≥ F2) (P < 0.001), severe fibrosis (≥ F3) (P < 0.001), and cirrhosis (F4) (P = 0.003). The area under the receiver operating characteristic curve for the prediction of ≥ F2, ≥ F3, and F4 using TE was 0.78, 0.79, and 0.96, respectively. TE performed best in children with autoimmune liver disease and in those posttransplant.
  
  
  CONCLUSIONS
  The present study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus, TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of noninvasively monitoring liver disease progression in children.
authors.affiliation: Paediatric Liver, GI and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK.
authors.forename: Emer
authors.initials: E
authors.lastname: Fitzpatrick
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.forename: Sunitha
authors.initials: S
authors.lastname: Vimalesvaran
authors.forename: Maria Sole
authors.initials: MS
authors.lastname: Basso
authors.forename: Anil
authors.initials: A
authors.lastname: Dhawan
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001327:Autoimmune Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D001706:Biopsy / Q000009:adverse effects; D002648:Child; D002908:Chronic Disease; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006505:Hepatitis / Q000000981:diagnostic imaging / Q000473:pathology; D006527:Hepatolenticular Degeneration / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D016031:Liver Transplantation / Q000000981:diagnostic imaging; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D012372:ROC Curve