title: The degree of spleen stiffness measured on acoustic radiation force impulse elastography predicts the severity of portal hypertension in patients with biliary atresia after portoenterostomy.
abstract: OBJECTIVE
  Acoustic radiation focus impulse (ARFI) elastography is a new method for assessing the degree of tissue stiffness. We herein evaluated the degree of spleen stiffness (SS) using ARFI elastography in patients with biliary atresia (BA) after Kasai portoenterostomy (KPE).
  
  
  METHODS
  We retrospectively collected the liver stiffness (LS) and SS values on ARFI elastography from 43 patients undergoing KPE between September 2010 and November 2013. We analyzed the correlations between these values and variables related to the severity of liver dysfunction and portal hypertension (PHT). The data were expressed as the standard deviation score (z-score) relative to the previously reported normal values for the patient's age.
  
  
  RESULTS
  The SS value was significantly associated with the spleen diameter and development of collateral vessels, in comparison to the LS value. Interestingly, there was a significant correlation between SS value and the portal vein (PV) diameter. Thirty patients (69.8%) consequently underwent LT; these patients showed higher SS values and smaller PV diameters than the patients monitored without LT.
  
  
  CONCLUSIONS
  The degree of SS measured on ARFI elastography can be used to predict the severity of PHT in BA patients after KPE.
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan; Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: uchida-h@ncchd.go.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Shigeta
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Matsunami
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan; Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanazawa
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: Department of Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kanamori
authors.affiliation: Department of Radiology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Miyasaka
authors.affiliation: Department of Radiology, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nosaka
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.affiliation: Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
mesh_terms: D001656:Biliary Atresia / Q000601:surgery*; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology*; D007223:Infant; D008297:Male; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013154:Spleen / Q000000981:diagnostic imaging*; D016896:Treatment Outcome
keywords: Acoustic radiation force impulse; Biliary atresia; Pediatric liver transplantation; Portal vein; Spleen stiffness