title: Feasibility and Diagnostic Accuracy of Supersonic Shear-Wave Elastography for the Assessment of Liver Stiffness and Liver Fibrosis in Children: A Pilot Study of 96 Patients.
abstract: OBJECTIVE
  To evaluate the feasibility of using supersonic shear-wave elastography (SSWE) in children and normal values of liver stiffness with the use of control patients of different ages (from neonates to teenagers) and the diagnostic accuracy of supersonic shear wave elastography for assessing liver fibrosis by using the histologic scoring system as the reference method in patients with liver disease, with a special concern for early stages of fibrosis.
  
  
  METHODS
  The institutional review board approved this prospective study. Informed consent was obtained from parents and children older than 7 years. First, 51 healthy children (from neonate to 15 years) were analyzed as the control group, and univariate and multivariate comparisons were performed to study the effect of age, transducer, breathing condition, probe, and position on elasticity values. Next, 45 children (from 1 month to 17.2 years old) who underwent liver biopsy were analyzed. SSWE measurements were obtained in the same region of the liver as the biopsy specimens. Biopsy specimens were reviewed in a blinded manner by a pathologist with the use of METAVIR criteria. The areas under the receiver operating characteristics curve (AUCs) were calculated for patients with fibrosis stage F0 versus those with stage F1-F2, F2 or higher, F3 or higher, and F4 or higher.
  
  
  RESULTS
  A successful rate of SSWE measurement was 100% in 96 patients, including neonates. Liver stiffness values were significantly higher when an SC6-1 probe (Aixplorer; SuperSonic Imagine SA, Aix-enProvence, France) was used than when an SL15-4 probe (Aixplorer) was used (mean ± standard deviation, 6.94 kPa ± 1.42 vs 5.96 kPa ± 1.31; P = .006). There was no influence of sex, the location of measurement, or respiratory status on liver elasticity values (P = .41-.93), although the power to detect such a difference was low. According to the degree of liver fibrosis at liver biopsy, 88.5%-96.8% of patients were correctly classified, with AUCs of 0.90-0.98 (95% confidence interval [CI]: 0.8, 1.0). The AUC for patients with stage F0 versus stage F1-F2 was 0.93 (95% CI: 0.87, 0.99).
  
  
  CONCLUSIONS
  SSWE allows accurate assessment of liver fibrosis, even in children with early stage (F1-F2) disease, and the choice of transducer influences liver stiffness values.
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Stéphanie
authors: S
authors: Franchi-Abella
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Lucie
authors: L
authors: Corno
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Emmanuel
authors: E
authors: Gonzales
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Guillemette
authors: G
authors: Antoni
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Monique
authors: M
authors: Fabre
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Béatrice
authors: B
authors: Ducot
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Danièle
authors: D
authors: Pariente
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Jean-Luc
authors: JL
authors: Gennisson
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Mickael
authors: M
authors: Tanter
authors: From the Departments of Pediatric Radiology (S.F.A., L.C., D.P.), Pediatric Hepatology (E.G.), and Epidemiology (G.A., B.D.), Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Assistance Publique Hôpitaux de Paris, Université Paris Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France; Departments of Pathology (M.F.) and Adult Radiology (J.M.C.), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris V, Assistance Publique Hôpitaux de Paris, Paris, France; and Institut Langevin, ESPCI ParisTech, CNRS UMR7587, INSERM U979, Paris, France (J.L.G., M.T.).
authors: Jean-Michel
authors: JM
authors: Corréas
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011446:Prospective Studies