Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography.
BACKGROUND
The objective of this study was to evaluate the feasibility of shear wave elastography (SWE), as a non-invasive means of assessing liver fibrosis stage in paediatric and adolescent patients.


METHODS
Consecutive paediatric and adolescent subjects scheduled for liver biopsy (LB) evaluation of known or suspected diffuse liver disease were included after informed guardian consent and subject assent in this IRB-approved single institution study. Elastograms were acquired prior to liver biopsy, from the liver under a breath-hold after normal inspiration when possible. Biopsy specimens underwent blinded pathologist review using the METAVIR scoring system.


RESULTS
Twenty-four patients (M : F = 13:11) with a mean age of 17 years (range: 1-21 years) underwent liver biopsy. The distribution of fibrosis on pathological examination was: F0 = 10, F1 = 9, F2 = 1, F3 = 3, and F4 = 1. Subjects with stages F0 and F1 fibrosis had a mean SWE value of 6.93 kPa (95% CI: 6.33-7.44 kPa) and 8.33 kPa (95% CI: 6.83-10.80 kPa) respectively. The SWE value for the one subject with stage F2 fibrosis was 6.36 kPa, whereas for F3 and F4 were 8.86 (95% CI: 5.70-11.40) and 17.85 kPa respectively. The correlation between SWE values and fibrosis grade was strong (r = 0.58, P = 0.003), and the area under the ROC curve differentiatiang ≥F2 fibrosis was 0.62 (95% CI: 0.26-0.98).


CONCLUSIONS
Estimation of liver stiffness using real-time SWE is feasible using the SC6-1 ultrasound probe in paediatric and adolescent patients and strongly correlates with the stage of fibrosis.
Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Manish
M
Dhyani
Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Michael S
MS
Gee
Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Joseph
J
Misdraji
Department of Pediatrics, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Esther Jacobowitz
EJ
Israel
Department of Pediatrics, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Uzma
U
Shah
Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, Massachusetts, USA.
Anthony E
AE
Samir
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003199:Computer Systems; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
liver biopsy; liver fibrosis; liver stiffness; shear wave elastography; ultrasound