title: Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation.
abstract: BACKGROUND
  Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation.
  
  
  OBJECTIVE
  To assess liver fibrosis by acoustic radiation force impulse elastography (ARFI) in children who had Kasai operation, with the goal of identifying an ARFI value cut-off for children requiring liver transplantation.
  
  
  METHODS
  Of the 32 post-Kasai children included, 19 were transplanted or listed for transplantation (group A), while 13 were not on the list during their follow-up (group B). We recorded biopsies, blood samples and ARFI values over time, including at Kasai operation and at transplantation. We estimated an association between groups and continuous variables using generalized estimating equations, and we compared categorical variables using the Fisher exact test.
  
  
  RESULTS
  Portal hypertension signs were similar in both groups, whereas ARFI values were higher in group A (mean±standard deviation=3.3±1.2 m/s) than in group B (2.0±0.7 m/s; P=.0003). Eighteen of 19 (94.7%) children in group A and 6/13 (46.2%) children in group B presented with two consecutive ARFI values ≥2 m/s (sensitivity=7%, specificity=53.8%; P=0.003).
  
  
  CONCLUSIONS
  We found that children who were transplanted had two consecutive ARFI values ≥2 m/s during follow-up. ARFI for evaluation of post-Kasai liver fibrosis may assist the long-term assessment of biliary atresia and may even guide treatment decisions.
authors.affiliation: Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland. sylviane.hanquinet-ginter@hcuge.ch.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
authors.affiliation: Division of Quality of Care, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Courvoisier
authors.affiliation: Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Rougemont
authors.affiliation: Department of Pediatric Surgery, Children's University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
authors.affiliation: Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Merlini
authors.affiliation: Department of Pediatric Gastroenterology, Children's University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Valérie A
authors.initials: VA
authors.lastname: McLin
authors.affiliation: Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland.
authors.forename: Mehrak
authors.initials: M
authors.lastname: Anooshiravani
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000000981:diagnostic imaging* / Q000601:surgery*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D012720:Severity of Illness Index
keywords: Acoustic radiation force impulse elastography (ARFI); Biliary atresia; Children; Cholestasis; Kasai operation; Liver stiffness; Liver transplantation; Shear wave elastography; Ultrasound