title: Transient liver elastography in unsedated control children: Impact of age and intercurrent illness.
abstract: OBJECTIVE
  Transient elastography (TE) is a rapid, non-invasive, reproducible assessment of liver fibrosis by liver stiffness measurement (LSM). Uncertainty remains regarding utility in children, unsedated and <6 years of age. The importance of general health at the time of study has not been addressed. We report our experience of TE in unsedated control children, impact of intercurrent illness and using new published reliability criteria.
  
  
  METHODS
  From April 2011 to March 2013, 173 studies were performed in unsedated, healthy control children and children with intercurrent illness without detectable liver disease presenting to the Royal Children's Hospital, Brisbane, Australia. LSM reliability was assessed using interquartile range/median (IQR/M ≤ 30%) of 10 valid measurements.
  
  
  RESULTS
  A total of 123 (F:M, 52:71) of 173 studies (71.1%) gave reliable results. In children 0-2 years reliability was 36%, and >2 years reliable results were obtained in ~80%. LSM increased with age; 0-2 years (3.5 ± 0.5 kPa), 3-5 years (3.8 ± 0.3 kPa) and 6-11 years (4.1 ± 0.2 kPa) with healthy older children 12-18 years similar to adults (4.5 ± 0.2 kPa). LSM did not vary with gender (female, 4.5 ± 0.2 vs. male, 4.8 ± 0.2 kPa). Children with intercurrent, non-hepatological illnesses had higher LSM (5.2 ± 0.2 kPa (range, 2.8-11.1 kPa)) compared to healthy children ((4.1 ± 0.1 kPa, range, 2.1-6.3 kPa); P = 0.0001).
  
  
  CONCLUSIONS
  TE in unsedated children is feasible from infancy but most reliable after 2 years. Intercurrent illness increases LSM; hence, study context is important when interpreting results.
authors.affiliation: Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.|Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Lewindon
authors.affiliation: Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Fariha
authors.initials: F
authors.lastname: Balouch
authors.affiliation: Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Tamara N
authors.initials: TN
authors.lastname: Pereira
authors.affiliation: Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Mora V
authors.initials: MV
authors.lastname: Puertolas-Lopez
authors.affiliation: Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Charlton
authors.initials: C
authors.lastname: Noble
authors.affiliation: Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Wixey
authors.affiliation: Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.|Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Grant A
authors.initials: GA
authors.lastname: Ramm
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008107:Liver Diseases / Q000175:diagnosis; D008297:Male
keywords: elastography; healthy children; hepatic fibrosis; liver stiffness measurement; ultrasound