title: Comparison of three ultrasound based elastographic techniques in children and adolescents with chronic diffuse liver diseases.
abstract: Non-invasive techniques for liver fibrosis assessment were developed for adults and recent researches tested their accuracy in children. The only validated elastographic method for non-invasive liver fibrosis evaluation in children is Transient Elastography (TE). The aim of our study was to investigate the feasibility of liver stiffness (LS) measurement in paediatric patients with chronic liver diseases by means of Acoustic Radiation Force Impulse Elastography (ARFI) and 2D-Shear Wave Elastography (2D-SWE), compared to TE as reference method.
  
  
  METHODS
  We enrolled 54 consecutive children and adolescents with different chronic liver diseases. All patients were examined by means of TE, ARFI, and 2D-SWE. All measurements were performed in the right liver lobe, in the same session, in fasting condition. We considered reliable LS elastographic measurements as follows: for TE and ARFI - the median value of ten measurements with a success rate >/=60% and an interquartile range<30%, for 2D-SWE - the median value of five measurements.
  
  
  RESULTS
  The successful measurement rate for TE was 94.4% (51/54). Taking TE as a reference method, sensitivity of ARFI for detecting fibrosis F1 was 71.42%, for F2-77.77%, for F3-62.5% and for F4-71.42%. Sensitivity of 2D-SWE for detecting F1 was 92.85%, for F2-83.33%, for F3-87.5% and for F4-85.71%. We found significant correlations between TE and 2D-SWE on the entire lot (Kappa correlation factor=0.843, p=0.001). Analyzing the subgroup with SR=60%-70%, we did not find significant correlation between TE and ARFI (Kappa correlation factor=0.172, p=0.452). Assessing the subgroup with SR>70%, we found a significant correlation between TE and ARFI (Kappa correlation factor=0.761, p=0.001).
  
  
  CONCLUSIONS
  Overall, 2D-SWE correlate better with TE compared to ARFI in children. Excluding patients with less satisfactory technical parameters, we obtained significant correlations between all three methods. Both SWE and ARFI are non-invasive techniques feasible of performing on paediatric patients along with TE.
authors.affiliation: 1st Pediatric Department, Timisoara, Romania. oana22_99@yahoo.com.
authors.forename: Oana
authors.initials: O
authors.lastname: Belei
authors.affiliation: Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Sporea
authors.affiliation: Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania.
authors.forename: Oana
authors.initials: O
authors.lastname: Gradinaru-Tascau
authors.affiliation: 1st Pediatric Department, Timisoara, Romania.
authors.forename: Laura
authors.initials: L
authors.lastname: Olariu
authors.affiliation: Gastroenterology and Hepatology Department, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Popescu
authors.affiliation: Ist Pediatric Department, Timisoara, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Simedrea
authors.affiliation: Ist Pediatric Department, Timisoara, Romania.
authors.forename: Otilia
authors.initials: O
authors.lastname: Marginean
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results