Real-time tissue elastography (RTE) for noninvasive evaluation of fibrosis in liver diseases in children in comparison to liver biopsy.
OBJECTIVE
To determine the value of real-time tissue elastography (RTE) in pediatric liver diseases in comparison to liver biopsy.


METHODS
RTE was performed on 34 patients (♀, n = 17; ♂, n = 17; range 0-21 years) with various acute and chronic liver diseases: autoimmune hepatitis (n = 5), liver transplantation (n = 5), Wilson's disease (n = 4), hepatopathy of unknown origin (n = 4), unclear cholestatic hepatitis (n = 2), thalassemia major (n = 2), glycogenosis (n = 2), hereditary fructose intolerance (n = 1), alpha-1-antitrypsin deficiency (n = 1), diabetes mellitus type 1 (n = 1), chronic intestinal pseudo-obstruction (n = 1), primary sclerosing cholangitis (n = 1), hepatitis B (n = 1), cirrhosis of unknown origin (n = 1), drug-induced hepatopathy (n = 1), unexplained transaminase elevation (n = 1), and nonalcoholic steatohepatitis (n = 1). Included children were biopsied. RTE was performed on a control group (n = 30; ♀, n = 15; ♂, n = 15). The mean value of strain (MEAN) in arbitrary units and the ratio of blue color-coded harder tissue (AREA) were calculated based on an elasticity histogram of the selected region of interest in liver parenchyma. They were compared with the histologically defined grade of liver fibrosis.


RESULTS
In comparison to the scoring systems, a moderate correlation was observed for MEAN and AREA by excluding the F0 patients [MEAN r = -0.575 to -0.645, AREA r = 0.545-0.607 (p < 0.05)]. Differentiation of the control group and low-grade fibrosis (F1) from high-grade fibrosis (F2-4) was significantly possible (p values <0.001 at 5 % significance level).


CONCLUSIONS
RTE parameters enable a possible differentiation of high fibrosis; however, their correlation with fibrosis stage was moderate. RTE seems to be a promising method in liver fibrosis grading in children.
Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg INF 430, 69120, Heidelberg, Germany.
Jens-Peter
JP
Schenk
Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg INF 430, 69120, Heidelberg, Germany. buketselmi@gmail.com.
Buket
B
Selmi
Institute of Pathology, University Hospital of Heidelberg, Heidelberg, Germany.
Christa
C
Flechtenmacher
Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg INF 430, 69120, Heidelberg, Germany.
Saroa El
SE
Sakka
Department of General Pediatrics, University Hospital of Heidelberg, Heidelberg, Germany.
Ulrike
U
Teufel
Department of General Pediatrics, University Hospital of Heidelberg, Heidelberg, Germany.
Guido
G
Engelmann
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D008297:Male; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D055815:Young Adult
Children; Liver fibrosis; Real-time elastography