Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study.
BACKGROUND
Biliary atresia commonly leads to liver fibrosis and cirrhotic complications, including esophageal varices.


OBJECTIVE
To evaluate liver and spleen stiffness measurements using acoustic radiation force impulse (ARFI) imaging for diagnosing grade of liver fibrosis and predicting the presence of esophageal varices in patients treated for biliary atresia.


METHODS
ARFI imaging of the spleen and native liver was performed in 28 patients with biliary atresia. We studied the relation between ARFI imaging values and liver histology findings (n=22), upper gastrointestinal endoscopy findings (n=16) and several noninvasive test results. Diagnostic accuracy was assessed using receiver operating characteristic curve analyses.


RESULTS
Liver stiffness measurements exhibited a significant difference among the different grades of liver fibrosis (P=0.009), and showed higher values in patients with high-risk esophageal varices than in the other patients (P=0.04). The areas under the receiver operating characteristic curves of liver stiffness measurements for liver fibrosis grades  ≥ F2, ≥F3 and = F4 were 0.83, 0.93 and 0.94, respectively. Patients with high-risk esophageal varices were preferentially diagnosed by the combined liver and spleen stiffness measurements (area under the curve, 0.92).


CONCLUSIONS
Liver and spleen stiffness measurements using ARFI imaging are potential noninvasive markers for liver fibrosis and esophageal varices in patients treated for biliary atresia.
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan. htomita@a3.keio.jp.|Department of Pediatric Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku,, Saitama-shi, 336-8522, Japan. htomita@a3.keio.jp.
Hirofumi
H
Tomita
Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Kiyoshi
K
Ohkuma
Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Yohei
Y
Masugi
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Naoki
N
Hosoe
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Ken
K
Hoshino
Division of Surgery, Department of Surgical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan.
Yasushi
Y
Fuchimoto
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Akihiro
A
Fujino
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Takahiro
T
Shimizu
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Mototoshi
M
Kato
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Takumi
T
Fujimura
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Hideo
H
Ishihama
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Nobuhiro
N
Takahashi
Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Yutaka
Y
Tanami
Department of Internal Medicine, Saitama City Hospital, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Hirotoshi
H
Ebinuma
Department of Internal Medicine, Saitama City Hospital, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Hidetsugu
H
Saito
Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Michiie
M
Sakamoto
Department of Pediatric Surgery, Saitama City Hospital, 2460 Mimuro, Midori-ku,, Saitama-shi, 336-8522, Japan.
Miwako
M
Nakano
Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku,, Tokyo, 160-8582, Japan.
Tatsuo
T
Kuroda
D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000150:complications* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D010865:Pilot Projects; D013154:Spleen / Q000000981:diagnostic imaging
Acoustic radiation force impulse imaging; Biliary atresia; Esophageal varices; Liver; Liver fibrosis; Liver stiffness; Spleen stiffness