A pilot study of ultrasound elastography as a non-invasive method to monitor liver disease in children with short bowel syndrome.
BACKGROUND
Our objective was to evaluate the accuracy of acoustic radiation force impulse (ARFI) elastography in determining extent of liver fibrosis in pediatric patients with short bowel syndrome (SBS).


METHODS
This prospective cohort study included pediatric patients with SBS who underwent ultrasound with ARFI measurements of shear wave speed (SWS) and liver biopsy within 30days of each other between 12/2014-9/2015. The mean and median SWS were compared to the stage of fibrosis. Receiver operating characteristic curves (ROC) were also generated to assess the classification accuracy of SWS measurements for mild (F0-F1) versus moderate/severe fibrosis (F2-F4).


RESULTS
Twelve patients were included with median age 1.4years and median weight 11.3kg. The median direct bilirubin level was 0.3mg/dL at the time of biopsy. On liver biopsy, 6 patients had mild fibrosis (F1), 3 had septal fibrosis (F3), and 3 had cirrhosis (F4). The area under the ROC curve for elastography to differentiate moderate/severe liver fibrosis from mild disease was 0.83 (95CI 0.58-1.00) and 0.86 (95CI 0.63-1.00) for the median SWS and mean SWS, respectively.


CONCLUSIONS
These early results suggest that ARFI ultrasound elastography may be a reliable non-invasive method to monitor liver fibrosis in pediatric patients with SBS.


METHODS
Prospective observational cohort.


METHODS
3.
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
Daniel
D
Lodwick
Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH.
Molly
M
Dienhart
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Jennifer N
JN
Cooper
Department of Pathology, Nationwide Children's Hospital, Columbus, OH.
Bonita
B
Fung
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH.
Joseph
J
Lopez
Department of Radiology, Nationwide Children's Hospital, Columbus, OH.
Sally
S
Smith
Department of Radiology, Nationwide Children's Hospital, Columbus, OH.
Patrick
P
Warren
Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH.
Jane
J
Balint
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH. Electronic address: Peter.minneci@nationwidechildrens.org.
Peter C
PC
Minneci
D001706:Biopsy; D002675:Child, Preschool; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000150:complications*
Elastography; Hepatic fibrosis; IFALD; Intestinal failure associated liver disease; Parenteral nutrition; Short bowel syndrome