Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

Abstract

Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD.

The Role of the Fatty Liver Index (FLI) in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review

“…Using the FLI, the study found that the prevalence of fatty liver disease (FLI ≥ 60) in Korean adults aged 20 years and older increased from 13.3% in 2009 to 15.5% in 2017. This increase was particularly prominent among men and the younger age group (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Furthermore, the study found that people with T2DM had the highest prevalence of fatty liver disease, with a steep increase seen in the young T2DM population.…”

“…Thus, the most well-known methods are liver elastography and blood markers of fibrosis. Elastography measures the stiffness of the tissues, and the assessment of liver fibrosis is based on ultrasound, which measures only a small component of the stiffness of the tissues [21][22][23].…”

Association between BMI Change, Transaminases, and Other Metabolic Parameters in Children with Nonalcoholic Fatty Liver Disease

“…There are limitations for using ALT for the assessment and management of pediatric NAFLD, but ALT is still widely used because it is cost-effective and noninvasive compared to other methods such as liver biopsy and MRI due to the need of sedation and increased radiation exposure with CT scan. Conventional ultrasound is not accurate enough for the assessment of NAFLD in children due to interobserver variability, and newer noninvasive methods such as elastography are not yet widely available, and there are still limitations in the pediatric population [ 20 ].…”

Advances in mechanical biomarkers

“…Examples of wearables in the market are CareUp or InstaBP, which range in precision and usability 322,335–337 . (E) Examples of elastography modalities available in the market: Transient elastography (TE, left), shear wave elastography (SWE, center), and magnetic resonance elastography (MRE, right) (Adapted from reference 338–340). (F) ARTIDIS tumoral biopsy in breast cancer and indentation scheme.…”