Elastography for Pediatric Chronic Liver Disease

Abstract

In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population.

How to perform shear wave elastography. Part I

“…In phantom studies, it has been shown that the readings with the higher frequency of the linear transducer are higher than those obtained with the convex transducer. Moreover, in children the acquisition could be more challenging due to the lack of cooperation and this could affect the feasibility of the technique [30,31].…”

“…Before launching the acquisition, the operator asks the patient to hold the breath in a neutral position without performing a Valsalva's maneuver for the few seconds needed for the acquisition [15]. Special applications in pediatric patients are discussed elsewhere [30,31,53].…”

“…Recently, it has been reported that portal vein thrombosis is also a confounder [67]. On the other hand, SWE can play a role in cases of liver congestion due to right-sided heart failure, congenital heart diseases or valvular diseases as well as in the hepatic sinusoidal obstruction syndrome or in the Budd-Chiari syndrome [31,68].…”

Targeting plasma cells with daratumumab aids in the treatment of post‐transplant autoimmune‐like hepatitis

“…He had a waxing and waning course of hepatitis for the first six months after initial therapy. This was accompanied by increased liver stiffness on ultrasound elastography, which can indicate inflammation in the acute setting and fibrosis in the chronic setting 18,19 . MRCP showed narrowing of the common hepatic bile duct and dilation of the intrahepatic bile ducts.…”

Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility

“…In this study, we evaluated a consecutive cohort of difficult patients in a nonacademic outpatient setting to determine the time to perform the examination and determine the range of LS, attenuation coefficient, and shear wave dispersion slopes by US. SWE is maturing with several organizations providing recommendations for performing and interpreting LS results [7,[24][25][26][27][28]. Guidelines have recommended not using Metavir cut-off values but the probability of cACLD as this is what is clinically important as these are the patients who are at risk for the complications of CLD including portal hypertension, liver failure, and hepatocellular carcinoma [22].…”