Quantitative Imaging in Pediatric Hepatobiliary Disease

Yoon, Haesung; Shin, Hyun Joo; Kim, Myung Joon; Lee, Mi Jung

doi:10.3348/kjr.2019.0002

Cited by 15 publications

(12 citation statements)

References 89 publications

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“…In addition to shear wave-based US elastography, magnetic resonance elastography (MRE) has emerged as another noninvasive method to evaluate liver fibrosis ( 30 31 32 33 ), and the reported diagnostic performance of MRE in evaluating liver fibrosis is generally higher than that of US-based elastography. MRE also provides excellent reproducibility and repeatability of liver stiffness measurements ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard

Lee

et al. 2020

Korean J Radiol

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Objective The aim of this study was to prospectively evaluate whether liver stiffness (LS) assessments, obtained by two-dimensional (2D)-shear wave elastography (SWE) with a propagation map, can evaluate liver fibrosis stage using histopathology as the reference standard. Materials and Methods We prospectively enrolled 123 patients who had undergone percutaneous liver biopsy from two tertiary referral hospitals. All patients underwent 2D-SWE examination prior to biopsy, and LS values (kilopascal [kPa]) were obtained. On histopathologic examination, fibrosis stage (F0–F4) and necroinflammatory activity grade (A0–A4) were assessed. Multivariate linear regression analysis was performed to determine the significant factors affecting the LS value. The diagnostic performance of the LS value for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis, and the optimal cut-off value was determined by the Youden index. Results Reliable measurements of LS values were obtained in 114 patients (92.7%, 114/123). LS values obtained from 2D-SWE with the propagation map positively correlated with the progression of liver fibrosis reported from histopathology ( p < 0.001). According to the multivariate linear regression analysis, fibrosis stage was the only factor significantly associated with LS ( p < 0.001). The area under the ROC curve of LS from 2D-SWE with the propagation map was 0.773, 0.865, 0.946, and 0.950 for detecting F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The optimal cut-off LS values were 5.4, 7.8, 9.4, and 12.2 kPa for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The corresponding sensitivity and specificity of the LS value for detecting cirrhosis were 90.9% and 88.4%, respectively. Conclusion The LS value obtained from 2D-SWE with a propagation map provides excellent diagnostic performance in evaluating liver fibrosis stage, determined by histopathology.

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Section: Discussionmentioning

confidence: 99%

Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard

Lee

et al. 2020

Korean J Radiol

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“…Magnetic resonance elastography (MRE) might be an alternative diagnostic tool for the liver fibrosis stage. The diagnostic performance and reproducibility of MRE is generally higher than that of SWE examination [ 38 – 40 ]. However, compared to ultrasound-based elastography examination, MRE has a longer acquisition time, higher cost, and requires sedation, especially for uncooperative pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of noninvasive liver stiffness assessment using shear-wave elastography for predicting liver fibrosis in children

et al. 2021

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Background Pediatric patients with liver disease require noninvasive monitoring to evaluate the risk of fibrosis progression. This study aimed to identify the significant factors affecting liver stiffness values using two-dimensional shear-wave elastography (2D-SWE), and determine whether liver stiffness can predict the fibrosis stage of various childhood liver diseases. Methods This study included 30 children (22 boys and 8 girls; mean age, 5.1 ± 6.1 years; range, 7 days–17.9 years) who had undergone biochemical evaluation, 2D-SWE examination, histopathologic analysis of fibrosis grade (F0 to F3), assessment of necroinflammatory activity, and steatosis grading between August 2016 and March 2020. The liver stiffness from 2D-SWE was compared between fibrosis stages using Kruskal–Wallis analysis. Factors that significantly affected liver stiffness were evaluated using univariate and multivariate linear regression analyses. The diagnostic performance was determined from the area under the receiver operating curve (AUC) values of 2D-SWE liver stiffness. Results Liver stiffness at the F0-1, F2, and F3 stages were 7.9, 13.2, and 21.7 kPa, respectively (P < 0.001). Both fibrosis stage and necroinflammatory grade were significantly associated with liver stiffness (P < 0.001 and P = 0.021, respectively). However, in patients with alanine aminotransferase (ALT) levels below 200 IU/L, the only factor affecting liver stiffness was fibrosis stage (P = 0.030). The liver stiffness value could distinguish significant fibrosis (≥ F2) with an AUC of 0.950 (cutoff value, 11.3 kPa) and severe fibrosis (F3 stage) with an AUC of 0.924 (cutoff value, 18.1 kPa). The 2D-SWE values for differentiating significant fibrosis were 10.5 kPa (≥ F2) and 18.1 kPa (F3) in patients with ALT levels below 200 IU/L. Conclusion The liver stiffness values on 2D-SWE can be affected by both fibrosis and necroinflammatory grade and can provide excellent diagnostic performance in evaluating the fibrosis stage in various pediatric liver diseases. However, clinicians should be mindful of potential confounders, such as necroinflammatory activity or transaminase level, when performing 2D-SWE measurements for liver fibrosis staging.

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“…This is due to its numerous advantages, such as relatively low cost, lack of invasiveness, high availability, and high rate of acceptance by the patient [ 50 ]. Steatosis is easily recognized by the experienced user presenting as high hepatic echogenicity, visualization of hepatic vessels, low diaphragm visualization, and posterior attenuation [ 51 , 52 ]. However, despite its many advantages, US presents high levels of interobserver and intraobserver variability and thus the results need to be interpreted with caution [ 53 ].…”

Section: ⧉ Imagistic Evaluationmentioning

confidence: 99%

Pediatric nonalcoholic fatty liver disease – a changing diagnostic paradigm

Trandafir

Frăsinariu

Leon-Constantin³

et al. 2021

Rom J Morphol Embryol

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Worldwide, nonalcoholic fatty liver disease (NAFLD) has emerged as the leading cause of chronic liver disease in children and adolescents, but also as a real public health issue. Over the last decades, the increase in the rates of obesity and overweight in children has led to the increase in the worldwide prevalence of pediatric NAFLD. Detection of a hyperechoic appearance of the liver at ultrasounds or elevated levels of transaminases, identified during a routine control in children, suggests NAFLD. The disorder can be diagnosed with either non-invasive strategies or through liver biopsy, which further allows the identification of specific histological aspects, distinct from those found in adults. Since NAFLD is a clinically heterogeneous disease, there is an imperative need to identify noninvasive biomarkers and screening techniques for early diagnosis in children, in order to prevent metabolic and cardiovascular complications later in adulthood. This review emphasizes the main diagnosis tools in pediatric NAFLD, a systemic disorder with multifactorial pathogenesis and varying clinical manifestations.

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Quantitative Imaging in Pediatric Hepatobiliary Disease

Cited by 15 publications

References 89 publications

Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard

Two-Dimensional-Shear Wave Elastography with a Propagation Map: Prospective Evaluation of Liver Fibrosis Using Histopathology as the Reference Standard

The usefulness of noninvasive liver stiffness assessment using shear-wave elastography for predicting liver fibrosis in children

Pediatric nonalcoholic fatty liver disease – a changing diagnostic paradigm

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