Shear wave elastography for evaluation of the urgency of liver transplantation in pediatric patients with biliary atresia

Abstract

Background: To investigate the role of two-dimensional shear wave elastography (2D-SWE) in the preoperative evaluation of pediatric patients with biliary atresia awaiting liver transplantation. Methods: Among a total of 152 pediatric patients enrolled in this single-institution prospective study between March 2018 and August 2019, 143 patients (age range, 4-97 months; median age, 7 months; 84 males, 59 females) who underwent successful routine ultrasound examination, SWE examination, and blood test before liver transplantation were included in the final analysis. The values of liver stiffness measured by SWE were compared with ultrasound and blood test parameters by Spearman's correlation analysis. Results: The overall median liver stiffness with 2D-SWE was 29.0 ± 10.9 kPa, with a range of 9.0-53.3 kPa. The success rate of 2D-SWE measurements was 98.0% (149/152). Liver stiffness measurement (LSMs) had no significant correlation with gender, age, weight, and height of the pediatric recipients. LSMs were correlated with ultrasound parameters including portal vein (PV) maximum velocity, PV direction, hepatic artery resistance index (HARI), spleen diameter, ascites, and blood test parameters (albumin level, platelet count level, and international normalized ratio). In the pediatric recipients with hepatofugal PV flow, high HARI (HARI ≧ 0.90), and ascites, or without Kasai operation, LSMs were significantly higher (P < .05). Conclusions: SWE is feasible and valuable for assessing liver damage in children with biliary atresia awaiting liver transplantation and might be used as selection criteria for children in need of priority access to liver transplantation.

Two-Dimensional Shear Wave Elastography Evaluation of Post-transplantation Complications in Pediatric Receipt: A Retrospective Cohort

“…2D SWE can detect the propagation of the shear wave, obtain elastic images based on conventional ultrasonic images, and quantitatively measure liver stiffness (16). The successful rate of LSM by 2D SWE was above 98% in children (17,18). The main factor affecting pediatric patient measurement was poor image quality caused by crying and movement, which can be solved by feeding and sedation.…”

Shear wave elastography and shear wave dispersion correlated to biopsy at the scheduled follow‐up of pediatric liver grafts

“…Even though liver biopsy is considered the gold standard for liver tissue characterization, it is an invasive and costly procedure, often requiring anesthesia in the pediatric cohort 7 . Therefore, noninvasive assessment of the liver parenchyma could be of great value to limit the need for invasive interventions and improve the surveillance of these children 8–10 …”

“…Methods for noninvasive liver tissue characterization have improved in recent years. Ultrasound‐based 2D‐shear wave elastography (SWE), a measure of liver stiffness, has been shown to correlate with the grade of fibrosis in adult chronic liver disease and appears to do so also in pediatric cohorts 8–18 . Recent studies are also showing promising results of 2D‐SWE in the surveillance of complications of pediatric liver transplant cohorts including acute rejection 8,9,19–21 .…”

“…7 Therefore, noninvasive assessment of the liver parenchyma could be of great value to limit the need for invasive interventions and improve the surveillance of these children. [8][9][10] Methods for noninvasive liver tissue characterization have improved in recent years. Ultrasound-based 2D-shear wave elastography (SWE), a measure of liver stiffness, has been shown to correlate with the grade of fibrosis in adult chronic liver disease and appears to do so also in pediatric cohorts.…”

“…Ultrasound-based 2D-shear wave elastography (SWE), a measure of liver stiffness, has been shown to correlate with the grade of fibrosis in adult chronic liver disease and appears to do so also in pediatric cohorts. [8][9][10][11][12][13][14][15][16][17][18] Recent studies are also showing promising results of 2D-SWE in the surveillance of complications of pediatric liver transplant cohorts including acute rejection. 8,9,[19][20][21] Even in adult liver recipients without signs of clinical complications, a recent study by Boeken et al, reported increased liver stiffness, speculating on multifactorial intra-and postprocedural changes as an underlying cause.…”