The Usefulness of Noninvasive Liver Stiffness Assessment Using Shear-Wave Elastography for Predicting Liver Fibrosis in Children

Abstract

Background: Pediatric patients with liver disease require noninvasive monitoring for the likelihood of fibrosis progression. The purpose of this study is to evaluate the significant factors affecting liver stiffness values from two-dimensional-shear wave elastography (2D-SWE), and whether liver stiffness can predict the fibrosis stage of various childhood liver diseases.Methods: This study comprised 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, and histopathologic analysis with fibrosis grade (F0 to F3), necroinflammatory activity, and steatosis grade between August 2016 and March 2020. The liver stiffness from 2D-SWE were compared between fibrosis stages using the Kruskal-Wallis analysis. The significant affecting factors to 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 the 2D-SWE liver stiffness.Results: Liver stiffness at the F0-1, F2, and F3 stages were 7.9, 13.2, and 21.7 kPa (P < 0.001). Both of fibrosis stage and necroinflammatory grade were factors significantly associated with liver stiffness (P < 0.001 and P = 0.021). Liver stiffness value could distinguish significant fibrosis (≥F2) with an AUC of 0.950 (cutoff value, 11.3 kPa) and the severe fibrosis (F3 stage) with an AUC of 0.924 (cutoff value, 18.1 kPa). Conclusion: The liver stiffness values from 2D-SWE can be effected through both fibrosis and necroinflammatory grade and can provide excellent diagnostic performance in evaluating the fibrosis stage, even in various liver disease.

Accuracy of noninvasive methods for the diagnosis of liver fibrosis in children with chronic viral hepatitis

“…TE, HA, and APRI were assessed in association with biopsy results via the receiver operator characteristic (ROC) curve. Biopsy was categorized into no fibrosis (F0) and fibrosis (1)(2)(3)(4)(5)(6). The best cutoff was selected, from which sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.…”

“…In addition to the variability of the nature and the extent of some etiologies causing fibrosis in both age groups, the pediatric liver fibrosis also characterized by its unpredictable course of progression; that may be more rapid in children necessitating frequent monitoring [1]. The different inflammation and immune response and ductular reaction in pediatric fibrosis enhance the need for evaluation the application and accuracy of novel radiological and biomarker diagnostics of fibrosis [2].…”

Usefulness of two-dimensional shear wave elastography in diagnosing hepatic veno-occlusive disease in pediatric patients undergoing hematopoietic stem cell transplantation

“…The liver stiffness on 2D-SWE was determined according to previously reported guidelines, using the median value of stiffness recorded from 10 measurements on the right lobe of the liver [13,20]. Patients maintained a fasting state for a minimum of 2 h before the examination but were free-breathing in a supine position during the 2D-SWE test [21,22].…”

“…2D-SWE is a tool for measuring liver stiffness and is used to evaluate the degree of hepatic fibrosis in patients. In particular, its potential has been shown in pediatric patients [12,13].…”

“…Recently, the advantages of two-dimensional shear wave elastography (2D-SWE) in the quantitative assessment of liver stiffness in pediatric patients with various hepatic pathologies have been reported [11][12][13]. The benefits of 2D-SWE have been demonstrated in children with chronic liver diseases such as non-alcoholic fatty liver disease [12].…”