Two-Dimensional Shear Wave Elastography Predicts Liver Fibrosis in Jaundiced Infants with Suspected Biliary Atresia: A Prospective Study

Abstract

Objective This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. Materials and Methods This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. Results The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 ( p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. Conclusion 2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Sound touch elastography for assessing cirrhosis preoperatively in infants with biliary atresia: Comparison with serum fibrosis biomarkers

“…In recent years, several research reports have been published on the non-invasive assessment of hepatic fibrosis in children with ultrasound elastography. Chen et al ( 14 ) used Aixplorer scanner (Supersonic Imagine) 2D Shear wave elastography (SWE) technology to measure jaundiced infants. The results showed that the 2D SWE value is positively correlated with the grade of hepatic fibrosis in children with BA, with a correlation coefficient of 0.789.…”

“…However, MRI elastography is expensive, requires a long examination time, and infants and young children need sedation ( 13 ). At present, a small number of studies show the feasibility of ultrasound elastography in the assessment of the stages of hepatic fibrosis in pediatric patients with BA ( 14 – 17 ), but the results are different with different ultrasound elastography techniques, and the number of patients included in each study is small.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 34 original research studies reporting OR published in the Korean Journal of Radiology in 2020–2021 [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 ] were evaluated against a rigorous standard (i.e., complete transparency in reporting), 91.2% (31/34) clearly mentioned how they defined the odds, 62.1% (18/29) unmistakably described the reference category for OR calculation for categorical variables, and 42.9% (9/21) specified the one-unit amount for OR for continuous variables. Therefore, there is room for improvement in reporting.…”

Ultrasound for the Diagnosis of Biliary Atresia: From Conventional Ultrasound to Artificial Intelligence

“…Since the progression of liver fibrosis in patients with BA is faster than that in other neonatal cholestasis, the measurement of liver stiffness might be useful to identify BA among infants with conjugated hyperbilirubinemia, especially when all conventional US features are negative. Elastography can be performed to quantify liver stiffness and fibrosis in infants with cholestasis [ 38 , 39 , 40 ] and to facilitate the differential diagnosis of BA [ 27 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. With the development of elastography technology, various types of elastography have been reported for the diagnosis of BA.…”