Ultrasound Shear Wave Elastography, Shear Wave Dispersion and Attenuation Imaging of Pediatric Liver Disease with Histological Correlation

Abstract

Aim: To evaluate the feasibility of multiple ultrasound markers for the non-invasive characterization of fibrosis, inflammation and steatosis in the liver in pediatric patients. Materials and methods: The quantitative ultrasound measures shear wave elastography (SWE), shear wave dispersion (SWD) and attenuation imaging (ATI) were compared and correlated with percutaneous liver biopsies and corresponding measures in a control cohort. Results: The median age of the 32 patients was 12.1 years (range 0.1–17.9), and that of the 15 controls was 11.8 years (range: 2.6–16.6). Results: There was a significant difference in SWE values between histologic grades of fibrosis (p = 0.003), with a positive correlation according to the grade (r = 0.7; p < 0.0001). Overall, a difference in SWD values between grades of inflammation was found (p = 0.009) but with a lack of correlation (r = 0.1; p = 0.67). Comparing inflammation grades 0–1 (median:13.6 m/s kHz [min; max; 8.4; 17.5]) versus grades 2–3 (16.3 m/s kHz [14.6; 24.2]) showed significant differences between the groups (p = 0.003). In the 30 individuals with a steatosis score of 0, ATI was measured in 23 cases with a median value of 0.56 dB/cm/MHz. Conclusion: Comprehensive ultrasound analysis was feasible to apply in children and has the potential to reflect the various components of liver affection non-invasively. Larger studies are necessary to conclude to what extent these image-based markers can classify the grade of fibrosis, inflammation and steatosis.

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

“…In this explorative study, we compared SWE and SWD to histology findings in elective pediatric liver transplant recipients without clinical complications. Both SWE and SWD values were slightly higher in this cohort of transplant recipients than corresponding values previously reported for healthy children 11,25,28 . SWE correlated with fibrosis in the pediatric liver recipients, but the correlation was weak and there was a large variation in SWE values within the different grades of fibrosis.…”

“…Our data were primarily collected from patients during anesthesia, which could be considered a limitation. However, it has previously been shown to have a weak impact at the group level 25 …”

“…The inclusion criteria were previous history of liver transplant surgery of any cause and consent to participate in the study provided by the child or parents/guardians. Twenty‐one of the patients were part of the study investigating 2D‐SWE as a marker for fibrosis in children with various chronic liver diseases 11 and 7 patients were part of a feasibility study of SWD 25 …”

“…Shear wave dispersion (SWD), a novel ultrasound measure based on elastography technology [Canon Medical, Aplio i800], has been proposed to reflect edema and/or inflammation in liver tissue by measuring liver tissue viscosity 23,24 . One pediatric feasibility study reported SWE and SWD as promising markers to rule out clinically significant fibrosis and inflammation, respectively, in a cohort of children with various liver diseases 25 . Further, Sugimoto et al, reported SWD as a potential marker of allograft damage in adult liver recipients 26 .…”

Fontan-associated liver disease: Diagnosis, surveillance, and management

“…Along with new measures in US elastography, shear wave dispersion has been reported to be related to tissue viscosity and thus seems to reflect the components of inflammation, edema, and necrosis (115)(116)(117)(118). In addition, the US attenuation imaging coefficient is an additional tool that enables the surrogate estimation of fat content in the liver (108,119).…”