Usefulness of Transient Elastography for Non-Invasive Diagnosis of Liver Fibrosis in Pediatric Non-Alcoholic Steatohepatitis

Abstract

Background Transient elastography (FibroScan ® ) is a non-invasive and rapid method for assessing liver fibrosis. While the feasibility and usefulness of FibroScan ® have been proven in adults, few studies have focused on pediatric populations. We aimed to determine the feasibility and usefulness of FibroScan ® in Korean children. Methods FibroScan ® examinations were performed in 106 children (age, 5–15 years) who visited the Konyang University Hospital between June and September 2018. Liver steatosis was measured in terms of the controlled attenuation parameter (CAP), while hepatic fibrosis was evaluated in terms of the liver stiffness measurement (LSM). Children were stratified into obese and non-obese controls, according to body mass index (≥ or < 95th percentile, respectively). Results The obese group was characterized by significantly higher levels of aspartate aminotransferase (AST, 57.00 ± 48.47 vs. 26.40 ± 11.80 IU/L; P < 0.001) and alanine aminotransferase (ALT, 91.27 ± 97.67 vs. 16.28 ± 9.78 IU/L; P < 0.001), frequency of hypertension and abdominal obesity (abdominal circumference > 95% percentile) ( P < 0.001), CAP (244.4–340.98 dB/m), and LSM (3.85–7.77 kPa) ( P < 0.001). On FibroScan ® , 30 of 59 obese children had fibrosis (LSM > 5.5 kPa), whereas the remaining 29 did not (LSM < 5.5 kPa). Obese children with fibrosis had higher levels of AST (73.57 ± 56.00 vs. 39.86 ± 31.93 IU/L; P = 0.009), ALT (132.47 ± 113.88 vs. 48.66 ± 51.29 IU/L; P = 0.001), and gamma-glutamyl transferase (106.67 ± 69.31 vs. 28.80 ± 24.26 IU/L; P = 0.042) compared to obese children without fibrosis. LSM had high and significant correlation ( P < 0.05) with AST, ALT, homeostasis model assessment for insulin resistance, and AST-to-platelet ratio index. Conclusion FibroScan ® is clinically feasible and facilitates non-invasive, rapid, reproducible, and reliable detection of hepatic steatosis and liver fibrosis in the Korean pediatric population.

Non-alcoholic fatty liver disease and childhood obesity

“…In terms of imaging techniques, ultrasound is unable to differentiate between steatosis and NASH [9]. Transient elastography and magnetic resonance elastography (MRE) are both used for the non-invasive assessment of liver fibrosis in the adult population, but their usefulness in children and adolescents with fatty liver disease remains under evaluation [27][28][29]. (Table 2) Age and sex:…”

Nonfasted Liver Stiffness Correlates with Liver Disease Parameters and Portal Hypertension in Pediatric Cholestatic Liver Disease

“…(12)(13)(14) The largest TE studies in children with liver disease have examined LSMs in liver transplant recipients (n = 117), cystic fibrosis (n = 249), hepatitis C (n = 223), fatty liver disease (n = 106), and BA (n = 100). (3,(15)(16)(17)(18) These studies correlate LSM with a variety of disease parameters, including clinical features of liver disease, manifestations of portal hypertension, and histologic assessment of fibrosis. The FORCE protocol is unique in that it has been developed in the context of three large-scale, prospective, multicenter, observational studies that collected comprehensive and high-quality clinical metadata in three major etiologies of neonatal cholestasis: BA, ALGS, and A1ATD.…”

Transient elastography for liver fibrosis in children with chronic liver disease

“…Few studies4 noted no difference in LSM value between S and M probe. Fibroscan S probe (5 MHz; diameter 5cm)4 is better in children <2 years and XL probe (2.5 MHz; diameter 10mm)5 in children with very thick adipose tissue but in my centre they were not available. In all 41 children LSM could be calculated with nil failure rates.…”