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

Abstract

Purpose: To evaluate the usefulness of two-dimensional shear wave elastography (2D-SWE) in diagnosing hepatic veno-occlusive disease (VOD) in pediatric patients.Methods: This study retrospectively included pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) between November 2019 and January 2021. All 34 patients (8.7 ± 5.0 years) were examined using 2D-SWE for an initial diagnosis. Subgroup analysis was performed using the data from follow-up examinations of patients diagnosed with VOD. The characteristics of the initial VOD diagnosis were compared with the longitudinal changes observed in VOD patients who underwent multiple ultrasound examinations.Results: In total, 19 patients were diagnosed with VOD at 17.6 ± 9.4 days after HSCT. All VOD patients showed hepatomegaly, ascites, and gallbladder wall thickening. Liver stiffness was higher in VOD patients than those in the non-VOD group (12.4 ± 1.1 vs. 6.3 ± 0.8 kPa, P < 0.001). Liver stiffness values above 7.2 kPa showed 84.2% sensitivity and 93.3% specificity in distinguishing VOD from non-VOD (area under the curve = 0.925; 95% confidence interval = 0.780 -0.987; P < 0.001). Subgroup analysis of 11 of the patients showed a linear decrease in liver stiffness values after VOD diagnosis with treatment (first, second, and third follow-ups; 13.5 ± 1.7, 11.3 ± 1.4, 9.5 ± 0.8 kPa, respectively), but without statistical significance in the pairwise analysis. Conclusion:Liver stiffness measured using 2D-SWE increases in pediatric patients who develop VOD after HSCT. Therefore, liver stiffness can be a predictive and quantitative parameter for diagnosing VOD.

Shear wave elastography and dispersion imaging for hepatic veno-occlusive disease prediction after pediatric hematopoietic stem cell transplantation: a feasibility study

“…The conditioning regimens can induce toxic damage to sinusoidal endothelial cells, resulting in local inflammation and migration of blood cells into the space of Disse, causing obstruction of the sinusoidal microcirculation, which can result in sinusoidal portal hypertension [ 3 , 15 , 19 ]. A recent retrospective study utilized SWE to diagnose veno-occlusive disease in pediatric patients [ 21 ], and found that a liver stiffness of 7.2 kPa or greater had a sensitivity of 84.2% and a specificity of 93.3% in differentiating veno-occlusive disease from non-veno-occlusive disease. However, due to its retrospective design, the study had inherent limitations, such as the absence of baseline SWE values before hematopoietic stem cell transplantation and irregular follow-up periods.…”

“…However, liver stiffness measured by SWE may be increased not solely due to fibrosis but to various other conditions, including inflammation, congestion, portal hypertension, and cholestasis [ 6 ]. Therefore, SWE can aid in the early detection of patients with suspected veno-occlusive disease [ 15 – 21 ]. Shear-wave dispersion (SWD) imaging reveals the shear wave slope, reflecting the viscosity associated with cellular inflammation, edema, and necrosis, providing a more comprehensive assessment of tissue characteristics compared to conventional US methods [ 22 – 24 ].…”