Using liver elastography to diagnose sinusoidal obstruction syndrome in pediatric patients undergoing hematopoetic stem cell transplant

Abstract

Sinusoidal obstruction syndrome (SOS) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Traditional ultrasound (US) has poor sensitivity and specificity. US shear wave elastography (SWE) is a newer technology that measures liver stiffness. This is a single-institution, prospective cohort study evaluating SWE in patients younger than 21 years who received HSCT from December 2015 through June 2017. SOS was defined using the modified Seattle criteria. Subjects had US with SWE at three scheduled time points. t-tests were used to assess for difference between the groups and ROC curves were generated. Twenty-five patients were included. Five subjects developed SOS. At day +5 HSCT, SOS patients had SWE velocities that increased by 0.25 ± 0.21 m/s compared to 0.02 ± 0.18 in patients without SOS (p = 0.020). At day +14, SOS patients had SWE velocities that significantly increased by 0.91 m/s ± 1.14 m/s compared to 0.03 m/s ± 0.23 m/s in patients without SOS (p = 0.010). SWE SOS diagnosis occurred on average 9 and 11 days before clinical and conventional US diagnosis, respectively. Patients who develop SOS have increased liver stiffness compared to patients who do not develop SOS. SWE changes occur before other imaging and clinical findings of SOS.

Liver Stiffness Measurement Allows Early Diagnosis of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome in Adult Patients Who Undergo Hematopoietic Stem Cell Transplantation: Results from a Monocentric Prospective Study

“…This increase in LSM values compared with previous measurements was significantly associated with the diagnosis of VOD/SOS. Our results obtained in an adult cohort are consistent with the findings of our previous study in a pediatric setting [28] using the same elastographic method and assessment schedule and with results reported by Reddivalla et al [31] using a different ultrasound elastography method (ie, acoustic radiation force impulse), again in a pediatric population. In addition, in patients who developed VOD/SOS and were specifically treated, LSM values were reduced within 2 to 4 weeks after diagnosis, reaching pretransplantation values.…”

“…To date, among these techniques, only transient elastography (TE) [28À30] and point-shear wave elastography by acoustic radiation force impulse imaging [29,31] have been evaluated for assessment of liver complications in pediatric patients undergoing HSCT. No study has yet been reported on the role of LSM in VOD/SOS assessment in the setting of adult HSCT.…”

Risk Factors for Development of and Progression of Hepatic Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome

“…Thromboelastography also has been used to assess bleeding risk in patients with VOD/SOS and guide treatment with defibrotide [73]. Novel hepatic diagnostic criteria for VOD/ SOS that have been investigated include liver stiffness, measured with ultrasound or acoustic radiation force impulse shear wave elastography, as an indication of venous congestion and fibrosis [74][75][76]. Several studies have demonstrated early diagnosis or prediction of VOD/SOS with this method, before the appearance of conventional clinical criteria [74][75][76].…”

“…Novel hepatic diagnostic criteria for VOD/ SOS that have been investigated include liver stiffness, measured with ultrasound or acoustic radiation force impulse shear wave elastography, as an indication of venous congestion and fibrosis [74][75][76]. Several studies have demonstrated early diagnosis or prediction of VOD/SOS with this method, before the appearance of conventional clinical criteria [74][75][76]. Other proposed methods involve the multifactorial, or panel, scoring approach for early diagnosis or prediction of VOD/SOS with the use of ultrasound [77][78][79][80].…”

Longitudinal evaluation of liver stiffness in three pediatric patients with veno‐occlusive disease

“…The possible role for on the use of LSM in the HSCT setting was suggested by Karlas et al, who stated that LSM, assessed both by TE (FibroScan®, Echosens, France) and ARFI, pSWE, could predict the onset of hepatobiliary complications in adult patients undergoing HSCT. In addition, Colecchia et al first and Reddivalla et al subsequently have demonstrated that LSM, using TE and two‐dimensional SWE, respectively, had a sudden increase up to more than a week before the diagnosis of VOD/SOS in pediatric patients. Recently, the same findings have been demonstrated in a monocentric cohort of 78 adult patients …”