Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography

Abstract

Introduction: The objective of this study was to evaluate the feasibility of shear wave elastography (SWE), as a non-invasive means of assessing liver fibrosis stage in paediatric and adolescent patients.

Materials and methods: Consecutive paediatric and adolescent subjects scheduled for liver biopsy (LB) evaluation of known or suspected diffuse liver disease were included after informed guardian consent and subject assent in this IRB-approved single institution study. Elastograms were acquired prior to liver biopsy, from the liver under a breath-hold after normal inspiration when possible. Biopsy specimens underwent blinded pathologist review using the METAVIR scoring system.

Results: Twenty-four patients (M : F = 13:11) with a mean age of 17 years (range: 1-21 years) underwent liver biopsy. The distribution of fibrosis on pathological examination was: F0 = 10, F1 = 9, F2 = 1, F3 = 3, and F4 = 1. Subjects with stages F0 and F1 fibrosis had a mean SWE value of 6.93 kPa (95% CI: 6.33-7.44 kPa) and 8.33 kPa (95% CI: 6.83-10.80 kPa) respectively. The SWE value for the one subject with stage F2 fibrosis was 6.36 kPa, whereas for F3 and F4 were 8.86 (95% CI: 5.70-11.40) and 17.85 kPa respectively. The correlation between SWE values and fibrosis grade was strong (r = 0.58, P = 0.003), and the area under the ROC curve differentiatiang ≥F2 fibrosis was 0.62 (95% CI: 0.26-0.98).

Conclusion: Estimation of liver stiffness using real-time SWE is feasible using the SC6-1 ultrasound probe in paediatric and adolescent patients and strongly correlates with the stage of fibrosis.

Keywords: liver biopsy; liver fibrosis; liver stiffness; shear wave elastography; ultrasound.

Conflict of interest statement

Conflict of interest: None of the authors have any conflict of interest.

© 2015 The Royal Australian and New Zealand College of Radiologists.

Figures

Fig. 1.

Example of SWE values obtained from offline quantification by placing a ROI placed in an elastogram obtained in (a) a 20-year-old female with autoimmune hepatitis type II and no fibrosis (F0) on biopsy who had a median SWE value of 6.08 kPa and (b) a 19-year-old female with AIH type I disease that had F4 fibrosis on biopsy and the SWE value of 17.94 kPa.

Fig. 2.

Box and Whisker plot represents the median values of SWE measurements obtained for each fibrosis stage.

Fig. 3.

Receiver-operating characteristic curve using median SWE values to differentiate significant fibrosis (F2–F4) from lesser degrees of fibrosis (F0, F1).