Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
BMC Med Imaging. 2021 Apr 12;21(1):68. doi: 10.1186/s12880-021-00601-8.
Pediatric patients with liver disease require noninvasive monitoring to evaluate the risk of fibrosis progression. This study aimed to identify the significant factors affecting liver stiffness values using two-dimensional shear-wave elastography (2D-SWE), and determine whether liver stiffness can predict the fibrosis stage of various childhood liver diseases.
This study included 30 children (22 boys and 8 girls; mean age, 5.1 ± 6.1 years; range, 7 days-17.9 years) who had undergone biochemical evaluation, 2D-SWE examination, histopathologic analysis of fibrosis grade (F0 to F3), assessment of necroinflammatory activity, and steatosis grading between August 2016 and March 2020. The liver stiffness from 2D-SWE was compared between fibrosis stages using Kruskal-Wallis analysis. Factors that significantly affected liver stiffness were evaluated using univariate and multivariate linear regression analyses. The diagnostic performance was determined from the area under the receiver operating curve (AUC) values of 2D-SWE liver stiffness.
Liver stiffness at the F0-1, F2, and F3 stages were 7.9, 13.2, and 21.7 kPa, respectively (P < 0.001). Both fibrosis stage and necroinflammatory grade were significantly associated with liver stiffness (P < 0.001 and P = 0.021, respectively). However, in patients with alanine aminotransferase (ALT) levels below 200 IU/L, the only factor affecting liver stiffness was fibrosis stage (P = 0.030). The liver stiffness value could distinguish significant fibrosis (≥ F2) with an AUC of 0.950 (cutoff value, 11.3 kPa) and severe fibrosis (F3 stage) with an AUC of 0.924 (cutoff value, 18.1 kPa). The 2D-SWE values for differentiating significant fibrosis were 10.5 kPa (≥ F2) and 18.1 kPa (F3) in patients with ALT levels below 200 IU/L.
The liver stiffness values on 2D-SWE can be affected by both fibrosis and necroinflammatory grade and can provide excellent diagnostic performance in evaluating the fibrosis stage in various pediatric liver diseases. However, clinicians should be mindful of potential confounders, such as necroinflammatory activity or transaminase level, when performing 2D-SWE measurements for liver fibrosis staging.
患有肝病的儿科患者需要进行非侵入性监测，以评估纤维化进展的风险。本研究旨在使用二维剪切波弹性成像（2D-SWE）确定影响肝硬度值的显著因素，并确定肝硬度是否可以预测各种儿童期肝病的纤维化分期。
本研究纳入了 2016 年 8 月至 2020 年 3 月期间接受生化评估、2D-SWE 检查、纤维化分级（F0 至 F3）的组织病理学分析、坏死性炎症活动评估和脂肪变性分级的 30 名儿童（22 名男孩和 8 名女孩；平均年龄 5.1 ± 6.1 岁；范围 7 天-17.9 岁）。使用 Kruskal-Wallis 分析比较纤维化分期之间的肝硬度。使用单变量和多变量线性回归分析评估显著影响肝硬度的因素。通过 2D-SWE 肝硬度的受试者工作特征曲线（AUC）值确定诊断性能。
F0-1、F2 和 F3 期的肝硬度分别为 7.9、13.2 和 21.7kPa（P<0.001）。纤维化分期和坏死性炎症分级均与肝硬度显著相关（P<0.001 和 P=0.021）。然而，在丙氨酸氨基转移酶（ALT）水平低于 200IU/L 的患者中，唯一影响肝硬度的因素是纤维化分期（P=0.030）。肝硬度值可以区分显著纤维化（≥F2），AUC 为 0.950（截断值为 11.3kPa），严重纤维化（F3 期），AUC 为 0.924（截断值为 18.1kPa）。在 ALT 水平低于 200IU/L 的患者中，区分显著纤维化的 2D-SWE 值分别为 10.5kPa（≥F2）和 18.1kPa（F3）。
2D-SWE 上的肝硬度值可受到纤维化和坏死性炎症分级的影响，并在评估各种儿童期肝病的纤维化分期方面提供出色的诊断性能。然而，当对 2D-SWE 进行肝纤维化分期测量时，临床医生应注意潜在的混杂因素，如坏死性炎症活动或转氨酶水平。
