Hebelka Hanna, de Lange Charlotte, Boström Håkan, Ekvall Nils, Lagerstrand Kerstin
From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
JPGN Rep. 2021 Dec 10;3(1):e156. doi: 10.1097/PG9.0000000000000156. eCollection 2022 Feb.
To evaluate the diagnostic accuracy of ultrasound shear wave elastography (SWE) prospectively and to determine cutoff value for nonfibrotic liver tissue in children with suspected or established liver disease.
In 90 consecutive pediatric patients, standardized 2D-SWE was performed during general anesthesia and free breathing. Liver stiffness was estimated with SWE followed by a percutaneous biopsy from the corresponding area. SWE values were compared with histology with fibrosis scored according to Batts & Ludwig classification (grade 0-4 = F0-F4) and to hepatic biomarkers.
Four patients with SWE interquartile range (IQR)/median ≥ 30% kPa were excluded. The remaining 86 children (59% males) had a mean age = 10.2 years (0.1-18). The distribution of individuals with median (min;max) SWE values (kPa) within each fibrosis grade were; F0[n = 10; 5.0(3.4;6.3)], F1[n = 24; 5.0(3.6;8.7)], F2[n = 32; 5.8(3.5;13.4)], F3[n = 12, 7.5(4.0;14.4)], and F4[n = 8; 12.5(6.6;21.0)]. There was a significant difference between fibrosis grades (0.03 > < 0.002) except between F0 and F1 respectively between F1 and F2. The AuROC differentiating F0-1 from F2-4 was 0.77(95% CI: 0.67-0.87). A cutoff SWE value of ≤4.5 kPa yielded 90% sensitivity and 68% specificity to rule out significant fibrosis (F2-F4). Out of the 18 children (21%) with SWE value ≤4.5 kPa, 12 had grade F0-1 and 6 had F2, although including some confounders for increased SWE measurements as steatosis/hepatitis/cholestasis.
2D-SWE ultrasound can reliably distinguish no/mild (F0/F1) from moderate/severe (F2-F4) fibrosis in children with suspected/established liver disease with good sensitivity and acceptable specificity. Our results show that in pediatric patients, when the indication for biopsy is to rule out significant fibrosis, SWE can be considered an alternative.
前瞻性评估超声剪切波弹性成像（SWE）的诊断准确性，并确定疑似或确诊肝病儿童非纤维化肝组织的临界值。
对90例连续的儿科患者在全身麻醉和自由呼吸状态下进行标准化二维SWE检查。用SWE评估肝脏硬度，随后从相应区域进行经皮肝活检。将SWE值与根据Batts&Ludwig分类（0-4级=F0-F4）评分的纤维化组织学结果以及肝脏生物标志物进行比较。
排除4例SWE四分位间距（IQR）/中位数≥30%kPa的患者。其余86名儿童（59%为男性）平均年龄为10.2岁（0.1-18岁）。各纤维化分级中SWE值中位数（最小值；最大值）（kPa）的个体分布为：F0[n=10；5.0（3.4；6.3）]，F1[n=24；5.0（3.6；8.7）]，F2[n=32；5.8（3.5；13.4）]，F3[n=12，7.5（4.0；14.4）]，F4[n=8；12.5（6.6；21.0）]。除F0和F1之间以及F1和F2之间外，纤维化分级之间存在显著差异（0.03＞＜0.002）。区分F0-1和F2-4的曲线下面积（AuROC）为0.77（95%CI：0.67-0.87）。≤4.5kPa的SWE临界值对排除显著纤维化（F2-F4）的敏感性为90%，特异性为68%。在18名（21%）SWE值≤4.5kPa的儿童中，12名纤维化分级为F0-1，6名纤维化分级为F2，尽管包括一些导致SWE测量值升高的混杂因素，如脂肪变性/肝炎/胆汁淤积。
二维SWE超声能够以良好的敏感性和可接受的特异性，可靠地区分疑似或确诊肝病儿童的无/轻度（F0/F1）与中度/重度（F2-F4）纤维化。我们的结果表明，在儿科患者中，当活检指征是排除显著纤维化时，SWE可被视为一种替代方法。
