Imtiaz Mehwish, Khaqan Muhammad Umer, Mazhar Maryam, Seerat Iqtadar
Mehwish Imtiaz, MBBS, FCPS (Paediatric Medicine) Clinical fellow in Paediatric Gastroenterology and Hepatology, Department of Paediatrics and Child Health, Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan.
Muhammad Umer Khaqan, MBBS Medical officer, Department of Paediatrics and Child health, Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan.
Pak J Med Sci. 2025 Feb;41(2):585-589. doi: 10.12669/pjms.41.2.9886.
BACKGROUND & OBJECTIVES: Liver biopsy remains the gold standard for assessment of liver fibrosis; however, it is limited practically because of issues of sampling errors and invasiveness. This opens the way for other important non-invasive processes of diagnosis including the role and utilisation of Shear Wave Elastography in coming years for liver diseases. This post-hoc study will firstly aim to establish the correlation existing between the currently preferred gold standard liver biopsy and 2D-Shear Wave elastography's diagnostic accuracy in paediatric patients presenting with suspected or confirmed liver disease.
This retrospective study was conducted in Pakistan Kidney and Liver Institute and Research Center in Lahore, Pakistan from August 2017 to January 2024. In this analysis, 37 Paediatric patients with various liver diseases who underwent liver biopsy for autoimmune hepatitis, Budd-Chiari syndrome, Wilson disease and other liver-related pathologies were included.
Thirty-seven patients with a mean age of 10 years (ranging from 4-14 years) were enrolled. According to this study, sixteen out of thirty seven (43%) cases of chronic liver disease were caused by autoimmune hepatitis. Patients' average liver stiffness as determined by SWE was 12.14 ± 0.75 kPa. According to elastography, the average liver stiffness in individuals with F0-F1 fibrosis was 6 ± 0.01 kPa, 7.67 ± 0.29 in stage F2, 8.62 ± 0.20 in stage F3, and 14.05 ± 3.69 kPa in stage F4. We discovered that the mean level of hepatic stiffness varied significantly depending on the degree of fibrosis (p = 0.0001).
SWE gauges the liver tissue's stiffness, which rises with fibrosis severity. Research has demonstrated that SWE, which is frequently equivalent to liver biopsy, has a high degree of accuracy in identifying and staging hepatic fibrosis.
肝活检仍是评估肝纤维化的金标准；然而，由于存在抽样误差和侵入性问题，其在实际应用中受到限制。这为其他重要的非侵入性诊断方法开辟了道路，包括未来几年剪切波弹性成像在肝脏疾病中的作用和应用。这项事后分析研究首先旨在确定目前首选的金标准肝活检与二维剪切波弹性成像在疑似或确诊肝病的儿科患者中的诊断准确性之间存在的相关性。
这项回顾性研究于2017年8月至2024年1月在巴基斯坦拉合尔的巴基斯坦肾脏和肝脏研究所及研究中心进行。在该分析中，纳入了37例因自身免疫性肝炎、布加综合征、威尔逊病和其他肝脏相关疾病接受肝活检的患有各种肝病的儿科患者。
共纳入37例平均年龄为10岁（4至14岁）的患者。根据本研究，37例慢性肝病病例中有16例（43%）由自身免疫性肝炎引起。通过剪切波弹性成像测定的患者平均肝脏硬度为12.14±0.75千帕。根据弹性成像，F0 - F1纤维化患者的平均肝脏硬度为6±0.01千帕，F2期为7.67±0.29千帕，F3期为8.62±0.20千帕，F4期为14.05±3.69千帕。我们发现，肝硬度的平均水平因纤维化程度而异，差异有统计学意义（p = 0.0001）。
剪切波弹性成像测量肝脏组织的硬度，其随纤维化严重程度增加而升高。研究表明，剪切波弹性成像通常与肝活检相当，在识别肝纤维化和进行分期方面具有高度准确性。
