Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children

Berná-Serna, Juan de Dios; Sanchez-Jimenez, R.; Velázquez-Marín, Francisca; Baranda, Pilar Sainz de; Guzmán-Aroca, Florentina; Fernández-Hernández, Carmen; Doménech-Abellán, Ernesto; Abellán-Rivero, Dolores; Ruíz-Merino, Guadalupe; Canteras-Jordana, Manuel

doi:10.1177/0284185117707359

Cited by 15 publications

(14 citation statements)

References 40 publications

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“…24,50 Only one study has been published utilizing ARFI in children with NAFLD but, in this European cohort, the NAFLD diagnosis was not made via biopsy. 51 Another form of elastography, magnetic resonance elastography (MRE), was not analyzed in this study. While MRE has somewhat comparable accuracy to ultrasound-based elastography, it has some significant drawbacks such as cost and increased test time.…”

Section: Discussionmentioning

confidence: 99%

Methods to improve the noninvasive diagnosis and assessment of disease severity in children with suspected nonalcoholic fatty liver disease (NAFLD): Study design

Rudolph

Bjorklund

Ovchinsky

et al. 2018

Contemporary Clinical Trials

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Background: Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity and is the most common liver disease in the developed world. In children with suspected NAFLD, present guidelines suggest consideration of alternative diagnoses via extensive blood testing, though the yield of this work up is unknown. Furthermore, the gold standard diagnostic test for NAFLD remains liver biopsy, making the development of non-invasive tests critically important. Objectives: Our objectives are: 1) to determine the accuracy of elastography and multiple serum biomarkers – each assessed individually and as algorithms (including those previously tested in adults) – for the diagnosis of nonalcoholic steatohepatitis (NASH) and early fibrosis in children and (2) to examine the utility of extensive testing for rare alternative diagnoses in overweight or obese children with elevated alanine aminotransferase (ALT) suspected to have NAFLD. Design: This is an ongoing, cross-sectional study in children 2 – 18 years of age with up to 2 years of prospective follow up. Eligible patients are asymptomatic, overweight or obese, and have an ALT ≥ 35 U/L upon enrollment. Two forms of elastography are obtained serially along with anthropometric data and routine laboratory tests. Elastography and serum biomarkers are also performed immediately prior to any clinically-indicated biopsy. Methods: Between April 2015 and April 2018, 193 children have been enrolled in this ongoing study and 71 have undergone liver biopsy. Here we carefully report the rationale, methodology, and preliminary data for this study.

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Section: Discussionmentioning

confidence: 99%

Methods to improve the noninvasive diagnosis and assessment of disease severity in children with suspected nonalcoholic fatty liver disease (NAFLD): Study design

Rudolph

Bjorklund

Ovchinsky

et al. 2018

Contemporary Clinical Trials

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“…Acoustic radiation force impulse (ARFI) is a non-invasive technique integrated into an US machine that uses sound waves to induce shear waves that propagate along the US beam. The method has been validated in adult NAFLD patients and results are promising in pediatric patients as well [ 66 ]. Although sample size was generally small in pediatric studies [ 67 , 68 ] and some authors included patients with diverse liver disease etiologies [ 69 , 70 ] the results indicated that ARFI could represent an adequate predictor of hepatic fibrosis [ 71 ].…”

Section: ⧉ Imagistic Evaluationmentioning

confidence: 99%

Pediatric nonalcoholic fatty liver disease – a changing diagnostic paradigm

Trandafir

Frăsinariu

Leon-Constantin³

et al. 2021

Rom J Morphol Embryol

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Worldwide, nonalcoholic fatty liver disease (NAFLD) has emerged as the leading cause of chronic liver disease in children and adolescents, but also as a real public health issue. Over the last decades, the increase in the rates of obesity and overweight in children has led to the increase in the worldwide prevalence of pediatric NAFLD. Detection of a hyperechoic appearance of the liver at ultrasounds or elevated levels of transaminases, identified during a routine control in children, suggests NAFLD. The disorder can be diagnosed with either non-invasive strategies or through liver biopsy, which further allows the identification of specific histological aspects, distinct from those found in adults. Since NAFLD is a clinically heterogeneous disease, there is an imperative need to identify noninvasive biomarkers and screening techniques for early diagnosis in children, in order to prevent metabolic and cardiovascular complications later in adulthood. This review emphasizes the main diagnosis tools in pediatric NAFLD, a systemic disorder with multifactorial pathogenesis and varying clinical manifestations.

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“…The results showed that children with laboratory parameters in the range of normal values, but also some with normal liver ultrasounds or with mild fatty infiltration, may in fact have had a significant degree of liver fibrosis. [ 48 ] ARFI is not only useful for the evaluation of pNAFLD in normal-weighed children, but also in obese patients or in children with ascites [ 49 ]. ARFI has shown an excellent correlation with the AST/ALT ratio in obese children and can be used as a non-invasive tool to detect pNAFLD and related hepatic parenchymal changes, especially in pediatric patients where biopsy is not a desired method [ 50 ].…”

Section: Elastographymentioning

confidence: 99%

Diagnosis and Staging of Pediatric Non-Alcoholic Fatty Liver Disease: Is Classical Ultrasound the Answer?

et al. 2021

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The increased prevalence of non-alcoholic fatty liver disease (NAFLD) requires special attention in pediatric patients, as it manifests in them in a more severe and progressive way compared to adults. The implementation of the appropriate therapeutic interventions is determinant of the attempts to treat it. For that purpose, early diagnosis and staging of the disease is essential. The purpose of this review was to find and reveal the most appropriate diagnostic strategies and tools for diagnosis and staging of pediatric NAFLD/NASH based on their accuracy, safety and effectiveness. The methodology followed was that of the literature review. Particular emphasis was put on the recent bibliography. A comparative study of published articles about the diagnosis and management of pediatric NAFLD/NASH was also performed. In terms of diagnosis, the findings converged on the use of classical ultrasound. Ultrasound presented average sensitivity and specificity for diagnosing the disease in children, while in the adult population, sensitivity and specificity were significantly higher. Proton density fat fraction magnetic resonance imaging has been increasingly used for the diagnosis of steatosis in pediatric patients. Elastography is an effective tool for staging liver fibrosis and discriminating NASH from NAFLD in children. Even though liver biopsy is the gold standard, especially for NASH, it should be avoided for pediatric patients. Biochemical tests are less specific and less sensitive for the diagnosis of NAFLD, and some of them are of high cost. It seems that diagnostic imaging should be a first-line tool for the staging and monitoring pediatric NAFLD/NASH in order for appropriate interventions to be implanted in a timely way.

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Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children

Cited by 15 publications

References 40 publications

Methods to improve the noninvasive diagnosis and assessment of disease severity in children with suspected nonalcoholic fatty liver disease (NAFLD): Study design

Methods to improve the noninvasive diagnosis and assessment of disease severity in children with suspected nonalcoholic fatty liver disease (NAFLD): Study design

Pediatric nonalcoholic fatty liver disease – a changing diagnostic paradigm

Diagnosis and Staging of Pediatric Non-Alcoholic Fatty Liver Disease: Is Classical Ultrasound the Answer?

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