Evaluation of Acoustic Radiation Force Impulse Imaging (ARFI) for the Determination of Liver Stiffness Using Transient Elastography as a Reference in Children

Abstract

Purpose: Transient elastography (Fibroscan?; (FS)) and acoustic radiation force impulse imaging (ARFI) represent noninvasive, user-friendly and quick methods providing an objective and reproducible measure of liver stiffness. The aim of the study was to evaluate cut-off values and performance of ARFI measurements in children using transient elastography as a reference. Methods/Patients: A total of 198 children were enrolled in this study. All patients underwent liver stiffness measurements with FS (FS-LS) as well as ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was studied. Results: Significantly higher rates of successful measurements were found for ARFI compared to FS (198/198 (100%) vs. 160/198 (80.8%); p<0.001). ARFI-SWV correlated significantly with FS-LS (r=0.751, p=0.001). ARFI-SWV increased significantly with the stage of fibrosis (1.19+0.15?m/s for patients with FS-LS<7.6?kPa); 1.34+0.22?m/s for patients with 7.6<FS-LS<13.0?kPa); and 1.83+0.58?m/s for patients with FS-LS>13.0?kPa). ARFI-SWV cut-off values were identified for no significant fibrosis (1.31?m/s; sensitivity 61.8% and specificity 79.5%) and for liver cirrhosis (1.63?m/s; sensitivity 70.0% and specificity 97.4%). The median values of liver stiffness measured by FS were age-dependent in 90 children without liver diseases with 4.8, 5.6, and 5.7?kPa in children 0?5, 6?11, and 12?18 years, respectively.

Elastometry Indices of Unchanged Liver in Healthy Children

“…Engelmann et al [12] established the values of stiffness median for age group 0-5 years, 4.40 kPa; for age group 6-11 years, 4.73 kPa; and for age group 11-18 years, 5.10 kPa (p = 0.001). Sagir et al [15] also observed age and stiffness dependence: 4.8 ± 1.4 kPa (0-5 years), 5.6 ± 1.3 kPa (6-11 years), and 5.7 ± 1.7 kPa (12-18 years). Stiffness values in these age groups coincided with the results obtained in our study.…”

“…Statistically significant differences between subgroups 2 and 3 were not established (p > 0.001). Thus, liver stiffness values in children older than 6 years [15] who studied normal indices of stiffness by transient elastography method in groups of 240 and 198 children. Engelmann et al [12] established the values of stiffness median for age group 0-5 years, 4.40 kPa; for age group 6-11 years, 4.73 kPa; and for age group 11-18 years, 5.10 kPa (p = 0.001).…”

The Role of Linear and Convex Probes to Determine the Normal Range of Splenic and Liver Stiffness in Healthy Children Assessed by Point Shear Wave Elastography

“…Other articles do include healthy children as a control group, but the samples are small (4,8,9). Therefore, our goal was to determine the potential benefits and limitations of the two probes in the pediatric age group.…”

“…p -SWE is mainly used to determine liver stiffness, which is then used for the staging of cirrhosis (3)(4)(5). To assess liver chirrosis or splenic stiffness, a convex probe is usually used (6)(7)(8)(9). Because of shortage of superficial fat tissue in pediatric patients, a linear probe with a higher frequency could easily be used.…”

Hepatitis C virus infection in children in the era of direct-acting antiviral

“…Paediatric studies have revealed that the improved diagnostic accuracy of liver fibrosis can be reached using a combination of non-invasive methods[ 83 , 97 ]. Therefore, more and more studies in children concern the clinical utility of combining 2 or more non-invasive fibrosis tests in children, and the first studies aimed at comparing the diagnostic performance of 2 imaging methods in a group of children to evaluate its correlation and utility in assessing liver fibrosis have been conducted[ 101 ].…”