Transient Elastography and Sonography for Prediction of Liver Fibrosis in Infants With Biliary Atresia

Abstract

Objectives The purpose of this study was to assess the diagnostic performance of transient elastography and sonography for noninvasive evaluation of liver fibrosis in infants with biliary atresia. Methods Forty‐seven infants with biliary atresia who underwent both transient elastography and sonography before surgery were included in this study. Two types of transient elastographic probes were used: an M probe, which is used for the general adult population; and an S probe, which is specific to children. Transient elastographic measurements and sonographic findings such as triangular cord thickness and hepatic artery and portal vein diameters were compared with the METAVIR histopathologic fibrosis scoring system. Results Only transient elastography (ρ = 0.63; P < .001) was significantly correlated with METAVIR fibrosis stages. The areas under the receiver operating characteristic curves for transient elastography were 0.86 and 0.96 for diagnosis of severe fibrosis and cirrhosis, respectively. The cutoff value of transient elastography for diagnosis of severe fibrosis was greater than 9.6 kPa, with sensitivity of 89.5% and specificity of 75%. The cutoff value of transient elastography for diagnosis of cirrhosis was greater than 18.1 kPa, with sensitivity of 100% and specificity of 90.5%. The success rate for the S probe (100%) was significantly higher than that for the M probe (77%; P < .001). Conclusions Transient elastography may be a useful noninvasive method for diagnosis of severe fibrosis and cirrhosis and may help predict outcomes before surgery or invasive liver biopsy in infants with biliary atresia. The success rate of transient elastography in infants was improved by using the S probe.

Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia

“…By contrast, the triangular cord sign or hepatic artery-portal vein ratio did not correlate with the degree of fibrosis, confirming the findings of Shin et al [13].…”

“…In the analysis of liver fibrosis in biliary atresia, one study reported experience with transient elastography [13], and another very recent study with 11 patients analyzed shear wave elastography by two ARFI methods -Virtual Touch Tissue Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) [14].…”

Comparison of three ultrasound based elastographic techniques in children and adolescents with chronic diffuse liver diseases.

“…A recent paediatric study compared TE with liver biopsies in a cohort of children with chronic C hepatitis, in order to elaborate the specific cut off values for this technique in paediatric patients [19], and another paediatric study focused on the performance of TE for evaluating liver fibrosis in infants with biliary atresia [20]. Recently, 2D-SWE accuracy was evaluated in children post liver transplantation [21].…”

Ultrasound elastography in the noninvasive diagnosis of liver disease in children: A review

“…However, while TE demonstrated a high degree of accuracy in distinguishing cirrhosis from non-cirrhosis, it was less accurate in differentiating the stage of fibrosis in non-cirrhotic patients (33). A TE value of greater than 9.6 kPa in biliary atresia had a sensitivity of 89.5% and specificity of 75% for severe fibrosis and a TE value greater than 18.1 kPa was 100% sensitive and 90.5% specific for cirrhosis (13). Goldschmidt et al (34) showed a good correlation between TE and histologic degree of fibrosis in pediatric patients post liver transplant.…”

“…The ARFI should be perpendicular to the liver capsule to prevent reverberation artifact below Glisson's capsule and pulsatility from near-by vessels, which can falsely elevate measured shear-wave speed (12). Multiple studies have shown increased accuracy in children with use of the pediatric S probe transducer (13 operates at 3.5MHz. The greatest accuracy of stiffness results from multiple measurements in the same location during a breath hold of a few seconds (14).…”