Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children—A Systematic Review

Andersen, S. B.; Ewertsen, Caroline; Carlsen, Jonathan Frederik; Henriksen, Birthe Merete; Nielsen, Michael Bachmann

doi:10.1097/mpg.0000000000001171

Cited by 38 publications

(27 citation statements)

References 66 publications

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“…Although liver stiffness appears to be one of the most promising noninvasive methods reflecting fibrosis stage, it is influenced both by the etiology of liver disease and patient age . Accordingly, the reported cutoffs and AUROC values for pediatric cirrhosis overlap markedly . Previously determined cutoffs for cirrhosis at the time of PE are slightly lower compared to our results .…”

Section: Discussioncontrasting

confidence: 84%

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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We investigated noninvasive follow‐up markers for histologic liver fibrosis and portal hypertension (PH) in patients with biliary atresia after successful portoenterostomy (PE). Among children with bilirubin <20 µmol/L after PE (n = 39), Metavir fibrosis stage was evaluated at PE and in follow‐up protocol liver biopsies (n = 83). PH was defined as endoscopically confirmed esophageal varices or thrombocytopenia associated with splenomegaly. The accuracy of liver biochemistry and stiffness in detecting liver fibrosis and PH was analyzed by the area under the receiving operating characteristic curve (AUROC) and multiple regression models. During a median native liver survival of 8.3 years (interquartile range 2.5‐10.8 years), cirrhosis (Metavir F4) had developed in 51% of patients and PH in 54% of patients. Cirrhosis was equally common in all age tertiles of 1.2‐2.1 years (n = 10/27), 3.9‐5.8 years (n = 12/28), and 9.0‐14 years (n = 12/28). In the two oldest age tertiles, histologic liver fibrosis had progressed further in patients with PH than without PH (P < 0.001). PH was accurately predicted by the aspartate aminotransferase‐to‐platelet ratio index (APRI) (cutoff, 0.70; AUROC, 0.92), bile acids (cutoff, 49 µmol/L; AUROC, 0.91), and liver stiffness (cutoff, 16.9 kPa; AUROC, 0.89; P < 0.001 each) across all age tertiles. Liver stiffness was the most accurate predictor of cirrhosis overall (AUROC, 0.82; P < 0.001), whereas bilirubin was >11 µmol/L in the youngest tertile (AUROC, 0.91; P < 0.001), bile acids was >80 µmol/L in the middle tertile (AUROC, 0.81; P = 0.009), and liver stiffness was >24 kPa in the oldest age tertile (AUROC, 0.96; P = 0.002). Conclusion: After successful PE, development of PH associates with progression of liver fibrosis and can be accurately detected by APRI and stiffness. Liver stiffness most accurately identified cirrhosis in older children, whereas biochemical markers of cholestasis closely reflected histologic cirrhosis in younger children.

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Section: Discussioncontrasting

confidence: 84%

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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“…25 Since its introduction in 2002 for assessment of liver fibrosis, 26 rapid improvements in the technique has resulted in the ability to accurately identify different stages of liver fibrosis for application in a variety of disorders, including nonalcoholic fatty liver disease and metabolic, autoimmune, and venoocclusive diseases. [27][28][29][30][31][32][33][34][35][36] In brief, there are 2 main types of ultrasound elastographies: shearwave and strain elastography ( Fig 6). The former is used to quantify absolute tissue stiffness by applying high-intensity pulses and detecting laterally propagating waves as a result of tissue deformation.…”

Section: Elastographymentioning

confidence: 99%

Advanced Ultrasound Techniques for Pediatric Imaging

2019

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Ultrasound has become a useful tool in the workup of pediatric patients because of the highly convenient, cost-effective, and safe nature of the examination. With rapid advancements in anatomic and functional ultrasound techniques over the recent years, the diagnostic and interventional utility of ultrasound has risen tremendously. Advanced ultrasound techniques constitute a suite of new technologies that employ microbubbles to provide contrast and enhance flow visualization, elastography to measure tissue stiffness, ultrafast Doppler to deliver high spatiotemporal resolution of flow, three-and four-dimensional technique to generate accurate spatiotemporal representation of anatomy, and high-frequency imaging to delineate anatomic structures at a resolution down to 30 mm. Application of these techniques can enhance the diagnosis of organ injury, viable tumor, and vascular pathologies at bedside. This has significant clinical implications in pediatric patients who are not easy candidates for lengthy MRI or radiation-requiring examination, and are also in need of a highly sensitive bedside technique for therapeutic guidance. To best use the currently available, advanced ultrasound techniques for pediatric patients, it is necessary to understand the diagnostic utility of each technique. In this review, we will educate the readers of emerging ultrasound techniques and their respective clinical applications.

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“…The authors observed that the stiffness values overlap considerably between early degrees of liver fibrosis. Although paediatric study results suggest that the fibrosis cut-off values are similar to those in adults, a small heterogeneous population does not allow for setting specific cut-off values for children[ 94 - 96 ]. Moreover, the diagnostic high accuracy demonstrated by the authors may be overestimated because of the heterogeneity of the studies, the small sample size, the small number of children with significant or severe fibrosis and problems with interpretations of liver biopsies in children caused by the diversity of the disease.…”

Section: Physical Techniquesmentioning

confidence: 99%

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

Pawłowska

Sobolewska-Pilarczyk

Domagalski

2018

WJG

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Hepatitis C virus (HCV) infection remains an important global health problem with chronic infection affecting approximately 11 million children worldwide. The emergence of direct-acting antiviral (DAA) therapies and the development of non-invasive methods for the determination of liver fibrosis will significantly improve the management of paediatric patients with chronic HCV infection in subsequent years. For paediatric patients, a new era of highly effective DAA agents is beginning, and the first results of available clinical trials are very promising. In this era, the identification and monitoring of patients continues to be an important issue. The availability of non-invasive serological and imaging methods to measure hepatic fibrosis enables the identification of patients with significant or advanced liver fibrosis stages. This article summarizes the current data on the epidemiology and progress of research aimed to evaluate the new therapies and non-invasive methods for liver injury in paediatric patients with chronic hepatitis C.

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Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children—A Systematic Review

Abstract: Ultrasound elastography was able to diagnose cirrhosis, distinguish healthy from fibrotic liver tissue, and showed consistent liver stiffness values in children without liver disease.

Cited by 38 publications

References 66 publications

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Advanced Ultrasound Techniques for Pediatric Imaging

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

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