Possibilities of shear wave elastography in the diagnosis of liver fibrosis and monitoring of autoimmune liver diseases in children

Authors

DOI:

https://doi.org/10.15574/SP.2023.136.34

Keywords:

children, autoimmune liver diseases, shear wave elastography, fibrosis

Abstract

Autoimmune liver disease (ALD) in children, when not diagnosed and treated timely, are characterised by a progressive course leading to liver cirrhosis. Monitoring the progression of the disease is crucial for evaluating the effectiveness of treatment in ALD patients. We believe that the use of ultrasound elastography is not only valuable for diagnosing liver fibrosis but also for monitoring the course of ALD in children, representing a promising research method.

Purpose - to assess the feasibility of using shear wave elastography for diagnosing liver fibrosis and monitoring the course of ALD in children.

Materials and methods. In 108 children with ALD aged 3-18 years, examined at the Department of Pediatric Hepatology of the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine», from 2019 to 2023, ultrasound shear wave elastography (2D-SWE) parameters were evaluated before treatment (baseline) and at 6, 12, 24, and 36 months of therapy, depending on the stage of liver fibrosis determined by histological method using the Metavir scoring system (F0-F4) in all children. Statistical analysis was performed using GraphPad Prism 9 version 10.0.0.

Results. The mean age of the children was 11 years (range 8-13.8 years), with 91% (n=98) having liver fibrosis stage ≥F2 according to Metavir. There was a significant correlation between complete biochemical remission and median 2D-SWE at 12, 24, and 36 months of treatment (p=0.0002; p=0.002; p=0.0004, respectively). The area under the ROC curve (AUC) for diagnosing liver fibrosis stage ≥F3 and F4 at 0, 6, 12, 24 and 36 months of treatment was 0.81; 0.78; 0.67; 0.81; 0.75 and 0.80; 0.91; 0.84; 0.89; 0.92, respectively. The optimal cutoff value for median 2D-SWE was 10.1 kPa; 8.9 kPa; 9.1 kPa; 8.9 kPa; 7.0 kPa and 14.0 kPa; 10.5 kPa; 10.2 kPa; 9.7 kPa; 8.1 kPa, respectively.

Conclusions. Shear wave elastography is an effective method for diagnosing fibrosis ≥F3 and cirrhosis in children with ALD. Reduction in 2D-SWE values in children with ALD during treatment is a predictor of its effectiveness.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Author Biography

V.S. Berezenko, SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine», Kyiv

Bogomolets National Medical University, Kyiv, Ukraine

References

Alhashmi GH, Gupta A, Trout AT, Dillman JR. (2020, Aug). Two-dimensional ultrasound shear wave elastography for identifying and staging liver fibrosis in pediatric patients with known or suspected liver disease: A clinical effectiveness study. Pediatr Radiol. 50(9): 1255-1262. https://doi.org/10.1007/s00247-020-04720-2; PMid:32588095

Andersen SB, Ewertsen C, Carlsen JF, Henriksen BM, Nielsen MB. (2016, Oct). Ultrasound Elastography Is Useful for Evaluation of Liver Fibrosis in Children-A Systematic Review. J Pediatr Gastroenterol Nutr. 63(4): 389-399. https://doi.org/10.1097/MPG.0000000000001171; PMid:26925609

Dhyani M, Gee MS, Misdraji J et al. (2015, Dec). Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography. J Med Imaging Radiat Oncol. 59(6): 687-694; quiz 751. https://doi.org/10.1111/1754-9485.12388; PMid:26503488 PMCid:PMC7474553

Dietrich C, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Thiele M. (2017). EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall in der Medizin - European Journal of Ultrasound. 38(04): e16-e47. https://doi.org/10.1055/s-0043-103952; PMid:28407655

European Association for the Study of the Liver. (2015). EASL Clinical Practice Guidelines: Autoimmune hepatitis. Journal of Hepatology. 63(4): 971-1004. https://doi.org/10.1016/j.jhep.2015.06.030; PMid:26341719

Ferraioli G, Barr RG, Dillman JR. (2021, May). Elastography for Pediatric Chronic Liver Disease: A Review and Expert Opinion. J. Ultrasound Med. 40(5): 909-928. https://doi.org/10.1002/jum.15482; PMid:32881048

Ferraioli G, Maiocchi L, Dellafiore 1 C, Tinelli C, Above E, Filice C. (2021, Jan). Performance and cutoffs for liver fibrosis staging of a two-dimensional shear wave elastography technique. Eur J Gastroenterol Hepatol. 33(1): 89-95. https://doi.org/10.1097/MEG.0000000000001702; PMid:32118850

Franchi-Abella S, Corno L, Gonzales E et al. (2016, Feb). Feasibility and diagnostic accuracy of supersonic shear-wave elastography for the assessment of liver stiffness and liver fibrosis in children: a pilot study of 96 patients. Radiology. 278(2): 554-562. https://doi.org/10.1148/radiol.2015142815; PMid:26305193

Galina P, Alexopoulou E, Mentessidou A, Mirilas P, Zellos A, Lykopoulou L et al. (2021, Jul). Diagnostic accuracy of two-dimensional shear wave elastography in detecting hepatic fibrosis in children with autoimmune hepatitis, biliary atresia and other chronic liver diseases. Pediatr Radiol. 51(8): 1358-1368. https://doi.org/10.1007/s00247-020-04959-9; PMid:33755748

Hartl J, Denzer U, Ehlken H, Zenouzi R, Peiseler M, Sebode M et al. (2016, Oct). Validation of transient elastography in autoimmune hepatitis: timing determines the impact of inflammation and fibrosis J Hepatol. 65(4): 769-775. https://doi.org/10.1016/j.jhep.2016.05.023; PMid:27238753

Hartl J, Ehlken H, Sebode M, Peiseler M, Krech T, Zenouzi R et al. (2018, Apr). Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis J Hepatol. 68(4): 754-763. https://doi.org/10.1016/j.jhep.2017.11.020; PMid:29180000

Hebelka H, de Lange C, Boström H, Ekvall N, Lagerstrand K. (2021). Shear Wave Elastography in the Differentiation of Nonfibrotic Versus Fibrotic Liver Disease in Children: A Prospective Study With Histological Correlation JPGN Reports. 3(1): e156. https://doi.org/10.1097/PG9.0000000000000156; PMid:37168740 PMCid:PMC10158420

Kim JR, Suh CH, Yoon HM, Lee JS, Cho YA, Jung AY. (2018, Mar). The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis. Eur Radiol. 28(3): 1175-1186. https://doi.org/10.1007/s00330-017-5078-3; PMid:29018925

Lawrence AE, Dienhart M, Cooper JN et al. (2019). Ultrasound elastography as a non-invasive method to monitor liver disease in children with short bowel syndrome: updated results. J Pediatr Surg. 54: 1179-1183. https://doi.org/10.1016/j.jpedsurg.2019.02.039; PMid:30885560

Lee S, Choi YH, Cho YJ, Lee SB, Cheon JE, Kim WS et al. (2021, Apr 12). The usefulness of noninvasive liver stiffness assessment using shear-wave elastography for predicting liver fibrosis in children. BMC Med Imaging. 21(1): 68. https://doi.org/10.1186/s12880-021-00601-8; PMid:33845776 PMCid:PMC8040233

Li C, Dhyani M, Bhan AK, Grajo JR, Pratt DS, Gee MS, Samir AE. (2019, Jan). Diagnostic Performance of Shear Wave Elastography in Patients With Autoimmune Liver Disease. J Ultrasound Med. 38(1):103-111. https://doi.org/10.1002/jum.14668; PMid:29761535 PMCid:PMC6586413

Marginean CO, Marginean C. (2012, Aug). Elastographic assessment of liver fibrosis in children: a prospective single center experience. Eur J Radiol. 81(8): e870-874. https://doi.org/10.1016/j.ejrad.2012.04.014; PMid:22609320

Mieli-Vergani G, Vergani D, Baumann U, Czubkowski P, Debray D, Dezsofi A et al. (2018, Feb). Diagnosis and Management of Paediatric Autoimmune Liver Disease: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr. 66(2): 345-360. https://doi.org/10.1097/MPG.0000000000001801; PMid:29356770

Phelps A, Ramachandran R, Courtier J et al. (2017, Jan-Feb). Ultrasound elastography: is there a shear wave speed cutoff for pediatric liver fibrosis and inflammation. Clin Imaging. 41: 95-100. https://doi.org/10.1016/j.clinimag.2016.10.012; PMid:27840268

Soh EG, Lee YH, Kim YR, Yoon KH, Choi KH. (2022, Oct). Usefulness of 2D shear wave elastography for the evaluation of hepatic fibrosis and treatment response in patients with autoimmune hepatitis. Ultrasonography. 41(4): 740-749. Epub 2022 Apr 3. https://doi.org/10.14366/usg.21266; PMid:36195317 PMCid:PMC9532207

Tutar O, Beser OF, Adaletli I et al. (2014, Jun). Shear wave elastography in the evaluation of liver fibrosis in children. Journal of Pediatric Gastroenterology and Nutrition. 58(6): 750-755. https://doi.org/10.1097/MPG.0000000000000329; PMid:24552673

Yada N, Sakurai T, Minami T, Arizumi T, Takita M, Hagiwara S et al. (2017). Influence of liver inflammation on liver stiffness measurement in patients with autoimmune hepatitis evaluation by combinational elastography. Oncology. 92; Suppl 1: 10-15. https://doi.org/10.1159/000451011; PMid:28056459

Published

2023-12-28

Issue

Section

Original articles