Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Table 1 Main characteristics of studies included in the meta-analysis

Ref.	Country	Study design	Elastography Method; machine; probe, if specified	Reference standard	Sample size	Type of patient	Main finding
Diagnosis
Hanquinet et al[14], Pediatric Radiology, 2015	Switzerland	Single center retrospective analysis	pSWE (VTQ); Acuson S2000 or S3000 (Siemens Healthcare, Erlangen, Germany)	Liver biopsy; Cholangiogram	20	Cholestatic infants; mean age 52.1 d	Utilizing SWE in addition to standard abdominal ultrasound can provide useful information on liver fibrosis to aid in the diagnosis of BA
Leschied et al[15], Pediatric Radiology, 2015	USA	Prospective cohort	pSWE (VTQ) and 2D-SWE (VTIQ), Acuson S3000 (Siemens Healthcare, Erlangen, Germany); 9L4 Transducer	Liver biopsy; Cholangiogram	11	Infants with suspected liver disease; mean age 3.8 mo	Shear wave speeds were significantly higher in children with BA than those without
Wang et al[31], Journal of Ultrasound Medicine, 2016	China	Single center case control	pSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); L15-4 linear probe	KPE	38	Cholestatic infants age 16 to 140 d	Mean shear wave speeds were higher for BA patients than non-BA cholestatic patients and control patients
Zhou et al [22], European Radiology, 2017	China	Single center prospective analysis	pSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); SL15-4 linear array transducer	Liver biopsy; Cholangiogram; surgical exploration	172	Cholestatic infants, age 2 to 140 d	SWE is useful to differentiate BA from non-BA; its performance does not outperform grey scale ultrasound
Wu et al[32], Hepatology, 2018	Taiwan	Single center prospective analysis	TE; FibroScan 502 Touch (Echosens, Paris, France); S1 probe	Liver biopsy; cholangiogram	48	Cholestatic infants, age 35 to 61 d	Liver stiffness assessment during the work up of cholestatic infants may facilitate diagnosis of BA
Dillman et al[16], Journal of Pediatrics, 2019	USA	Multiple center prospective analysis	2D-SWE (VTIQ) and pSWE (VTQ); Acuson S2000 or S3000 (Siemens Healthcare, Erlangen, Germany); 9L4 linear transducer probe	Not specified	41	Cholestatic infants, age 24 to 52 d	SWE and GGT can help discriminate BA from other causes of cholestasis
Duan et al[33], BioMed Research International, 2019	China	Single center case control	2D-SWE; TUS-Aplio 500 (Canon Medical Systems, Tokyo, Japan); 14L5 linear array probe	Liver biopsy; KPE	138	Cholestatic infants, age 5-90 d	SWE can help distinguish BA from other cholestatic diseases; the diagnostic specificity increases when combined with grey-scale ultrasound
Chen et al[17], European Radiology, 2020	China	Single center multiple method (prospective and retrospective) analysis	pSWE (VTQ); Acuson S2000 (Siemens Healthcare, Erlangen, Germany); 4-9MHz linear transducer	Liver biopsy; cholangiogram	308 in subgroup 1; 187 in subgroup 2	Cholestatic infants, age under 100 d	Shear wave speed, coupled with presence of triangular cord sign, provided moderate-to-high accuracy for BA diagnosis. This study also found high diagnostic performance in a risk stratification model built on five predictors (shear wave speed, triangular cord sign, GGT, abnormal gallbladder, clay-colored stool)
Liu et al[18], International Journal of Clinical Practice, 2020	China	Single center retrospective analysis	2D-SWE (VTIQ) and pSWE (VTQ); Acuson OXANA2 (Siemens Healthcare, Erlangen, Germany); 3-5.5 MHz-6C1 convex and 4-9MHz 9L4 linear array probe	Surgical exploration	59	Cholestatic infants, age 25 to 141 d	VTQ and VTIQ can help distinguish BA from non-BA in cholestatic infants; VTIQ has higher sensitivity and specificity than VTQ
Shen et al[34], BMC Pediatrics, 2020	China	Single center retrospective analysis	pSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); L15-4 linear probe	Not specified	282	Cholestatic infants, age under 120 d	Liver stiffness measurements and GGT values have the potential to decrease rates of BA misdiagnosis
Wang et al[35], Academic Radiology, 2020	China	Single center prospective analysis	2D-SWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); linear probe	Liver biopsy; Cholangiogram	294	Cholestatic infants, age under 70 d	Age, gallbladder morphology, and liver elasticity incorporated together into a nomogram shows an improved predictive value for BA diagnosis
Follow-up
Chongsrisawat et al[36], BMC Gastroenterology, 2011	Thailand	Single center prospective analysis	TE; FibroScan 502 Touch (Echosens, Paris, France)	Endoscopy	73	BA patients after KPE, mean age 9.11 yr	TE is useful for predicting the presence of EV/GV in BA patients post-KPE
Colecchia et al[37], Digestive and Liver Disease, 2011	Italy	Single center prospective analysis	TE; FibroScan (Echosens, Paris, France)	Endoscopy	31	BA patients after KPE, age 4 to 25 yr	Non-invasive studies, such as liver stiffness measurement, can predict the presence of EV in BA patients post-KPE
Shin et al[38], Journal of Ultrasound Medicine, 2014	South Korea	Single center retrospective analysis	TE; FibroScan 502 Touch (Echosens, Paris, France); S or M probe	Liver biopsy	47	BA patients, mean age 60 d	TE may be a useful, non-invasive method for diagnosing severe fibrosis and cirrhosis; may predict outcomes before surgery or liver biopsy in infants with BA
Shen et al[39], World Journal of Gastroenterology, 2015	China	Single center retrospective analysis	TE; FibroScan (Echosens, Paris, France); S probe	Liver biopsy	31	BA patients, age 34 to 121 d	TE can be a useful, non-invasive technique to assess liver fibrosis in children with BA. The cut-off value of 15.15 kPa can distinguish cirrhotic from non-cirrhotic patients
Chen et al[40], Nature Scientific Reports, 2016	China	Single center retrospective analysis	2D-SWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); SC-1 curvilinear probe	Liver biopsy	24	BA patients after KPE, mean age 6.6 yr	2D-SWE has more promise as a means of assessing liver fibrosis in BA patients than APRI or FIB-4 scoring
Tomita et al[20], Pediatric Radiology, 2016	Japan	Single center prospective analysis	pSWE (VTQ); Acuson S2000 (Siemens Healthcare, Erlangen, Germany); 4C1 probe	Liver biopsy; endoscopy	28	BA patients, age 0.1 to 33.6 yr	Liver and spleen stiffness measured via ARFI has potential as a non-invasive marker of liver fibrosis and esophageal varices in BA patients
Sintusek et al[41], Journal of Pediatric Gastroenterology and Nutrition, 2019	Thailand	Single center prospective analysis	TE; FibroScan Compact 530 (Echosens, Paris, France); S or M probe	Endoscopy	51	BA patients after KPE, mean age 10.63 yr	Spleen stiffness can predict the presence of esophageal varices in children with BA; combination of spleen and liver stiffness measurements to diagnose varices increases diagnostic yield
Yokoyama et al[19], Hepatology Research, 2019	Japan	Single center prospective study	2D-SWE; Aplio i900 (Canon Medical Systems, Tokyo, Japan); i8CX1 transducer	Endoscopy	34	BA patients after KPE, age 1034 to 3940 d	Spleen stiffness (measured via 2D-SWE) is the most accurate predictor of high risk esophageal/gastric varices in BA patients
Srisuwan et al[21], Siriraj Medical Journal, 2021	Thailand	Single center cross-sectional study	TE; FibroScan 502 Touch (Echosens, Paris, France); S or M probe	Endoscopy	20	BA patients after KPE, age 2.3 to 21.0 yr	There is correlation between liver stiffness measurement and clinical/radiological evidence of portal hypertension. TE can predict presence of esophageal varices with high sensitivity

Point SW: Point shear wave elastography; 2D SW: Two-dimensional shear wave elastography; VTIQ: Virtual Touch IQ, alternative nomenclature for two-dimensional shear wave elastography; VTQ: Virtual touch quantification, alternative nomenclature for point Shear Wave Elastography; TE: Transient elastography; KPE: Kasai hepatoportoenterostomy; BA: Biliary atresia; EV: Esophageal varices; GV: Gastric varices; ARFI: Acoustic radiation force impulse.