Meta-Analysis
Copyright ©The Author(s) 2022.
World J Gastroenterol. Aug 28, 2022; 28(32): 4726-4740
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4726
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, 2015SwitzerlandSingle center retrospective analysispSWE (VTQ); Acuson S2000 or S3000 (Siemens Healthcare, Erlangen, Germany)Liver biopsy; Cholangiogram20Cholestatic infants; mean age 52.1 dUtilizing 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, 2015USAProspective cohortpSWE (VTQ) and 2D-SWE (VTIQ), Acuson S3000 (Siemens Healthcare, Erlangen, Germany); 9L4 TransducerLiver biopsy; Cholangiogram11Infants with suspected liver disease; mean age 3.8 moShear wave speeds were significantly higher in children with BA than those without
Wang et al[31], Journal of Ultrasound Medicine, 2016ChinaSingle center case controlpSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); L15-4 linear probeKPE38Cholestatic infants age 16 to 140 dMean shear wave speeds were higher for BA patients than non-BA cholestatic patients and control patients
Zhou et al [22], European Radiology, 2017ChinaSingle center prospective analysispSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); SL15-4 linear array transducerLiver biopsy; Cholangiogram; surgical exploration172Cholestatic infants, age 2 to 140 dSWE is useful to differentiate BA from non-BA; its performance does not outperform grey scale ultrasound
Wu et al[32], Hepatology, 2018TaiwanSingle center prospective analysisTE; FibroScan 502 Touch (Echosens, Paris, France); S1 probeLiver biopsy; cholangiogram48Cholestatic infants, age 35 to 61 dLiver stiffness assessment during the work up of cholestatic infants may facilitate diagnosis of BA
Dillman et al[16], Journal of Pediatrics, 2019USAMultiple center prospective analysis2D-SWE (VTIQ) and pSWE (VTQ); Acuson S2000 or S3000 (Siemens Healthcare, Erlangen, Germany); 9L4 linear transducer probeNot specified41Cholestatic infants, age 24 to 52 dSWE and GGT can help discriminate BA from other causes of cholestasis
Duan et al[33], BioMed Research International, 2019ChinaSingle center case control2D-SWE; TUS-Aplio 500 (Canon Medical Systems, Tokyo, Japan); 14L5 linear array probeLiver biopsy; KPE138Cholestatic infants, age 5-90 dSWE can help distinguish BA from other cholestatic diseases; the diagnostic specificity increases when combined with grey-scale ultrasound
Chen et al[17], European Radiology, 2020ChinaSingle center multiple method (prospective and retrospective) analysispSWE (VTQ); Acuson S2000 (Siemens Healthcare, Erlangen, Germany); 4-9MHz linear transducerLiver biopsy; cholangiogram308 in subgroup 1; 187 in subgroup 2Cholestatic infants, age under 100 dShear 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, 2020ChinaSingle center retrospective analysis2D-SWE (VTIQ) and pSWE (VTQ); Acuson OXANA2 (Siemens Healthcare, Erlangen, Germany); 3-5.5 MHz-6C1 convex and 4-9MHz 9L4 linear array probeSurgical exploration59Cholestatic infants, age 25 to 141 dVTQ 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, 2020ChinaSingle center retrospective analysispSWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); L15-4 linear probeNot specified282Cholestatic infants, age under 120 dLiver stiffness measurements and GGT values have the potential to decrease rates of BA misdiagnosis
Wang et al[35], Academic Radiology, 2020ChinaSingle center prospective analysis2D-SWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); linear probeLiver biopsy; Cholangiogram294Cholestatic infants, age under 70 dAge, 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, 2011ThailandSingle center prospective analysisTE; FibroScan 502 Touch (Echosens, Paris, France)Endoscopy73BA patients after KPE, mean age 9.11 yrTE is useful for predicting the presence of EV/GV in BA patients post-KPE
Colecchia et al[37], Digestive and Liver Disease, 2011ItalySingle center prospective analysisTE; FibroScan (Echosens, Paris, France)Endoscopy31BA patients after KPE, age 4 to 25 yrNon-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, 2014South KoreaSingle center retrospective analysisTE; FibroScan 502 Touch (Echosens, Paris, France); S or M probeLiver biopsy47BA patients, mean age 60 dTE 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, 2015ChinaSingle center retrospective analysisTE; FibroScan (Echosens, Paris, France); S probeLiver biopsy31BA patients, age 34 to 121 dTE 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, 2016ChinaSingle center retrospective analysis2D-SWE; Aixplorer (SuperSonic Imagine SA, Aix-en-Provence, France); SC-1 curvilinear probeLiver biopsy24BA patients after KPE, mean age 6.6 yr2D-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, 2016JapanSingle center prospective analysispSWE (VTQ); Acuson S2000 (Siemens Healthcare, Erlangen, Germany); 4C1 probeLiver biopsy; endoscopy28BA patients, age 0.1 to 33.6 yrLiver 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, 2019ThailandSingle center prospective analysisTE; FibroScan Compact 530 (Echosens, Paris, France); S or M probeEndoscopy51BA patients after KPE, mean age 10.63 yrSpleen 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, 2019JapanSingle center prospective study2D-SWE; Aplio i900 (Canon Medical Systems, Tokyo, Japan); i8CX1 transducerEndoscopy34BA patients after KPE, age 1034 to 3940 dSpleen 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, 2021ThailandSingle center cross-sectional studyTE; FibroScan 502 Touch (Echosens, Paris, France); S or M probeEndoscopy20BA patients after KPE, age 2.3 to 21.0 yrThere is correlation between liver stiffness measurement and clinical/radiological evidence of portal hypertension. TE can predict presence of esophageal varices with high sensitivity