Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2024; 13(3): 96369
Published online Sep 25, 2024. doi: 10.5501/wjv.v13.i3.96369
Transient elastography and diffusion-weighted magnetic resonance imaging for assessment of liver fibrosis in children with chronic hepatitis C
Mohamed A El-Guindi, Alif A Allam, Ahmed A Abdel-Razek, Gihan A Sobhy, Menan E Salem, Mohamed A Abd-Allah, Mostafa M Sira
Mohamed A El-Guindi, Alif A Allam, Gihan A Sobhy, Menan E Salem, Mohamed A Abd-Allah, Mostafa M Sira, Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Shebin El-Koom 32511, Menoufia, Egypt
Ahmed A Abdel-Razek, Department of Diagnostic Radiology, Mansoura Faculty Medicine, Mansoura 13551, Egypt
Author contributions: El-Guindi MA, Sira MM, and Sobhy GA were involved in the study concept and design; El-Guindi MA, Allam AA, Sobhy GA, Salem ME, Abd-Allah MA, and Sira MM were involved in the recruitment of patients, clinical evaluation, follow-up, and contributed to data acquisition; Sira MM performed the statistical analysis and designed the figures; El-Guindi MA, Sira MM, and Sobhy GA performed the data interpretation; El-Guindi MA, Sira MM, Sobhy GA, and Salem ME wrote the manuscript; Abdel-Razek AA performed the radiological assessment and revised the first drafted manuscript; Sira MM wrote the final draft; El-Guindi MA, Allam AA, Sobhy GA, Salem ME, Abd-Allah MA, and Sira MM reviewed and approved the final manuscript.
Supported by Egyptian Ministry for Scientific Research, Science, Technology & Innovation Funding Authority (STDF), No. HCV-3506.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the National Liver Institute Menoufia University (approval No. NLI-IRB 00003413 FWA0000227, 0035).
Informed consent statement: All the legal guardians of the study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items—and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mostafa M Sira, MD, Professor, Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University, Gamal Abdel Nasser Street, Shebin El-Koom 32511, Menoufia, Egypt. msira@liver.menofia.edu.eg
Received: May 5, 2024
Revised: June 23, 2024
Accepted: July 15, 2024
Published online: September 25, 2024
Processing time: 116 Days and 1 Hours
Abstract
BACKGROUND

Chronic hepatitis C (CHC) is a health burden with consequent morbidity and mortality. Liver biopsy is the gold standard for evaluating fibrosis and assessing disease severity and prognostic purposes post-treatment. Noninvasive alternatives for liver biopsy such as transient elastography (TE) and diffusion-weighted magnetic resonance imaging (DW-MRI) are critical needs.

AIM

To evaluate TE and DW-MRI as noninvasive tools for predicting liver fibrosis in children with CHC.

METHODS

This prospective cross-sectional study initially recruited 100 children with CHC virus infection. Sixty-four children completed the full set of investigations including liver stiffness measurement (LSM) using TE and measurement of apparent diffusion coefficient (ADC) of the liver and spleen using DW-MRI. Liver biopsies were evaluated for fibrosis using Ishak scoring system. LSM and liver and spleen ADC were compared in different fibrosis stages and correlation analysis was performed with histopathological findings and other laboratory parameters.

RESULTS

Most patients had moderate fibrosis (73.5%) while 26.5% had mild fibrosis. None had severe fibrosis or cirrhosis. The majority (68.8%) had mild activity, while only 7.8% had moderate activity. Ishak scores had a significant direct correlation with LSM (P = 0.008) and were negatively correlated with both liver and spleen ADC but with no statistical significance (P = 0.086 and P = 0.145, respectively). Similarly, histopathological activity correlated significantly with LSM (P = 0.002) but not with liver or spleen ADC (P = 0.84 and 0.98 respectively). LSM and liver ADC were able to significantly discriminate F3 from lower fibrosis stages (area under the curve = 0.700 and 0.747, respectively) with a better performance of liver ADC.

CONCLUSION

TE and liver ADC were helpful in predicting significant fibrosis in children with chronic hepatitis C virus infection with a better performance of liver ADC.

Keywords: Apparent diffusion coefficient; Chronic hepatitis C; Diffusion-weighted magnetic resonance imaging; Liver fibrosis; Liver stiffness; Transient elastography

Core Tip: Although liver biopsy is not a necessity in the diagnosis of hepatitis C virus and is no longer a prerequisite for starting antiviral therapy, it remains a critical necessity to assess liver fibrosis for prognostic purposes. Noninvasive prediction of liver fibrosis is a challenging issue, especially in the pediatric population. Several studies have evaluated noninvasive serological and radiological tools for fibrosis prediction, among which are liver stiffness measurement using transient elastography (TE) and apparent diffusion coefficient using diffusion-weighted magnetic resonance imaging. The current study evaluated TE and diffusion-weighted magnetic resonance imaging compared to liver biopsy in assessing liver fibrosis.