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Ahmad MF, Solanki S, Kanojia RP, Bhatia A, Lal SB, Saxena AK, Gupta K. Evaluation of Hepatic Shear Wave Elastography to Assess Liver Fibrosis in Biliary Atresia Patients and Its Correlation with Liver Histology and Surgical Outcomes: A Prospective Observational Study. Indian J Radiol Imaging 2024; 34:646-652. [PMID: 39318570 PMCID: PMC11419772 DOI: 10.1055/s-0044-1787668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
Introduction The native liver survival in biliary atresia (BA) depends on various factors, and one of the crucial factors is the rate of progression of liver fibrosis after portoenterostomy, but there is no reliable investigation to assess it. This study evaluated shear wave elastography (SWE) to detect liver fibrosis in BA patients and assess its utility during follow-up. Materials and Methods This was an observational study; SWE was done preoperatively and postoperatively at 3 and 6 months. The SWE values were analyzed to determine their correlations with preoperative liver histology as well as with postoperative SWE variation between different postoperative outcomes. Results Twenty-one patients were included in the study; the preoperative SWE values were strongly correlated with liver biopsy grading ( p < 0.001). At the 3 months postoperatively, SWE was done for 18 children: 12 in group A (patent bilioenteric drainage on hepatobiliary iminodiacetic acid scan) and 6 (nonpatent) in group B; mean SWE value was 12.8 and 17.3 kPa, respectively ( p < 0.001). Ten children from group A underwent SWE 6 months postoperatively, and the mean value was 13.23 kPa. Conclusion The SWE values correlate with liver histology grading, suggesting a reliable alternative to biopsy. Additionally, the baseline SWE values and their trend during follow-up can provide information on the disease's progression.
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Affiliation(s)
- Md Fahim Ahmad
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Solanki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Prakash Kanojia
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna B. Lal
- Division of Pediatric, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K. Saxena
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Medyńska-Przęczek A, Stochel-Gaudyn A, Wędrychowicz A. Liver fibrosis assessment in pediatric population - can ultrasound elastography be an alternative method to liver biopsy? A systematic review. Adv Med Sci 2024; 69:8-20. [PMID: 38198895 DOI: 10.1016/j.advms.2023.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Liver diseases of various etiologies are becoming increasingly common in the pediatric population. So far, the gold diagnostic standard in these disorders is liver biopsy. This procedure is invasive, painful and requires general anesthesia in this group of patients. Due to the continuous development of new research techniques, such as liver elastography, it is necessary to evaluate them in the context of their diagnostic usefulness. Ultrasound elastography, as a quick and effective method, is being used more and more often in the assessment and monitoring of liver dysfunction in both adults and children. There are several techniques of liver elastography, such as transient elastography, shear wave elastography consisting of various subtypes such as two-dimensional shear wave elastography, acoustic radiation force impulse and point shear wave elastography, which differ in terms of the measurement technique and the achieved results. The purpose of our review was to determine whether techniques of liver elastography could replace liver biopsy. Although now, based on the analyzed papers, elastography cannot replace liver biopsy, in our opinion, the role of this tool in monitoring pediatric patients with liver diseases will grow in the coming years.
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Affiliation(s)
- Aleksandra Medyńska-Przęczek
- School of Medical and Health Sciences, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-530, Poland.
| | - Anna Stochel-Gaudyn
- Department of Paediatrics, Gastroenterology and Nutrition, Pediatric Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-663, Poland
| | - Andrzej Wędrychowicz
- Department of Paediatrics, Gastroenterology and Nutrition, Pediatric Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-663, Poland
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Liu XY, Lu JF, Wang LD, Wang ZY. Diagnostic value of shear wave velocity measured by virtual touch tissue imaging quantification combined with hepatic blood flow index measured by single-photon emission computed tomography first-pass method for hepatitis B fibrosis. Shijie Huaren Xiaohua Zazhi 2023; 31:492-500. [DOI: 10.11569/wcjd.v31.i12.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/17/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The degree of liver fibrosis in patients with chronic liver disease can be evaluated by combining single-photon emission computed tomography (SPECT) first-pass method to measure hepatic blood flow index with virtual touch tissue imaging quantification (VTIQ) to detect shear wave velocity (SWV).
AIM To evaluate the clinical value of VTIQ combined with SPECT first-pass method for the diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB).
METHODS Forty-two CHB patients with liver fibrosis at our hospital from August 2020 to August 2021 were selected as a study group, and another 42 patients with CHB without hepatic fibrosis were selected as a control group. VTIQ was performed to obtain the shear wave transverse velocity (SWV), and SPECT examination was performed to obtain liver blood flow index. General data, routine blood indexes [white blood cell count (WBC), absolute monocyte count (AMC), and neutrophil count (NEUT)], blood coagulation function [prothombin time (PT) and prothrombin activity (PTA)], liver function indexes [total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB)] and SWV, and liver blood flow index were compared between the two groups. The degree of liver fibrosis in the study group was determined through liver tissue pathology, and SWV and liver blood flow index were compared among patients with different liver fibrosis degrees. Spearman correlation coefficient was used to assess the correlation of SWV and liver blood flow index with CHB liver fibrosis degree. The value of SWV and liver blood flow index in diagnosing CHB liver fibrosis was assessed by receiver operating characteristic (ROC) curve analysis.
RESULTS The SWV and liver blood flow index of the study group were significantly higher than those of the control group (P < 0.05). The SWV and hepatic blood flow index were significantly higher in patients with liver fibrosis grade S3-S4 in the study group than in those with grade S1-S2, and and in those with grade S2 than in those with grade S1 (P < 0.05). SWV and liver blood flow index were positively correlated with CHB liver fibrosis degree (P < 0.05). The area under the curve (AUC) values of SWV and liver blood flow index, alone or in combination, for the diagnosis of CHB liver fibrosis were all > 0.7, and the AUC of the combination was the largest (0.930).
CONCLUSION SWV measured by VTIQ combined with liver blood flow index measured by SPECT has appreciated value in the diagnosis of CHB liver fibrosis and in the assessment of the degree of liver fibrosis.
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Affiliation(s)
- Xiang-Yan Liu
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Fang Lu
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Li-Dong Wang
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Zhuo-Yi Wang
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
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Herrmann J, Petit P, Grabhorn E, Lenz A, Jürgens J, Franchi-Albella S. Liver cirrhosis in children - the role of imaging in the diagnostic pathway. Pediatr Radiol 2023; 53:714-726. [PMID: 36040526 PMCID: PMC10027649 DOI: 10.1007/s00247-022-05480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
Liver cirrhosis in children is a rare disease with multifactorial causes that are distinct from those in adults. Underlying reasons include cholestatic, viral, autoimmune, hereditary, metabolic and cardiac disorders. Early detection of fibrosis is important as clinical stabilization or even reversal of fibrosis can be achieved in some disorders with adequate treatment. This article focuses on the longitudinal evaluation of children with chronic liver disease with noninvasive imaging tools, which play an important role in detecting cirrhosis, defining underlying causes, grading fibrosis and monitoring patients during follow-up. Ultrasound is the primary imaging modality and it is used in a multiparametric fashion. Magnetic resonance imaging and computed tomography are usually applied second line for refined tissue characterization, clarification of nodular lesions and full delineation of abdominal vessels, including portosystemic communications.
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Affiliation(s)
- Jochen Herrmann
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Philippe Petit
- Aix Marseille Université, Hopital Timone-Enfants, Marseille, France
| | - Enke Grabhorn
- Department of Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center, Hamburg, Germany
| | - Julian Jürgens
- Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Stéphanie Franchi-Albella
- Department of Pediatric Radiology, Hôpital Bicêtre, National Reference Centre for Rare Pediatric Liver Diseases, Paris, France
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Ozdogan E, Arikan C. Liver fibrosis in children: a comprehensive review of mechanisms, diagnosis, and therapy. Clin Exp Pediatr 2023; 66:110-124. [PMID: 36550776 PMCID: PMC9989719 DOI: 10.3345/cep.2022.00367] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
Chronic liver disease incidence is increasing among children worldwide due to a multitude of epidemiological changes. Most of these chronic insults to the pediatric liver progress to fibrosis and cirrhosis to different degrees. Liver and immune physiology differs significantly in children from adults. Because most of pediatric liver diseases have no definitive therapy, a better understanding of population and disease-specific fibrogenesis is mandatory. Furthermore, fibrosis development has prognostic significance and often guide treatment. Evaluation of liver fibrosis continues to rely on the gold-standard liver biopsy. However, many high-quality studies put forward the high diagnostic accuracy of numerous diagnostic modalities in this setting. Herein, we summarize and discuss the recent literature on fibrogenesis with an emphasis on pediatric physiology along with a detailed outline of disease-specific signatures, noninvasive diagnostic modalities, and the potential for antifibrotic therapies.
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Affiliation(s)
- Elif Ozdogan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Cigdem Arikan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine, Istanbul, Turkey
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Demirtaş D, Ünal E, İdilman İS, Akçören Z, Göktaş MA, Boyraz MS, Karahan S, Orhan D, Haliloğlu M, Karçaaltıncaba M, Özen H. Magnetic resonance elastography in evaluation of liver fibrosis in children with chronic liver disease. Insights Imaging 2023; 14:39. [PMID: 36854936 PMCID: PMC9975132 DOI: 10.1186/s13244-023-01390-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Magnetic resonance elastography (MRE) has been used to stage liver fibrosis in adults. We aimed to assess the agreement between the Ishak scoring system and magnetic resonance elastography-measured liver stiffness (MRE-LS) in children. This study included all the children who underwent abdominal MRE and liver biopsies between February 2018 and January 2021. The correlation between MRE-LS and Ishak fibrosis stage, MRE parameters, and clinical and biochemical markers affecting this relationship was investigated. RESULTS A total of 52 patients (31 male; a median age of 11.8 years) were included in the study. The MRE-LS values were significantly different between Ishak fibrosis stages (p = 0.036). With a cut-off value of 2.97 kilopascals, MRE-LS had sensitivity, specificity, PPV, NPV and accuracy values of 90.9%, 82.9%, 58.8%, 97.1%, and 84.6%, respectively, for differentiating mild/moderate fibrosis (F0, 1, 2, 3) from severe fibrosis (F ≥ 4). Although MRE-LS was moderately correlated with Ishak fibrosis score and histological activity index and weakly correlated with aspartate aminotransferase, hepatic steatosis, and R2*, only Ishak fibrosis score was a significant predictor of MRE-LS. MRE-measured spleen stiffness was weakly correlated with the Ishak fibrosis score. CONCLUSIONS MRE has high sensitivity and specificity for evaluating liver fibrosis in children. MRE may be used to evaluate liver fibrosis in pediatric patients.
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Affiliation(s)
- Duygu Demirtaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Emre Ünal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlkay S İdilman
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zuhal Akçören
- Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Akif Göktaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meryem Seda Boyraz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mithat Haliloğlu
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hebelka H, de Lange C, Boström H, Ekvall N, Lagerstrand K. Shear Wave Elastography in the Differentiation of Nonfibrotic Versus Fibrotic Liver Disease in Children: A Prospective Study With Histological Correlation. JPGN REPORTS 2022; 3:e156. [PMID: 37168740 PMCID: PMC10158420 DOI: 10.1097/pg9.0000000000000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 05/13/2023]
Abstract
To evaluate the diagnostic accuracy of ultrasound shear wave elastography (SWE) prospectively and to determine cutoff value for nonfibrotic liver tissue in children with suspected or established liver disease. Methods In 90 consecutive pediatric patients, standardized 2D-SWE was performed during general anesthesia and free breathing. Liver stiffness was estimated with SWE followed by a percutaneous biopsy from the corresponding area. SWE values were compared with histology with fibrosis scored according to Batts & Ludwig classification (grade 0-4 = F0-F4) and to hepatic biomarkers. Results Four patients with SWE interquartile range (IQR)/median ≥ 30% kPa were excluded. The remaining 86 children (59% males) had a mean age = 10.2 years (0.1-18). The distribution of individuals with median (min;max) SWE values (kPa) within each fibrosis grade were; F0[n = 10; 5.0(3.4;6.3)], F1[n = 24; 5.0(3.6;8.7)], F2[n = 32; 5.8(3.5;13.4)], F3[n = 12, 7.5(4.0;14.4)], and F4[n = 8; 12.5(6.6;21.0)]. There was a significant difference between fibrosis grades (0.03 > P < 0.002) except between F0 and F1 respectively between F1 and F2. The AuROC differentiating F0-1 from F2-4 was 0.77(95% CI: 0.67-0.87). A cutoff SWE value of ≤4.5 kPa yielded 90% sensitivity and 68% specificity to rule out significant fibrosis (F2-F4). Out of the 18 children (21%) with SWE value ≤4.5 kPa, 12 had grade F0-1 and 6 had F2, although including some confounders for increased SWE measurements as steatosis/hepatitis/cholestasis. Conclusions 2D-SWE ultrasound can reliably distinguish no/mild (F0/F1) from moderate/severe (F2-F4) fibrosis in children with suspected/established liver disease with good sensitivity and acceptable specificity. Our results show that in pediatric patients, when the indication for biopsy is to rule out significant fibrosis, SWE can be considered an alternative.
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Affiliation(s)
- Hanna Hebelka
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte de Lange
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Boström
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Ekvall
- Department of Pediatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lorton O, Toso S, El-Begri Talbi H, Anooshiravani M, Poletti PA, Hanquinet S, Salomir R. A tailored passive driver for liver MRE in pediatric patients. Front Pediatr 2022; 10:999830. [PMID: 36568430 PMCID: PMC9768363 DOI: 10.3389/fped.2022.999830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Magnetic resonance elastography (MRE) is increasingly used in the pediatric population for diagnosis and staging of liver fibrosis. However, the MR-compatible driver and sequences are usually those used for adult patients. Our feasibility study aimed to adapt the standardized adult MRE passive driver and vibrational parameters to a pediatric population. Methods We designed an elliptic passive driver shaped on a torus equipped with an elastic membrane and adapted to children's morphologies. As a first step, eight children (aged 8-18 years) were enrolled in a prospective pilot study aiming to determine the threshold vibrational amplitude for MRE using a custom passive driver, based on phase aliasing assessment and the occurrence of signal void artifacts on magnitude MR images. In the second step, the practicality and the consistency of the custom driver were assessed in a further 11 pediatric patients (aged 7-18 years). In the third step, we compared our custom driver vs. the commercial driver on six adult volunteers, in terms of the reliable region of interest area within the acquired MRE slices, the shear wave maps' quality, and measured stiffness values obtained. Results Based on pediatric patient data, the threshold vibrational amplitude expressed as percentage of maximum output was found to be 0.4 and 1.1 times the body weight (kg) at 40 and 60 Hz frequencies, respectively. In comparison to the commercial passive driver, the custom driver improved threefold the contact with the body surface, also enabling a more comfortable examination as self-assessed by the volunteers. Conclusions Our custom driver was more comfortable for the volunteers and was able to generate more homogenous shear waves, yielding larger usable hepatic area, and more reliable stiffness values.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR 949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Correspondence: Orane Lorton
| | - Seema Toso
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Hayat El-Begri Talbi
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Mehrak Anooshiravani
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Sylviane Hanquinet
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR 949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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Metabolic Fatty Liver Disease in Children: A Growing Public Health Problem. Biomedicines 2021; 9:biomedicines9121915. [PMID: 34944730 PMCID: PMC8698722 DOI: 10.3390/biomedicines9121915] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022] Open
Abstract
Metabolic-associated fatty liver disease (MAFLD), previously called nonalcoholic fatty liver diseases (NAFLD), is one of the most important causes of chronic liver disease worldwide and will likely become the leading cause of end-stage liver disease in the decades ahead. MAFLD covers a continuum of liver diseases from fatty liver to nonalcoholic steatohepatitis (NASH), liver fibrosis/cirrhosis and hepatocellular cancer. Importantly, the growing incidence of overweight and obesity in childhood, 4% in 1975 to 18% in 2016, with persisting obesity complications into adulthood, is likely to be harmful by increasing the incidence of severe MAFLD at an earlier age. Currently, MAFLD is the leading form of chronic liver disease in children and adolescents, with a global prevalence of 3 to 10%, pointing out that early diagnosis is therefore crucial. In this review, we highlight the current knowledge concerning the epidemiology, risk factors and potential pathogenic mechanisms, as well as diagnostic and therapeutic approaches, of pediatric MAFLD.
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Wang B, Guo Q, Wang JY, Yu Y, Yi AJ, Cui XW, Dietrich CF. Ultrasound Elastography for the Evaluation of Lymph Nodes. Front Oncol 2021; 11:714660. [PMID: 34485150 PMCID: PMC8415874 DOI: 10.3389/fonc.2021.714660] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
The differential diagnosis of lymphadenopathy is important for predicting prognosis, staging, and monitoring the treatment, especially for cancer patients. Conventional computed tomography and magnetic resonance imaging characterize lymph node (LN) with disappointing sensitivity and specificity. Conventional ultrasound with the advantage of high resolution has been widely used for the LN evaluation. Ultrasound elastography (UE) using color map or shear wave velocity can non-invasively demonstrate the stiffness and homogeneity of both the cortex and medulla of LNs and can detect early circumscribed malignant infiltration. There is a need of a review to comprehensively discuss the current knowledge of the applications of various UE techniques in the evaluation of LNs. In this review, we discussed the principles of strain elastography and shear wave-based elastography, and their advantages and limitations in the evaluation of LNs. In addition, we comprehensively introduced the applications of various UE techniques in the differential diagnosis of reactive LNs, lymphoma, metastatic LNs, and other lymphadenopathy. Moreover, the applications of endoscopic UE and endobronchial UE are also discussed, including their use for improving the positive rate of diagnosis of fine-needle aspiration biopsy.
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Affiliation(s)
- Bin Wang
- Department of Ultrasound, The First People’s Hospital of Yueyang, Yueyang, China
| | - Qi Guo
- Department of Medical Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Yu Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai-Jiao Yi
- Department of Ultrasound, The First People’s Hospital of Yueyang, Yueyang, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ferraioli G, Barr RG, Dillman JR. Elastography for Pediatric Chronic Liver Disease: A Review and Expert Opinion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:909-928. [PMID: 32881048 DOI: 10.1002/jum.15482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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12
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Özkan EÖ, Ozkan MB, İsik İA. Evaluation of the Clinical Role of Strain Elastography in Patients Diagnosed With Congenital Torticollis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320983242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this study was to determine the elasticity of sternocleidomastoid muscle (SCM) in patients with congenital muscular torticollis (CMT). Methods: In all, 41 patients and 22 controls were included in the study, and the elasticity of the patients’ SCM was measured. Echogenicity, thickness, and strain values of the SCM were also obtained. Results: The thickness and strain values of the SCM were higher in the patient group than in the control group ( P = .02 and P = .15). For median values, there was no difference in echogenicity and strain. In the strain elastography evaluation of the receiver operating curve (ROC) for muscle echogenicity in the isoechoic muscle group, the specificity and sensitivity were determined to be 100% and 22%, respectively, for the area under the curve (AOC) value of 0.558 (95% confidence interval [CI], 0.424–0.6686), and the cutoff value was <1.4. In the hyperechoic muscle group, the ROC for AUC values was found to be 0.542 (95% CI, 0.411–0.6686), and the cutoff value was >1.4 with 100% sensitivity and 20.75 specificity. Conclusions: The strain elastography technique can be used in the diagnosis of CMT.
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Affiliation(s)
| | - Mehmet Burak Ozkan
- Department of Pediatric Radiology, Antalya Research and Training Hospital, Antalya, Turkey
| | - İshak Abdurrahman İsik
- Department of Pediatric Gastroenterology, Antalya Research and Training Hospital, Antalya, Turkey
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Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
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Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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14
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Mărginean CO, Meliţ LE, Huţanu A, Ghiga DV, Săsăran MO. The gap between overweight and obesity status in children - (STROBE-compliant article). Medicine (Baltimore) 2021; 100:e24520. [PMID: 33530279 PMCID: PMC7850705 DOI: 10.1097/md.0000000000024520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Overweight might represent only the early stage of obesity or it might act as a trigger of self-awareness turning into an ideal chance for preventing further obesity development.The aim of this study was to assess the differences between overweight and obese children in terms of anthropometric, low-grade systemic inflammation, liver impairment and atherosclerotic risk.We performed a study on 132 children aged between 5 and 18 years, divided according to the BMI into 2 groups: group 1 to 76 obese children, and group 2 to 56 overweight children, assessing anthropometric, laboratory and elastography parameters.We obtained significantly higher values of anthropometric parameters in obese children versus overweight ones. We found higher levels of leukocytes, lymphocytes, AST, ALT, and E median (P = .0345, P = .0103, P < .0001, P = .0008 and P < .0001) in the obese group as compared to the overweight one. BMI was positively correlated with neutrophils, NLR, ESR, glycemia, anthropometric parameters, and E median (P = .0007/<.0001/.0018/.0044/<.0001/<.0001/<.0001/<.0001/<.0001/.0204); and negatively with lymphocytes and HDL-cholesterol (r = -0.2747/-0.2181, P = .0116/.0120).Our study underlined significant differences between overweight and obese children in terms of inflammatory status and liver impairment suggesting that the risk is directly related to the increase in BMI.
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Affiliation(s)
| | | | - Adina Huţanu
- Research Laboratory, Center for Advanced Medical and Pharmaceutical Research
| | | | - Maria Oana Săsăran
- Department of Pediatric III, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureş, Gheorghe Marinescu Street No 38, Romania
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15
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Pediatric Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Quantification of Hepatic and Splenic Stiffness After Fontan Procedure in Children and Clinical Implications. Ultrasound Q 2020; 36:350-356. [PMID: 33298772 DOI: 10.1097/ruq.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We aimed to investigate Fontan associated liver disease in children by shear wave elastography (SWE). This is a single-center, prospective case-control study included 41 patients with Fontan physiology and 30 healthy controls. Hepatic and splenic shear wave elasticity values were exhibited both as kPa and m/s. The mean hepatic SWE values of Fontan patients (n = 41; 15.8 ± 3.2 kPa or 2.5 ± 1.8 m/s) were significantly higher than the control group (n = 30; 5.59 ± 0.6 kPa or 1.37 ± 0.07 m/s) (P < 0.001). The mean splenic SWE values of Fontan patients were (25.6 ± 4.61 kPa or 2.85 ± 0.22 m/s) significantly higher than the control group (15.9 ± 1.44 kPa or 2.29 ± 0.1 m/s) (P < 0.001). There were statistically significant positive correlations among the follow-up duration after the Fontan procedure with NT-proBNP (P = 0.008, r = 1) and prothrombin time (P = 0.009, r = 0.4) as well as the hepatic SWE values with alanine aminotransferase (P = 0.039, r = 0.32), gamma-glutamyl transferase (P = 0.045, r = 0.31), and PT (P = 0.011, r = 0.39). There has been statistically significant moderate positive correlations of splenic stiffness values with PT (P = 0.047, r = 0.34), and INR (P = 0.038, r = 0.35). The sensitivity and specificity of liver stiffness cutoff value as 11.1 kPa for detection of Fontan associated liver disease were 95% and 100%, respectively. The hepatic and splenic stiffness increase independently in Fontan patients due to parenchymal disease. Hepatic SWE is a reliable and noninvasive predictor of early hepatic alterations that could not be detected only by biochemical results or routine ultrasound examinations.
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17
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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 2020; 50:1255-1262. [PMID: 32588095 DOI: 10.1007/s00247-020-04720-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ultrasound shear wave elastography (SWE) measures liver stiffness noninvasively, but few studies have defined cutoff values for detecting liver fibrosis in pediatric patients using 2-D ultrasound SWE. OBJECTIVE To evaluate the diagnostic performance of 2-D ultrasound SWE and define cutoff values for liver fibrosis in pediatric patients, using Canon (Toshiba) Aplio ultrasound systems. MATERIALS AND METHODS This was an institutional review board-approved retrospective study of patients (≤18 years old) who had undergone both liver 2-D ultrasound SWE and percutaneous liver biopsy within 6 months. Liver biopsies were staged using the METAVIR (fibrosis) scoring system. Continuous data were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. RESULTS Forty-six patients, with a median age of 11.5 years (interquartile range: 8.0-14.3 years), were included. Twenty-three patients were male (50%). Twenty-seven patients had a METAVIR fibrosis score of F0-1, and 19 patients had a score of F2-4. For differentiating METAVIR F0-1 from F2--4, the area under the ROC (AuROC) was 0.75 (95% confidence interval [CI]: 0.60-0.90). A cutoff of >1.89 m/s yielded sensitivity of 73.7% (95% CI: 51.2-88.2) and specificity of 77.8% (95% CI: 59.2-89.4). For the subset of patients without histological hepatic steatosis (n=35), the AuROC was 0.86 (95% CI: 0.71-1.0). The same cutoff of >1.89 m/s yielded a sensitivity of 80.0% (95% CI: 54.8-93.0) and specificity of 95.0% (95% CI 76.4-99.7). CONCLUSION Two-dimensional ultrasound SWE distinguishes patients with no/mild fibrosis from those with moderate/severe fibrosis with good sensitivity and specificity. Diagnostic performance is comparable to that published for magnetic resonance elastography and is likely adversely impacted by steatosis.
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18
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The assessment of liver fibrosis in children with obesity on two methods: transient and two dimensional shear wave elastography. Sci Rep 2019; 9:19800. [PMID: 31875010 PMCID: PMC6930277 DOI: 10.1038/s41598-019-56358-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to assess the liver stiffness values in children with obesity versus healthy children on 2D-SWE and TE taking into account different laboratory parameters. We performed a case-control study on 287 children aged between 3 to 18 years, admitted in a Romanian Pediatric Tertiary Hospital, which we divided according to the body mass index (BMI) into two groups: the study group-77 children with obesity, and control group-210 children with normal weight. All children underwent anamnesis, clinical exam, laboratory parameters, ultrasound exam, and elastography. Children with obesity presented higher values of platelets, AST, ALT, and AAR as compared to control group (p = 0.0005/p = 0.0065/p < 0.0001/p < 0.0001). We found no significant differences for APRI between the two groups (p = 0.9827), although the values were higher in children with obesity. Significantly higher values of liver stiffness in children with obesity on both 2D-SWE and TE (p = 0.0314/p < 0.0001) were obtained. Similarly, the velocity values measured by 2D-SWE were also significantly higher in the study group (p < 0.0001). Our findings revealed significantly higher levels of platelets, transaminases, AAR, and liver stiffness values on both TE and 2D-SWE in children with obesity. 2D-SWE and TE might represent useful non-invasive methods for predicting liver impairment associated to pediatric obesity.
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Farmakis SG, Buchanan PM, Guzman MA, Hardy AK, Jain AK, Teckman JH. Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease. Pediatr Radiol 2019; 49:1742-1753. [PMID: 31418057 DOI: 10.1007/s00247-019-04493-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/14/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND While liver biopsy remains the gold standard, given the procedure risks and sampling errors, there is a need for reliable noninvasive biomarkers of hepatic fibrosis. OBJECTIVE Determine the accuracy of two-dimensional shear wave elastography (2-D SWE) in predicting the histological severity of liver fibrosis in pediatric patients with known or suspected liver disease. MATERIALS AND METHODS Subjects 0-18 years old with known or suspected liver disease and liver biopsy within 30 days (n=70) were included. Comparisons by 2-D SWE were made to a control group (n=79). Two-dimensional SWE was performed using the GE LOGIQ E9 system. Liver biopsy specimens were scored according to METAVIR and Ishak scoring systems using Spearman's Rho correlation. Receiver operator characteristic (ROC) analysis, Kruskal-Wallis and Mann-Whitney U tests were conducted. RESULTS Control group median 2-D SWE measurements were lower than in subjects with any degree of liver fibrosis (P<0.001). Those with METAVIR F0 and Ishak 0 scores had significantly lower median 2-D SWE measurements (1.35 m/s; 1.36 m/s) than those with more advanced liver disease (F1-F3: 1.49-1.62 m/s; 1-4: 1.45-1.63 m/s) (P<0.05 for all), whereas the 2-D SWE in the higher scores were similar. Results did not differ between METAVIR and Ishak scores for any degree of fibrosis. Fibrosis scores moderately correlated with median 2-D SWE measurements (rs=0.43). The area under the curve for F1 compared to combined control/F0 was 0.89 (95% confidence interval [CI] 0.83-0.95; P<0.001) with sensitivity of 94.6% and specificity of 78.6%. Results for Ishak score 1 were similar. The ideal cutoff value for identifying fibrosis was determined to be 1.29 m/s. CONCLUSION The liver 2-D SWE measurements correlated with the histological liver fibrosis scores, regardless of the histopathological scoring system, although 2-D SWE was better at identifying patients with early fibrosis, not at distinguishing among the individual fibrosis levels. Two-dimensional SWE using the GE LOGIQ US system is useful for identifying pediatric patients at risk for liver fibrosis.
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Affiliation(s)
- Shannon G Farmakis
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO, 63110, USA.
| | - Paula M Buchanan
- Center of Health Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Miguel A Guzman
- Department of Pathology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Anna K Hardy
- Department of Radiology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Ajay K Jain
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffrey H Teckman
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
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Sun PX, Tong YY, Shi J, Zhang H, Liu SJ, Du J. Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology. World J Clin Cases 2019; 7:3463-3473. [PMID: 31750329 PMCID: PMC6854399 DOI: 10.12998/wjcc.v7.i21.3463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness. Virtual touch imaging quantification (VTIQ) based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.
AIM To determine the standard value in healthy children, and to identify possible factors that might influence the VTIQ measurement.
METHODS With the ethical approval, 202 children between 1 month and 15 years old were included in this study. None of them had any liver or systematic diseases. All children had a normal ultrasound scan and normal body mass index (BMI) range. The subjects were divided into four age and BMI groups. The effects of gender, age, liver lobe, measurement depth, and BMI on liver elasticity were investigated.
RESULTS A significant correlation was found between age and shear wave velocity (SWV) value. At measurement depths of 1.5 cm and 2.0 cm in the left lobe, there were significant differences among the age groups. SWV values were significantly negatively correlated with the measurement depth. Gender, liver lobe, and BMI showed no significant effect on the SWV values. Age and BMI may influence the quality of the elastogram.
CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children. The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.
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Affiliation(s)
- Pei-Xuan Sun
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yu-Yang Tong
- Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Jing Shi
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Huan Zhang
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shi-Jian Liu
- Department of Clinical Epidemiology and Biostatistics, Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jun Du
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Wu S, Tu R, Liang X. Patchy echogenicity of the liver in patients with chronic hepatitis B does not indicate poorer elasticity. Ultrasonography 2019; 38:327-335. [PMID: 31302950 PMCID: PMC6769196 DOI: 10.14366/usg.18071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study was conducted to investigate whether the presence of patchy echogenicity in the liver of patients with chronic hepatitis B (CHB) is predictive of liver stiffness. METHODS A total of 200 CHB patients with and without patchy echogenicity of the liver were assigned to two groups, with 100 patients in each group, and 32 of them underwent liver biopsy. Additionally, 80 healthy subjects, 100 inactive HBV carriers, and 100 patients with decompensated hepatic cirrhosis were assigned to the control groups. Laboratory tests and clinical data were collected, and shear wave velocity (SWV) of the liver was measured for all 480 subjects. RESULTS The median SWV in patients with a normal liver, inactive hepatitis B virus carriers, CHB patients with and without patchy echogenicity, and decompensated hepatic cirrhosis were 1.07 m/sec, 1.08 m/sec, 1.16 m/sec, 1.16 m/sec, and 2.02 m/sec, respectively; there was no significant difference in SWV values between CHB patients with patchy echogenicity and those without patchy echogenicity. Furthermore, among CHB patients with and without patchy echogenicity, no significant difference in SWV was found according to fibrosis stage. CONCLUSION The presence of patchy echogenicity of the liver does not indicate a higher degree of liver stiffness.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Rong Tu
- Department of Radiology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xian Liang
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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22
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Özkan MB, Bilgic M, Bicakci U, Germiyanoglu C. Diagnostic Accuracy of Virtual Touch Quantification and Virtual Touch Imaging Quantification Sonoelastography Techniques in Pediatric Undescended Testes Patients. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318818077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine the usefulness of virtual touch quantification (VTQ) and virtual touch imaging quantification (VTIQ) techniques for assessing undescended testes stiffness, by age and location. One testicle from each of 84 participants (31 of whom were healthy volunteers) was assessed by the point shear-wave elastography (p-SWE) method, using both VTQ and VTIQ techniques. The patients were grouped by location of assessment (intra-abdominal, inguinal, and scrotal) and age (group 1, healthy patients; group 2, patients age one and younger; and group 3, patients older than age one). Although the VTQ and VTIQ methods for group 2 showed similar results in the Bland-Altman plot, for group 3, the VTIQ method was more effective than the VTQ method. The use of p-SWE with VTIQ may be an appropriate technique for determining the tissue stiffness of testes located in the inguinal canal and for patients over one year of age.
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Affiliation(s)
- Mehmet Burak Özkan
- Department of Pediatric Radiology Department, Dr Sami Ulus Research and Training Hospital, Altindag, Ankara, Turkey
| | - Meltem Bilgic
- Department of Pediatric Radiology, Omu, Samsun, Turkey
| | - Unal Bicakci
- Department of Pediatric Surgery, Omu, Samsun, Turkey
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23
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Ferraioli G, Wong VWS, Castera L, Berzigotti A, Sporea I, Dietrich CF, Choi BI, Wilson SR, Kudo M, Barr RG. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2419-2440. [PMID: 30209008 DOI: 10.1016/j.ultrasmedbio.2018.07.008] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology has produced these guidelines for the use of elastography techniques in liver diseases. For each available technique, the reproducibility, results and limitations are analyzed, and recommendations are given. This set of guidelines updates the first version, published in 2015. Since the prior guidelines, there have been several advances in technology. The recommendations are based on the international published literature, and the strength of each recommendation is judged according to the Oxford Centre for Evidence-Based Medicine. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of liver diseases.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, School of Medicine, University of Pavia, Pavia, Italy
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Laurent Castera
- Service d'Hepatologie, Hopital Beaujon, Clichy, Assistance Publique-Hopitaux de Paris, INSERM UMR 1149 CRI, Universite Denis Diderot Paris-VII, Paris, France
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Switzerland
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Stephanie R Wilson
- Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka Sayama, Japan
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, Ohio, USA.
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25
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Liang X, Wu B, Shang H, Han X, Jing H, Sun Y, Cheng W. VTIQ evaluates antitumor effects of NET-1 siRNA by UTMD in HCC xenograft models. Oncol Lett 2018; 16:2893-2902. [PMID: 30127877 PMCID: PMC6096142 DOI: 10.3892/ol.2018.8994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/27/2018] [Indexed: 12/15/2022] Open
Abstract
The present study used a virtual touch tissue imaging and quantification (VTIQ) method to investigate the change in elasticity in xenograft tumor tissue models following silencing of the neuroepithelial-transforming protein 1 (NET-1) gene by ultrasound-targeted microbubble destruction (UTMD). A total of 24 xenograft models were established by subcutaneous injection of human hepatocellular carcinoma SMMC-7721 cells in BALB/c female nude mice. Then, NET-1 small interfering RNA (siRNA)-conjugated nanobubbles and a glypican-3 antibody were synthesized. The mean and maximum shear wave speed (SWSmean and SWSmax) in the tumor tissue were measured prior to, during, and following therapy using VTIQ. The growth of the tumor size and survival time were recorded. The levels of NET-1 protein were evaluated by immunohistochemical staining. In addition, tumor, liver and kidney tissues of the nude mice were collected to confirm whether gene transfection treatment was toxic in vivo. In the UTMD delivery gene group, SWSmean was correlated with the maximum diameter of the tumor (r=0.9806, P=0.0194). The immunohistochemical staining data indicated that the level of NET-1 protein in the treated groups was significantly decreased compared with those in the control groups. Additionally, no structural damage was observed in the nude mice liver and kidney tissues following treatment. Therefore, VTIQ measurement identified potential changes in the elastic properties of the tumors, which in turn may be associated with the stages of tumor development. The delivery method, UTMD, improves the antitumor effects of NET-1 siRNA and supports gene transfection as a promising therapeutic strategy.
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Affiliation(s)
- Xitian Liang
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Bolin Wu
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Haitao Shang
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Xue Han
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Hui Jing
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Yixin Sun
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
| | - Wen Cheng
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Nangang, Harbin, Heilongjiang 150000, P.R. China
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Dietrich CF, Sirli R, Ferraioli G, Popescu A, Sporea I, Pienar C, Kunze C, Taut H, Schrading S, Bota S, Schreiber-Dietrich D, Yi D. Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients. APPLIED SCIENCES 2018; 8:944. [DOI: 10.3390/app8060944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Studies performed using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have shown that these techniques are all feasible and accurate in children for the evaluation of liver fibrosis due to several etiologies. However, for some specific pediatric pathologies, such as biliary atresia, the evidence is still limited. As shown in adults, inflammation is a confounding factor when assessing fibrosis severity and care should be taken when interpreting the results. Due to the scarce comparative data between serological tests and elastography techniques in children, a definite conclusion regarding which is the best cannot be drawn. Neither non-invasive elastographic techniques nor laboratory scores allow determination of the presence and the degree of inflammation, necrosis, iron or copper deposits.
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Affiliation(s)
- Christoph F. Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 Bad Mergentheim, Germany
| | - Roxana Sirli
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Giovanna Ferraioli
- Ultrasound Unit, Clinical Sciences and Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Medical School University of Pavia, 27100 Pavia, Italy
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Corina Pienar
- Pediatrics Department, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Christian Kunze
- Klinik für Radiologie, Abteilung Kinderradiologie, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
| | - Heike Taut
- Klinik und Poliklinik für Kinder-und Jugendmedizin, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, 01307 Dresden, Germany
| | - Simone Schrading
- Klinik für Diagnostische und Interventionelle Radiologie, University of Aachen, 52062 Aachen, Germany
| | - Simona Bota
- Department of Gastroenterology, Hepatology, Nephrology and Endocrinology, Klinikum Klagenfurt am Wörthersee, 9020 Klagenfurt am Wörthersee, Austria
| | - Dagmar Schreiber-Dietrich
- Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 Bad Mergentheim, Germany
| | - Dong Yi
- Department of ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200433, China
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Burak Özkan M, Bilgici M, Eren E, Caltepe G. Diagnostic accuracy of point shear wave elastography in the detection of portal hypertension in pediatric patients. Diagn Interv Imaging 2018; 99:151-156. [DOI: 10.1016/j.diii.2017.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 12/28/2022]
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Kim BJ, Kim CK, Park JJ. Non-invasive evaluation of stable renal allograft function using point shear-wave elastography. Br J Radiol 2017; 91:20170372. [PMID: 29022743 DOI: 10.1259/bjr.20170372] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of point shear-wave elastography (SWE) in evaluating patients with stable renal allograft function who underwent protocol biopsies. METHODS 95 patients with stable renal allograft function that underwent ultrasound-guided biopsies at predefined time points (10 days or 1 year after transplantation) were enrolled. Ultrasound and point SWE examinations were performed immediately before protocol biopsies. Patients were categorized into two groups: subclinical rejection (SCR) and non-SCR. Tissue elasticity (kPa) on SWE was measured in the cortex of all renal allografts. RESULTS SCR was pathologically confirmed in 34 patients. Tissue elasticity of the SCR group (31.0 kPa) was significantly greater than that of the non-SCR group (24.5 kPa) (=0.016), while resistive index value did not show a significant difference between the two groups (p = 0.112). Tissue elasticity in renal allografts demonstrated significantly moderate negative correlation with estimated glomerular filtration rate (correlation coefficient = -0.604, p < 0.001). Tissue elasticity was not independent factor for SCR prediction on multivariate analysis. CONCLUSION As a non-invasive tool, point SWE appears feasible in distinguishing between patients with SCR and without SCR in stable functioning renal allografts. Moreover, it may demonstrate the functional state of renal allografts. Advances in knowledge: On point SWE, SCR has greater tissue elasticity than non-SCR.
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Affiliation(s)
- Bom Jun Kim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,2 Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jung Jae Park
- 3 Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
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