BACKGROUND A limited number of publications correlate bidimensional shear-wave elastography (2-D SWE) and stages of liver fibrosis in children. OBJECTIVE To correlate liver elastography values using 2-D SWE and liver biopsy classified by Knodell-Ishak score to evaluate fibrosis in pediatric patients with liver disease, and to propose values of 2-D SWE (kPa) correlating with Knodell-Ishak score, which have not been defined in the literature. MATERIALS AND METHODS We conducted a prospective cross-sectional observational study on the performance of diagnostic tests. Between June 2016 and June 2018, elastography was performed in 213 children and young adults who had undergone liver biopsy. B mode, Doppler and 2-D SWE were performed using an Aixplorer (SuperSonic Imagine, Aix-en-Provence, France). Histology samples were classified using the Knodell-Ishak score. We evaluated performance by assessing sensitivity, specificity, positive predictive value and negative predictive value. To determine cut-off points for the continuous variables, we used receiver operating characteristic (ROC) curves. All the cutoff values we established apply only to the SuperSonic Aixplorer system. RESULTS Measurement with 2-D SWE was successful, with a good correlation with fibrosis stage. The area under the curve (AUC) to differentiate between early (Stages 1-2) and moderate (Stages 3-4) fibrosis was 0.91 (95% confidence interval [CI]: 0.87-0.96), with a sensitivity of 92% and specificity of 86%, with a cutoff value 12 kPa (2 m/s). The AUC of severe fibrosis (early stages of cirrhosis; Stage 5) was 0.95 (95% CI: 0.92-0.97), with a sensitivity of 94% and specificity of 90%, with a cutoff value 18.5 kPa (2.48 m/s). In two patients with hematopoietic stem cell transplantation and suspicion of graft versus host disease we found high 2-D SWE values in correlation with the fibrosis stages (Stage 0 with a median of 13 kPa [2.08 m/s] with hemosiderosis Grade 2 in one child and Stage 2 with a median of 46 kPa [3.91 m/s] and hemosiderosis Grade 4 in the other). CONCLUSION Our study shows the usefulness and accuracy of 2-D SWE for detecting liver fibrosis in pediatric patients. We propose reference values for Knodell-Ishak Stages 1 and 5. We found hemosiderosis as a possible confounding factor that hasn't been described with 2-D SWE.

中文翻译：

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评估儿童肝纤维化的二维剪切波弹性成像：与组织病理学Knodell-Ishak评分相关的参考值的提议。

背景技术有限的出版物将二维剪切波弹性成像（2-D SWE）与儿童肝纤维化的阶段联系起来。目的利用2-D SWE和按Knodell-Ishak评分分类的肝活检对肝弹性成像值进行关联，以评估小儿肝病患者的纤维化，并提出与Knodell-Ishak评分相关的2-SWE（kPa）值。文献中尚未定义。材料与方法我们对诊断测试的性能进行了前瞻性的横断面观察研究。在2016年6月至2018年6月之间，对213位接受肝活检的儿童和年轻人进行了弹性成像。B模式，多普勒和2-D SWE是使用Aixplorer（法国普罗旺斯地区艾克斯的SuperSonic Imagine）进行的。组织学样本使用Knodell-Ishak评分进行分类。我们通过评估敏感性，特异性，阳性预测值和阴性预测值来评估表现。为了确定连续变量的临界点，我们使用了接收器工作特性（ROC）曲线。我们建立的所有截止值仅适用于SuperSonic Aixplorer系统。结果二维SWE测量成功，与纤维化分期有很好的相关性。区分早期（1-2期）和中度（3-4期）纤维化的曲线下面积（AUC）为0.91（95％置信区间[CI]：0.87-0.96），敏感性为92％，特异性为86％，临界值为12 kPa（2 m / s）。严重纤维化（肝硬化的早期； 5期）的AUC为0.95（95％CI：0.92-0.97），灵敏度为94％，特异性为90％，临界值为18.5 kPa（2.48 m / s）。在两名接受造血干细胞移植并怀疑移植物抗宿主疾病的患者中，我们发现2-D SWE值与纤维化阶段相关（0期，中位数为13 kPa [2.08 m / s]，含铁血沉着病等级为2级儿童和2级患者，中位数为46 kPa [3.91 m / s]，另一级患者则为4级铁血铁血病。结论我们的研究表明2-D SWE在儿科患者中检测肝纤维化的有效性和准确性。我们提出了Knodell-Ishak第1和第5期的参考值。我们发现含铁血黄素沉着病是可能的混杂因素，而二维SWE尚未对此进行描述。在两名接受造血干细胞移植并怀疑移植物抗宿主疾病的患者中，我们发现2-D SWE值与纤维化阶段相关（0期，中位数为13 kPa [2.08 m / s]，含铁血沉着病等级为2级儿童和2级患者，中位数为46 kPa [3.91 m / s]，另一级患者则为4级铁血铁血病。结论我们的研究表明2-D SWE在儿科患者中检测肝纤维化的有效性和准确性。我们提出了Knodell-Ishak第1和第5期的参考值。我们发现含铁血黄素沉着病是可能的混杂因素，而二维SWE尚未对此进行描述。在两名接受造血干细胞移植并怀疑移植物抗宿主疾病的患者中，我们发现2-D SWE值与纤维化阶段相关（0期，中位数为13 kPa [2.08 m / s]，含铁血沉着病等级为2级儿童和2级患者，中位数为46 kPa [3.91 m / s]，另一级患者则为4级铁血铁血病。结论我们的研究表明2-D SWE在儿科患者中检测肝纤维化的有效性和准确性。我们提出了Knodell-Ishak第1和第5期的参考值。我们发现含铁血黄素沉着病是可能的混杂因素，而二维SWE尚未对此进行描述。91 m / s]和其他的铁血沉着病4级。结论我们的研究表明2-D SWE在儿科患者中检测肝纤维化的有效性和准确性。我们提出了Knodell-Ishak第1和第5期的参考值。我们发现含铁血黄素沉着病是可能的混杂因素，而二维SWE尚未对此进行描述。91 m / s]和其他的铁血沉着病4级）。结论我们的研究表明2-D SWE在儿科患者中检测肝纤维化的有效性和准确性。我们提出了Knodell-Ishak第1和第5期的参考值。我们发现含铁血黄素沉着病是可能的混杂因素，而二维SWE尚未对此进行描述。