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Bidimensional shear-wave elastography for assessing liver fibrosis in children: a proposal of reference values that correlate with the histopathological Knodell–Ishak score

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina

    Esteban P. Dardanelli, Maria Eugenia Orozco, Juliana Lostra, Clarisa Laprida, Solange Lulkin & José E. Lipsich

  2. Department of Pathology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Buenos Aires, Argentina

    Andrea P. Bosaleh

  3. Department of Research and Development, Hospital de Pediatría J. P. Garrahan Buenos Aires, Buenos Aires, Argentina

    Carolina Cernadas

Authors
  1. Esteban P. Dardanelli
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  2. Maria Eugenia Orozco
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  3. Juliana Lostra
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  4. Clarisa Laprida
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  6. Andrea P. Bosaleh
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  7. Carolina Cernadas
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  8. José E. Lipsich
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Correspondence to Esteban P. Dardanelli.

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Dardanelli, E.P., Orozco, M.E., Lostra, J. et al. Bidimensional shear-wave elastography for assessing liver fibrosis in children: a proposal of reference values that correlate with the histopathological Knodell–Ishak score. Pediatr Radiol 50, 817–826 (2020). https://doi.org/10.1007/s00247-020-04632-1

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  • DOI: https://doi.org/10.1007/s00247-020-04632-1

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