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Updated: May 19, 2026
Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
Published on: August 29, 2025
Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver
Emer Fitzpatrick1, Alberto Quaglia, Sunitha Vimalesvaran
1Paediatric Liver, GI and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK.
Insights
Transient elastography (TE) reliably assesses liver fibrosis in children, offering a noninvasive alternative to biopsy. This method aids in monitoring pediatric liver disease progression.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Liver fibrosis severity dictates pediatric liver disease outcomes.
- Liver biopsy, the current standard, has limitations in children, including sedation needs, sampling errors, and bleeding risks.
Purpose of the Study:
- To compare noninvasive assessment tools for liver fibrosis in a pediatric cohort.
- To evaluate the efficacy of transient elastography (TE) against liver biopsy in children.
Main Methods:
- 104 children with chronic liver disease underwent transient elastography (TE) alongside liver biopsy.
- Liver biopsies were histopathologically scored for fibrosis (F0-F4).
- TE results were compared with biopsy-determined fibrosis stages.
Main Results:
- TE was successful in 93% of pediatric patients.
- TE effectively discriminated significant fibrosis (≥F2), severe fibrosis (≥F3), and cirrhosis (F4) (P<0.001).
- TE showed high predictive accuracy (AUC 0.78-0.96) and performed best in autoimmune liver disease and post-transplant patients.
Conclusions:
- Transient elastography (TE) is a reliable tool for staging liver fibrosis in children.
- TE can serve as a valuable noninvasive adjunct to liver biopsy for monitoring pediatric liver disease progression.
Background:
Outcome of liver disease in children is mainly determined by severity and progression of liver fibrosis. Liver biopsy is the accepted standard for evaluating fibrosis but is limited by the need for sedation in children, sampling error, and risks including bleeding. The aim of the present study was to compare tools for noninvasive assessment of liver fibrosis in a paediatric cohort.
Methods:
Children undergoing liver biopsy for chronic liver disease were recruited and underwent transient elastography (TE). Liver biopsies were scored by a hepatohistopathologist from F0 (no fibrosis) to F4 (cirrhosis). TE was compared with biopsy score.
Results:
During the study period, 104 children (62 boys) were enrolled (median age 13.6 years). Diagnosis was autoimmune liver disease in 27; nonalcoholic fatty liver disease in 37; posttransplant in 16; hepatitis B/C in 8; Wilson disease in 5; and the remainder, miscellaneous. TE was successful in all but 7 patients and was a good discriminator of significant fibrosis (≥ F2) (P < 0.001), severe fibrosis (≥ F3) (P < 0.001), and cirrhosis (F4) (P = 0.003). The area under the receiver operating characteristic curve for the prediction of ≥ F2, ≥ F3, and F4 using TE was 0.78, 0.79, and 0.96, respectively. TE performed best in children with autoimmune liver disease and in those posttransplant.
Conclusions:
The present study demonstrates that TE is a reliable tool in distinguishing different stages of liver fibrosis in paediatric patients. Thus, TE may serve as a useful adjunct to liver biopsy for diagnostic purposes providing a reliable method of noninvasively monitoring liver disease progression in children.
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