Points to be considered when applying FibroScan S probe in children with biliary atresia
Seung Kim1, Yunkoo Kang, Mi Jung Lee
1*Department of Pediatrics †Department of Radiology and Research Institute of Radiological Science ‡Department of Pediatric Surgery, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, South Korea.
Insights
The S1 probe is recommended for assessing liver stiffness in children with a small thorax (< 45 cm). For children with a larger thorax (> 45 cm), the M probe may be acceptable if S probes are unavailable.
Area of Science:
- Pediatric gastroenterology
- Hepatology
- Medical imaging
Background:
- Transient elastography (TE) is increasingly used in pediatric populations.
- Smaller probes (S1, S2) have expanded TE applications to children.
- Biliary atresia requires accurate liver stiffness assessment for management.
Purpose of the Study:
- To compare the performance of FibroScan S (S1, S2) and M probes in children with biliary atresia.
- To evaluate probe choice and interpretation of liver stiffness measurements based on thoracic perimeter.
- To assess the correlation between liver stiffness and the aspartate aminotransferase-to-platelet ratio index (APRI) using different probes.
Main Methods:
- Liver stiffness measurements were obtained from 100 pediatric patients using S1, S2, and M probes.
- Patients were grouped by thoracic perimeter (≤ 45 cm vs > 45 cm).
- Success rates, interquartile ranges, and correlations with APRI were analyzed.
Main Results:
- In small-thorax patients (< 45 cm), the S1 probe showed the highest success rate and strongest correlation with APRI.
- In large-thorax patients (> 45 cm), the S2 and M probes demonstrated high inter-probe agreement.
- All probes showed good correlation with APRI in the large-thorax group.
Conclusions:
- The S1 probe is recommended for children with biliary atresia and a thorax perimeter < 45 cm.
- The M probe can be considered for children with a thorax perimeter > 45 cm when S probes are unavailable.
- Probe selection should be tailored to patient thoracic size for accurate liver stiffness measurement.
Objectives:
With the introduction of smaller probes (S1, S2), the use of transient elastography has been expanded to children. Accordingly, we aimed to address points of consideration in probe choice and interpretation of measured liver stiffness by applying and comparing FibroScan S and M probes in biliary atresia.
Methods:
Using S1, S2, and M probes, 3 liver stiffness measurements, success rates, and interquartile ranges were obtained from 100 patients. Patients were assigned to 2 groups according to thoracic perimeter (≤ 45 cm vs > 45 cm). In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index was analyzed.
Results:
In the small-thorax group, the success rate was highest with the S1 probe and the intraclass correlation coefficient (ICC) was highest for S1 versus S2 (0.98), compared with that for S1 versus M (0.69) and S2 versus M (0.77). In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51). In the small-thorax group, correlations between aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement were stronger for S1 (0.65) and S2 (0.64) than for M (0.49). In the large-thorax group, all probes showed good correlation, S1 (0.68), S2 (0.62), and M (0.62).
Conclusions:
We recommend that the S1 probe is more appropriate for use in small children, especially those with a thorax perimeter of < 45 cm. If no S probe is available, the M probe may be acceptable in children whose thorax perimeter is > 45 cm.
