Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation
Sylviane Hanquinet1, Delphine S Courvoisier2, Anne-Laure Rougemont3
1Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland. sylviane.hanquinet-ginter@hcuge.ch.
Insights
Acoustic radiation force impulse elastography (ARFI) can help identify children with biliary atresia post-Kasai operation who may need liver transplantation. Higher ARFI values indicate a greater likelihood of requiring transplantation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Biliary atresia often leads to progressive liver fibrosis and cirrhosis after the Kasai operation.
- Liver transplantation is the only definitive treatment for advanced stages.
Purpose of the Study:
- To evaluate liver fibrosis using acoustic radiation force impulse elastography (ARFI) in children post-Kasai operation.
- To establish an ARFI value threshold for identifying children who may require liver transplantation.
Main Methods:
- A cohort of 32 children post-Kasai operation was divided into two groups: transplanted/listed (Group A) and not listed (Group B).
- ARFI values, liver biopsies, and blood samples were collected and analyzed over time.
- Statistical analysis included generalized estimating equations and Fisher exact test to compare groups.
Main Results:
- Children requiring transplantation (Group A) showed significantly higher ARFI values (3.3±1.2 m/s) compared to those not listed (Group B, 2.0±0.7 m/s).
- Two consecutive ARFI values ≥2 m/s were observed in 94.7% of transplanted children versus 46.2% of non-transplanted children.
Conclusions:
- Elevated ARFI values, specifically two consecutive measurements ≥2 m/s, are associated with the need for liver transplantation in children post-Kasai operation.
- ARFI elastography shows promise as a non-invasive tool for assessing liver fibrosis and guiding treatment decisions in biliary atresia management.
Background:
Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation.
Objective:
To assess liver fibrosis by acoustic radiation force impulse elastography (ARFI) in children who had Kasai operation, with the goal of identifying an ARFI value cut-off for children requiring liver transplantation.
Materials And Methods:
Of the 32 post-Kasai children included, 19 were transplanted or listed for transplantation (group A), while 13 were not on the list during their follow-up (group B). We recorded biopsies, blood samples and ARFI values over time, including at Kasai operation and at transplantation. We estimated an association between groups and continuous variables using generalized estimating equations, and we compared categorical variables using the Fisher exact test.
Results:
Portal hypertension signs were similar in both groups, whereas ARFI values were higher in group A (mean±standard deviation=3.3±1.2 m/s) than in group B (2.0±0.7 m/s; P=.0003). Eighteen of 19 (94.7%) children in group A and 6/13 (46.2%) children in group B presented with two consecutive ARFI values ≥2 m/s (sensitivity=7%, specificity=53.8%; P=0.003).
Conclusion:
We found that children who were transplanted had two consecutive ARFI values ≥2 m/s during follow-up. ARFI for evaluation of post-Kasai liver fibrosis may assist the long-term assessment of biliary atresia and may even guide treatment decisions.
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