Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver
Behairy El-Sayed Behairy1, Mostafa Mohamed Sira1, Khaled Refat Zalata1
1Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
Insights
Transient elastography (TE) reliably stages liver fibrosis in children with chronic liver diseases. However, disease-specific cut-off values are needed due to varying liver stiffness measurements (LSM) across etiologies.
Area of Science:
- Pediatric Hepatology
- Noninvasive Liver Disease Assessment
- Fibrosis Staging
Background:
- Liver biopsy is invasive for staging pediatric liver fibrosis.
- Noninvasive methods are crucial for accurate fibrosis assessment in children.
- Transient elastography (TE) offers a potential noninvasive alternative.
Purpose of the Study:
- To evaluate transient elastography (TE) for staging liver fibrosis in children.
- To compare TE with liver biopsy and morphometry.
- To assess TE's reliability across different chronic liver diseases.
Main Methods:
- 90 children with chronic hepatitis C virus (HCV), autoimmune hepatitis (AIH), or Wilson disease underwent TE for liver stiffness measurement (LSM).
- Liver biopsies were analyzed for fibrosis using Ishak score and morphometry (FAF).
- Spearman correlation and regression analyses assessed LSM's association with fibrosis; ROC curves determined cut-off values.
Main Results:
- LSM strongly correlated with Ishak scores (r=0.879) and FAF (r=0.839).
- TE accurately discriminated fibrosis stages with high sensitivity (81.4–100%) and specificity (75.0–97.2%).
- LSM values varied significantly by etiology (AIH > Wilson disease > HCV).
Conclusions:
- Transient elastography is a reliable tool for staging liver fibrosis in children.
- Disease-specific cut-off values for LSM are essential for accurate staging.
- TE facilitates noninvasive fibrosis assessment in pediatric chronic liver diseases.
Aim:
To evaluate transient elastography (TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.
Methods:
A total of 90 children [50 with chronic hepatitis C virus (HCV), 20 with autoimmune hepatitis (AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement (LSM) using TE. Liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction (FAF) using digital image analysis (morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was also performed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiver-operating characteristic curve. Cut-off values with optimal clinical performance (optimal sensitivity and specificity simultaneously) were selected.
Results:
The majority of HCV group had minimal activity (80%) and no/mild fibrosis (72%). On the other hand, the majority of AIH group had mild to moderate activity (70%) and moderate to severe fibrosis (95%) and all Wilson disease group had mild to moderate activity (100%) and moderate to severe fibrosis (100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter (r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH (16.15 ± 7.23 kPa) compared to Wilson disease (8.30 ± 0.84 kPa) and HCV groups (7.43 ± 1.73 kPa). Multiple regression analysis revealed that Ishak fibrosis stage was the only independent variable associated with higher LSM (P < 0.0001).
Conclusion:
TE appears reliable in distinguishing different stages of liver fibrosis in children. However, its values vary according to the disease type. For that, a disease-specific estimation of cut-off values for fibrosis staging is worthy.
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