Ultrasound elastography: is there a shear wave speed cutoff for pediatric liver fibrosis and inflammation?
Andrew Phelps1, Raga Ramachandran1, Jesse Courtier1
1UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, 94158.
Insights
Shear wave speed (SWS) in pediatric liver disease shows potential for detecting fibrosis. However, a cutoff of 1.7 m/s is insufficient alone for screening due to low negative predictive value.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Liver fibrosis and inflammation are significant concerns in pediatric liver disease.
- Accurate non-invasive diagnostic tools are crucial for timely intervention.
Purpose of the Study:
- To determine a shear wave speed (SWS) cutoff for identifying liver fibrosis and inflammation in children.
- To evaluate the diagnostic performance of SWS in pediatric liver disease.
Main Methods:
- Prospective study involving 41 children undergoing liver biopsy.
- Measurement of liver shear wave speed (SWS) using point shear wave elastography.
- Correlation of SWS values with histopathological findings of fibrosis and inflammation.
Main Results:
- A significant difference in SWS was observed between patients with and without fibrosis when inflammation was absent (1.8 vs. 1.4 m/s, P=.02).
- A SWS cutoff of 1.7 m/s demonstrated 100% positive predictive value but only 24% negative predictive value for detecting fibrosis or inflammation.
- These findings suggest limitations in using SWS as a standalone diagnostic marker.
Conclusions:
- Point shear wave elastography alone is inadequate as a screening tool for liver fibrosis and inflammation in a diverse pediatric patient group.
- Further research is needed to refine SWS applications or combine it with other modalities for improved diagnostic accuracy.
- The study highlights the complexity of non-invasive liver assessment in pediatric populations.
Objective:
The objective was to identify a shear wave speed (SWS) cutoff in pediatric liver disease to detect fibrosis and inflammation.
Methods:
We performed an institutional-review-board-approved prospective study of liver SWS in 41 children undergoing liver biopsy.
Results:
In patients without inflammation, SWS was higher when fibrosis was present compared to when fibrosis was not present (average SWS 1.8 vs. 1.4 m/s, respectively, P=.02). A SWS cutoff of 1.7 m/s had 100% positive predictive value and 24% negative predictive value for detecting fibrosis or inflammation.
Conclusion:
Point shear wave elastography is an insufficient stand-alone screening tool for liver fibrosis and inflammation in a heterogeneous patient population.
