Transient Elastography-Based Liver Stiffness Age-Dependently Increases in Children
Daisuke Tokuhara1, Yuki Cho1, Haruo Shintaku1
1Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan.
Insights
Transient elastography (TE) provides non-invasive liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) values in children. LSM increases with age in healthy pediatric patients, while CAP remains consistent across age groups.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Liver transient elastography (TE) offers a non-invasive method for assessing liver health in children.
- Establishing pediatric reference values for TE is crucial for accurate diagnosis and monitoring.
- Current reference ranges for TE in pediatric populations are limited.
Purpose of the Study:
- To determine reference values for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) using M-probe TE in children aged 1 to 18 years.
- To evaluate the feasibility and age-dependency of TE parameters in a pediatric cohort.
- To establish normative data for non-invasive liver assessment in healthy children.
Main Methods:
- Transient elastography (TE) with an M probe was performed on 139 pediatric patients (1-18 years).
- Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were recorded.
- Patients were stratified into three age groups: 1-5 years, 6-11 years, and 12-18 years. Exclusion criteria included overweight/obesity, known liver disease, elevated liver enzymes, or hepatic abnormalities.
Main Results:
- Successful M-probe TE was achieved in 123 children (88.5%) without anesthesia.
- Median LSM showed a significant age-dependent increase: 3.4 kPa (1-5 yrs), 3.8 kPa (6-11 yrs), and 4.1 kPa (12-18 yrs) (P=0.001).
- Median CAP was consistent across all age groups, with a median value of 183 (112-242) for ages 1-18 years.
Conclusions:
- M-probe transient elastography is a feasible and reliable method for assessing liver stiffness and fat deposition in children as young as 1 year.
- Liver stiffness measurement (LSM) in healthy children increases with age.
- Controlled attenuation parameter (CAP) measurements for hepatic fat deposition do not vary significantly with age in pediatric patients.
Background And Aims:
Pediatric use of liver transient elastography (TE) is attractive for its non-invasiveness, but reference values have not been established. We aimed to determine reference values for TE in children.
Methods:
In pediatric patients (1 to 18 years), TE (FibroScan®) with an M probe was used for both liver stiffness measurement (LSM) and measurement of hepatic fat deposition by using a controlled attenuation parameter (CAP). The patients were divided into three relevant age groups: preschoolers (1 to 5 years), elementary school children (6 to 11 years), and adolescents (12 to 18 years). Overweight or obese patients or those with known liver disease, elevated serum liver enzymes, or hepatic echogenic abnormality were excluded from the study.
Results:
Among 139 children, 123 (88.5%; 62 male; median age, 11.7 years; age range, 1.3 to 17.2 years) were successfully subjected to M-probe TE without anesthesia. Median LSM increased with age: it was 3.4 kPa (2.3 to 4.6 kPa, 5th to 95th percentiles) at ages 1 to 5 years; 3.8 (2.5 to 6.1) kPa at ages 6 to 11; and 4.1 (3.3 to 7.9) kPa at ages 12 to 18 (P = 0.001). Median CAP was not age dependent: it was 183 (112 to 242) for ages 1 to 18 years.
Conclusions:
M-probe TE is suitable in a wide age range of children from age 1 year up. In children without evidence of liver disease, LSM has an age-dependent increase, whereas CAP does not differ between ages 1 and 18.
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