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Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a
Lu-Yao Zhou1, Hong Jiang2, Quan-Yuan Shan1
1Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
Insights
Supersonic shear wave elastography (SSWE) is feasible for assessing infants with potential biliary atresia (BA). However, grey-scale ultrasonography (US) demonstrates superior diagnostic performance compared to SSWE in identifying BA.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Hepatology
Background:
- Biliary atresia (BA) is a serious condition in infants causing conjugated hyperbilirubinaemia.
- Accurate and timely diagnosis is crucial for effective treatment and improved outcomes.
- Grey-scale ultrasonography (US) is a standard imaging technique for evaluating infants with suspected BA.
Purpose of the Study:
- To prospectively evaluate the diagnostic accuracy of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) in infants.
- To compare the performance of SSWE with conventional grey-scale US for BA diagnosis.
- To establish normal liver stiffness values using SSWE in an infant control group.
Main Methods:
- A prospective study involving 172 infants suspected of BA and 40 healthy infants for controls.
- Supersonic shear wave elastography (SSWE) was used to measure liver stiffness.
- Results were compared with grey-scale ultrasonography (US) findings; statistical analyses included Mann-Whitney U test, t-tests, and regression analysis.
Main Results:
- SSWE measurements were successful in 100% of controls and 96.4% of the study group.
- Liver stiffness measured by SSWE significantly correlated with infant age, direct, and indirect bilirubin levels.
- Grey-scale US showed superior diagnostic performance (AUC 0.893) compared to SSWE (AUC 0.790) for identifying BA.
Conclusions:
- SSWE is a feasible technique for assessing liver stiffness in infants.
- While SSWE can help differentiate BA from non-BA, its diagnostic performance is inferior to grey-scale US.
- Grey-scale US remains the preferred imaging modality for diagnosing biliary atresia in infants.
Objectives:
To prospectively assess the diagnostic performance of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) among infants with conjugated hyperbilirubinaemia by comparing this approach with grey-scale ultrasonography (US).
Methods:
Forty infants were analysed as the control group to determine normal liver stiffness values. The use of SSWE values for identifying BA was investigated in 172 infants suspected of having BA, and results were compared with the results obtained by grey-scale US. The Mann-Whitney U test, unpaired t-test, Spearman correlation and linear regression were also performed.
Results:
The success rates of SSWE measurements in the control and study group were 100% (40/40) and 96.4% (244/253), respectively. Age, direct bilirubin, and indirect bilirubin all significantly correlated with SSWE in the liver (all P < 0.001). Linear regression showed that age had a greater effect on SSWE values than direct or indirect bilirubin. The diagnostic performance of liver stiffness values in identifying BA was lower than that of grey-scale US (area under the receiver operating characteristic curve [AUC], 0.790 vs 0.893, P < 0.001).
Conclusions:
SSWE is feasible and valuable in differentiating BA from non-BA. However, its diagnostic performance does not exceed that of grey-scale US.
Key Points:
• SSWE could be successfully performed in an infant population. • For infants, the liver stiffness will increase as age increases. • SSWE is potentially useful in assessing infants suspected of biliary atresia. • SSWE is inferior to grey-scale US in identifying biliary atresia.
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