Liver Stiffness Measured by Shear-wave Elastography for Evaluating Intrahepatic Portal Hypertension in Children

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Medical Imaging

Background:

• Portal hypertension is a serious complication of pediatric liver diseases.
• Accurate, non-invasive methods are needed to assess portal hypertension in children.
• Shear-wave elastography (SWE) shows promise for evaluating liver stiffness (LS).

Purpose of the Study:

• To correlate liver stiffness (LS) measured by SWE with hepatic venous-pressure gradient (HVPG).
• To evaluate SWE's diagnostic performance for predicting clinically significant portal hypertension (CSPH) in children.
• To assess the reliability of SWE measurements using the coefficient of variation (CV).

Main Methods:

• 33 SWE measurements were performed on 32 children within 2 weeks of HVPG measurement.
• Correlation between LS and HVPG was analyzed.
• Receiver-operating characteristic (ROC) curve analysis assessed diagnostic performance for CSPH (HVPG ≥ 10 mmHg).
• Reliability was determined by the coefficient of variation (CV).

Main Results:

• LS significantly correlated with HVPG (r=0.742, P<0.001).
• SWE demonstrated excellent diagnostic performance for CSPH (AUC=0.914), with a cutoff of 18.4 kPa yielding 87.5% sensitivity and 84.0% specificity.
• LS measurements with CV ≤ 0.2 showed a strong correlation with HVPG (r=0.774, P<0.001), unlike those with CV > 0.2 (r=0.598, P=0.089).

Conclusions:

• SWE is a highly effective tool for diagnosing clinically significant portal hypertension in pediatric liver disease.
• LS measurements with a CV ≤ 0.2 are reliable and recommended for clinical use.
• SWE offers a valuable, non-invasive alternative to HVPG measurement in children.