Hepatic shear wave elastography in children under free-breathing and breath-hold conditions
Caroline Jung1, Michael Groth2, Kay Uwe Petersen3
1Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
Insights
Free-breathing hepatic 2D shear wave elastography (2D SWE) in children provides similar results to breath-holding. This method is faster and suitable for pediatric patients, especially infants and less cooperative children.
Area of Science:
- Pediatric imaging
- Hepatology
- Medical diagnostics
Background:
- Hepatic 2D shear wave elastography (2D SWE) is crucial for assessing liver stiffness in children.
- Breath-holding techniques can be challenging for pediatric patients, potentially affecting measurement accuracy and duration.
Purpose of the Study:
- To compare hepatic 2D SWE measurements between free-breathing and breath-hold conditions in children.
- To evaluate measurement agreement and time expenditure for both techniques.
Main Methods:
- Retrospective evaluation of 57 children undergoing standardized 2D SWE.
- Liver elastograms acquired under free-breathing and breath-hold conditions.
- Comparison of median stiffness, IQR, and IQR/median ratio using correlation, ICC, Bland-Altman, and t-tests.
Main Results:
- Strong correlation (r=0.97) in median liver stiffness between free-breathing (7.22±4.5kPa) and breath-hold (7.21±4.11kPa) conditions.
- Significantly lower time expenditure for free-breathing (79.3±32.5sec) vs. breath-holding (143.7±51.8sec) to acquire 12 elastograms.
- Very high agreement (ICC 0.993-0.994) for median liver stiffness regardless of the number of elastograms (12, six, or three).
Conclusions:
- Free-breathing hepatic 2D SWE yields comparable results to breath-hold techniques.
- The free-breathing approach offers a substantial time-saving benefit, especially when fewer elastograms are used.
- This technique is well-suited for pediatric populations, including infants and children unable to perform breath-holds, aiding in the diagnosis of liver disease.
Objectives:
To compare hepatic 2D shear wave elastography (2D SWE) in children between free-breathing and breath-hold conditions, in terms of measurement agreement and time expenditure.
Methods:
A cohort of 57 children (12.7±4.3 years) who underwent standardized 2D SWE between May and October 2015 were retrospectively evaluated. Liver elastograms were obtained under free-breathing and breath-hold conditions and time expenditure was measured. Median stiffness, interquartile range (IQR), and IQR/median ratio were calculated based on 12, six, and three elastograms. Results were compared using Pearson correlation coefficient, intraclass correlation coefficient (ICC), Bland-Altman analysis, and Student's t.
Results:
Median liver stiffness under free-breathing and breath-hold conditions correlated strongly (7.22±4.5kPa vs. 7.21±4.11kPa; r=0.97, P<0.001). Time to acquire 12 elastograms with free-breathing was lower than that with breath-holding (79.3±32.5sec vs. 143.7±51.8sec, P<0.001). Results for median liver stiffness based of 12, six, and three elastograms demonstrated very high agreement for free-breathing (ICC 0.993) and for breath-hold conditions (ICC 0.994).
Conclusions:
Hepatic 2D SWE performed with free-breathing yields results similar to the breath-hold condition. With a substantially lower time requirement, which can be further reduced by lowering the number of elastograms, the free-breathing technique may be suitable for infants and less cooperative children not capable of breath-holding.
Key Points:
• Hepatic 2D SWE performed with free-breathing yields results similar to breath-hold condition. • Benefit of the free-breathing approach is the substantially lower time requirement. • Lowering the number of elastograms can further reduce time expenditure. • Free-breathing 2D SWE is suitable in children with suspected liver disease.
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