Ultrasound Elastography as a Non-Invasive Method to Monitor Liver Disease in Children with Short Bowel Syndrome:
Amy E Lawrence1, Molly Dienhart2, Jennifer N Cooper1
1Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
Insights
Acoustic radiation force impulse (ARFI) ultrasound elastography accurately assesses liver disease in children with short bowel syndrome (SBS). This non-invasive method aids in monitoring fibrosis progression, offering a reliable alternative to biopsies.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Short bowel syndrome (SBS) in children can lead to significant liver disease, including fibrosis.
- Accurate, non-invasive monitoring of liver disease is crucial for managing SBS patients.
- Liver biopsy, while definitive, is invasive and carries risks.
Purpose of the Study:
- To evaluate the diagnostic accuracy of acoustic radiation force impulse (ARFI) ultrasound elastography for staging liver fibrosis in pediatric SBS patients.
- To determine if ARFI elastography can reliably differentiate between various stages of liver fibrosis.
Main Methods:
- Prospective observational cohort study involving 31 pediatric patients with SBS.
- Comparison of ARFI elastography-derived shear wave speed (SWS) measurements with liver biopsy results.
- Statistical analysis using t-tests and receiver operating characteristic (ROC) curves to assess accuracy.
Main Results:
- A significant positive correlation was observed between the stage of liver fibrosis and mean SWS (p<0.001).
- ARFI elastography demonstrated good accuracy in distinguishing mild fibrosis (F0-F1) from moderate to severe fibrosis (F2-F4) (AUC=0.80).
- The method also accurately differentiated mild to moderate fibrosis (F0-F2) from severe fibrosis (F3-F4) (AUC=0.84).
Conclusions:
- ARFI elastography is a highly accurate and non-invasive tool for assessing liver disease severity in children with SBS.
- This imaging technique provides a valuable, less invasive alternative to liver biopsy for monitoring hepatic fibrosis.
- ARFI elastography can aid clinicians in timely management decisions for pediatric SBS patients with liver complications.
Purpose:
The purpose of the study was to determine the accuracy of acoustic radiation force impulse (ARFI) ultrasound elastography in assessing the degree of liver disease in children with short bowel syndrome (SBS).
Methods:
A prospective observational cohort study of patients with SBS who underwent a liver biopsy and ARFI elastography was performed. Mean shear wave speed (SWS) and stage of fibrosis was evaluated using t-tests. Receiver operating characteristic curves (ROC) were generated and the area under the curves (AUC) estimated in order to assess the accuracy of SWS measurements to discriminate between stages of fibrosis.
Results:
Thirty-seven paired elastography and biopsy samples from 31 patients were included. The median age was 0.6 years, and 61% were male. There was a significant positive correlation between stage of fibrosis and mean SWS (β=0.16 m/s increase per stage, p=<0.001). ROC analysis revealed that mean SWS had good accuracy for discriminating between mild liver fibrosis (F0-F1) and moderate to severe fibrosis (F2-F4) (AUC=0.80, 95% CI 0.65-0.95). In addition, ROC analysis demonstrated that mean SWS can also accurately discriminate between mild to moderate fibrosis (F0-F2) and more severe fibrosis (F3-F4) (AUC=0.84, 95% CI 0.71-0.96).
Conclusion:
ARFI elastography is an accurate, non-invasive method to monitor liver disease in children with SBS.
Type Of Study:
Retrospective Cohort Study LEVEL OF EVIDENCE: II.
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