Evaluation of liver tissue by ultrasound elastography and clinical parameters in children with multiple blood cell
Georg W Wurschi1, Karim Kentouche2, Karl-Heinz Herrmann3
1Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital of Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
Insights
Ultrasound elastography and clinical scores can detect liver tissue changes in children with iron overload from blood transfusions, though not directly correlated with MRI iron measurements.
Area of Science:
- Pediatric Medicine
- Radiology
- Hepatology
Background:
- Children with frequent blood transfusions risk iron overload and liver damage.
- Noninvasive methods for screening liver changes are needed.
Purpose of the Study:
- To correlate ultrasound (US) elastography with MRI in pediatric patients post-bone marrow transplant.
- To assess US's ability to monitor liver tissue changes alongside clinical parameters.
Main Methods:
- Acoustic Radiation Force Impulse (ARFI) elastography, T2*-weighted MRI, and a clinical score (HepScore) were used.
- 45 pediatric patients were evaluated before and after transplantation (100 and 365 days).
- Correlations between US findings, HepScore, and MRI were analyzed.
Main Results:
- 64.4% of patients showed iron accumulation on MRI; 33.3% had increased liver stiffness on US.
- No significant direct correlation was found between ARFI elastography and MRI-measured iron.
- US elastography combined with HepScore showed potential in detecting liver alterations.
Conclusions:
- Combining US elastography and HepScore aids in detecting liver tissue alterations due to iron overload.
- Direct correlation between MRI-derived iron estimates and ARFI imaging was not significant.
- This combined approach offers a noninvasive strategy for monitoring liver health in transfused children.
Background:
Children receiving multiple blood cell transfusions are prone to iron overload and successive tissue damage in liver parenchyma, making noninvasive screening options desirable. Ultrasound (US) elastography using acoustic radiation force impulse (ARFI) imaging enables evaluation of liver parenchyma stiffness, and MRI allows for quantification of liver iron concentration.
Objective:
The objective was to correlate US elastography with MRI in children who had undergone bone marrow transplantation and to evaluate the modification of liver tissue with US in combination with clinical parameters at follow-up.
Materials And Methods:
ARFI, T2*-weighted MRI and a clinical score (HepScore, based on parameters of liver function) were performed in 45 patients (24 male; mean age 9.7 years) before and 100 days and 365 days after transplantation. All received multiple blood transfusions (mean number 22.2 up until 1 year after transplantation). We correlated US findings and HepScore with MRI findings.
Results:
We observed signs of iron accumulation in 29/45 (64.4%) patients on MRI (T2*<10 ms) and 15/45 (33.3%) showed increased tissue stiffness (ARFI>5.5 kPa). Correlation of elastography and MRI was not significant (P=0.57; n=51 matched measurements). Comparing US elastography with HepScore in receiver operating characteristic (ROC) curve analysis indicated a cut-off for affected parenchyma if HepScore was >5 points (sensitivity 67%, specificity 68%). Simultaneous increases of both indicated tissue alteration.
Conclusion:
Combining US and HepScore enabled detection of liver tissue alteration through iron overload, but we found no direct significant effect of estimated iron from MRI on ARFI imaging.
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