Liver Stiffness Measurement by Vibration Controlled Transient Elastography Does Not Correlate to Hepatic Iron
Peter Costa1, Bryan Rudolph2, Debora Kogan-Liberman2
1Section of Pediatric Gastroenterology, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC.
Insights
Liver stiffness in children with sickle cell disease (SCD) may be elevated with age, but not directly linked to iron overload from transfusions. Vibration controlled transient elastography (VCTE) is a feasible tool for monitoring liver health in these patients.
Area of Science:
- Pediatric Hepatology
- Hematology
- Medical Technology
Background:
- Children with sickle cell disease (SCD) face risks of liver injury from sickle cell hepatopathy and iron overload due to chronic transfusions (CT).
- Assessing liver health noninvasively is crucial for managing SCD complications.
Purpose of the Study:
- To investigate the association between iron overload and liver stiffness measurement (LSM) in children with SCD.
- To evaluate the utility of vibration controlled transient elastography (VCTE) in this pediatric population.
Main Methods:
- Vibration controlled transient elastography (VCTE) was performed on pediatric patients (≤21 years) with SCD.
- Magnetic resonance imaging T2* was used for iron quantification in patients who received CT.
- Liver stiffness measurements (LSM) were compared between patients with and without CT and correlated with iron levels.
Main Results:
- No significant difference in LSM was observed between patients who received CT and those who did not (P=0.923).
- No correlation was found between iron quantification and LSM (r=-0.077, P=0.769).
- Children aged 12 years and older demonstrated abnormal LSM compared to reference ranges (P=0.013).
Conclusions:
- VCTE is a feasible noninvasive method for assessing liver stiffness in children with SCD.
- Elevated LSM in older children suggests potential liver disease progression, independent of iron overload alone.
- LSM may serve as a valuable tool for monitoring liver disease in SCD, regardless of iron burden.
Background:
Children with sickle cell disease (SCD) are at risk of liver injury because of sickle cell hepatopathy and iron overload from chronic transfusions (CT). The authors examine the association between iron overload and liver stiffness measurement (LSM) by vibration controlled transient elastography (VCTE), which has been shown to correlate with fibrosis.
Methods:
Patients 21 years of age and less with SCD had VCTE performed; those who received CT underwent magnetic resonance imaging T2* for iron quantification.
Results:
The authors enrolled 42 patients, 17 (40%) of whom received CT. There was no difference in LSM between patients who underwent CT (5.5±1.5 kPa) and those who did not (5.2±2.3 kPa) (P=0.923). There was no correlation between iron quantification and LSM (r=-0.077, P=0.769). However, children 12 years of age and older had abnormal LSM when compared with a reference range (P=0.013).
Conclusion:
VCTE is a noninvasive technology that is feasible in children with SCD. LSM values were elevated in older children but did not correlate with iron overload, suggesting that fibrosis may not be affected by iron overload alone. Though additional data are needed, LSM may be a useful test for the progression of liver disease in SCD regardless of iron burden.
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