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Validation of attenuation imaging coefficient, shear wave elastography, and dispersion as emerging tools for
Metin Cetiner1, Felix Schiepek1, Ilja Finkelberg1
1Children's Hospital, Pediatrics II, University of Essen, Essen, Germany.
Insights
This study establishes reference charts for novel ultrasound techniques (ATI, SWE, SWD) in children, aiding in the diagnosis of pediatric liver disease. These noninvasive methods are reliable and efficient for pediatric liver assessment.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Ultrasound Technology
Background:
- Rising incidence of pediatric liver disease necessitates improved diagnostic tools.
- Subtle liver changes in children can be challenging to detect with conventional methods.
- Emerging ultrasound technologies like attenuation imaging coefficient (ATI), shear wave elastography (SWE), and dispersion (SWD) offer quantitative tissue properties.
Purpose of the Study:
- To establish normative values and reference charts for ATI, SWE, and SWD in a pediatric population.
- To assess the feasibility and reliability of these advanced ultrasound techniques in children.
- To provide a foundation for the clinical implementation of these tools in diagnosing pediatric liver conditions.
Main Methods:
- Prospective monocentric study involving 112 children aged 0-17.92 years.
- Measurements of ATI, SWE, and SWD performed using an Aplio i800 ultrasound system.
- Percentile charts derived using the Lambda-Mu-Sigma (LMS) approach, accounting for age, sex, and BMI SDS.
Main Results:
- Normative data and reference charts were successfully generated for ATI, SWE, and SWD.
- ATI showed a correlation with age, SWD with BMI SDS, and SWE with abdominal wall thickness and sex.
- SWE demonstrated a correlation with SWD, while ATI did not correlate with SWE or SWD.
Conclusions:
- The study provides crucial reference data for ATI, SWE, and SWD in healthy children.
- These noninvasive ultrasound techniques are time-effective, reliable, and suitable for pediatric liver disease diagnostics.
- Implementation of these tools can enhance the diagnostic accuracy of liver ultrasound in pediatric patients.
Introduction:
The number of children with acute and chronic liver disease is rising. Moreover, liver involvement may be limited to subtle changes in organ texture especially in early childhood and some syndromic conditions, such as ciliopathies. Attenuation imaging coefficient (ATI), shear wave elastography (SWE), and dispersion (SWD) are emerging ultrasound technologies providing data about attenuation, elasticity, and viscosity of liver tissue. This additional and qualitative information has been correlated with certain liver pathologies. However, limited data are available for healthy controls and have mainly been raised in adults.
Methods:
This prospective monocentric study was conducted at a university hospital with a specialization in pediatric liver disease and transplantation. Between February and July 2021, 129 children aged 0-17.92 years were recruited. Study participants attended outpatient clinics due to minor illnesses excluding liver or cardiac diseases, acute (febrile) infections or other conditions affecting liver tissue and function. ATI, SWE, and SWD measurements were performed on an Aplio i800 (Canon Medical Systems) with an i8CX1 curved transducer by two different investigators with long-standing experience in pediatric ultrasound according to a standardized protocol.
Results:
Considering multiple potential covariates, we derived percentile charts for all 3 devices relying on the Lambda-Mu-Sigma (LMS) approach. 112 children were considered for further analysis, excluding those with abnormal liver function and under-/overweight (BMI SDS<-1.96/> 1.96, respectively). Age range was 0-17.92 years (mean 6.89±0.50SD), 58% were male. The mean duration of the ultrasound examination (basic ultrasound plus SWE, SWD, and ATI) was 6.67±0.22 minutes and it was well tolerated in 83% (n=92) of cases. While ATI was related to age, SWD was found to depend on BMI SDS, and SWE on abdominal wall thickness and sex. ATI correlated with neither SWE nor SWD, but SWE was correlated with SWD.
Conclusions:
Our study provides norm values and reference charts for ATI, SWE, and SWD considering important covariates including age, sex and, BMI. This may help to implement these promising tools into imaging diagnostics of liver disease and to improve the diagnostic relevance of liver ultrasound. In addition, these noninvasive techniques proved to be time-effective and highly reliable, which make them ideal for application in children.
