Diagnostic performance and reproducibility of shear wave elastography techniques for liver stiffness assessment in
Manli Fu1, Chao Geng1,2, Liqiong Shi1
1Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
Insights
Shear wave elastography (SWE) reliably assesses liver stiffness in infants with biliary atresia post-Kasai portoenterostomy (KPE). However, technique variations necessitate standardized protocols for accurate, interchangeable use.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Medical Imaging
Background:
- Biliary atresia leads to progressive liver fibrosis in infants.
- Non-invasive liver monitoring is crucial after Kasai portoenterostomy (KPE).
- Shear wave elastography (SWE) presents a promising, non-invasive alternative to liver biopsy.
Purpose of the Study:
- To evaluate the diagnostic performance of three SWE modalities: point-SWE (p-SWE), 2D-SWE, and supersonic-SWE.
- To assess the reproducibility and inter-technique consistency of these SWE methods in children with biliary atresia post-KPE.
- To compare the effectiveness of different SWE techniques in measuring liver stiffness.
Main Methods:
- Prospective study involving 76 children (47 biliary atresia post-KPE, 29 healthy controls).
- Liver stiffness was measured using p-SWE, 2D-SWE, and supersonic-SWE.
- Statistical analysis included Mann-Whitney U test, Friedman test, ICCs, Spearman correlation, and generalized linear model.
Main Results:
- Biliary atresia patients exhibited significantly higher liver stiffness than controls across all SWE techniques (P < 0.001).
- Supersonic-SWE showed higher stiffness values and better reproducibility (ICC: 0.90) compared to p-SWE and 2D-SWE.
- Left lobe anteroposterior diameter was an independent predictor of liver stiffness (P < 0.001).
Conclusions:
- SWE is a reliable tool for assessing liver stiffness in pediatric biliary atresia patients.
- Significant inter-technique and inter-vendor discrepancies exist, indicating a need for standardized protocols.
- Current SWE techniques should not be used interchangeably without standardization.
Background:
Biliary atresia casuses progressive liver fibrosis in infants. After Kasai portoenterostomy (KPE), non-invasive liver monitoring is essential. Shear wave elastography (SWE) offers a promising alternative to biopsy.
Objectives:
To evaluate the diagnostic performance, reproducibility, and inter-technique consistency of three shear wave elastography (SWE) modalities-point-SWE (p-SWE), two-dimensional SWE (2D-SWE), and supersonic shear imaging (supersonic-SWE)-in children with biliary atresia post-KPE.
Materials And Methods:
This prospective study (March 2024-November 2024) recruited 76 children: 47 biliary atresia patients (mean age, 5.7 ± 3.3 years; 24 girls) post-KPE and 29 healthy controls (mean age, 6.9 ± 3.2 years; 12 girls). Liver stiffness values were obtained using three SWE techniques. Statistical methods included the Mann-Whitney U test, Friedman test, intraclass correlation coefficients (ICCs), Spearman correlation, and generalized liner model analysis.
Results:
Biliary atresia group showed significantly higher liver stiffness values than controls across all techniques (supersonic-SWE: 8.20 vs. 5.20 kPa, p-SWE: 6.60 vs. 3.50 kPa, 2D-SWE: 4.90 vs. 2.90 kPa; all P< 0.001). Supersonic-SWE yielded higher liver stiffness values than p-SWE and 2D-SWE (P< 0.05). Strong correlations were observed. Reproducibility was good to excellent (ICCs: 0.74 to 0.90), with supersonic-SWE demonstrating the highest ICC. Anteroposterior diameter of the left lobe was an independent predictor significantly associated with liver stiffness values (P< 0.001). Supersonic-SWE required longer measurement time than other techniques (P< 0.001).
Conclusion:
SWE is a reliable tool for liver stiffness assessment in biliary atresia patients, however, inter-technique and inter-vendor discrepancies highlight the need for standardized protocol and techniques should not be used interchangeably.
