Ultrasound elastography in pediatric care: bridging innovation and noninvasive diagnostics

This review explores the application and limitations of ultrasound elastography (USE) in the pediatric population, addressing its diagnostic value across different organs and suggesting future directions for research and clinical practice. A literature review was conducted using PubMed to identify studies published between 2010 and 2025 that examined USE applications in children. The search focused on studies assessing the liver, kidney, bowel, pancreas, muscle, connective tissue, and lung. The review highlights the established clinical application of USE in the assessment of liver fibrosis. It also provides an overview of new potential applications in kidney diseases, inflammatory bowel disease, cystic fibrosis, and muscle disorders. Two-dimensional shear wave elastography (2D-SWE) demonstrates excellent diagnostic accuracy in liver disease. However, in kidney applications, variability in results and the lack of standardized protocols limit clinical utility. SWE has shown promise in in the early detection of pancreatic insufficiency and muscle stiffness in cerebral palsy. Emerging applications include monitoring lung fibrosis and assessing fetal lung development. Despite its advantages-being noninvasive, repeatable, and well tolerated-USE remains limited by operator dependency, lack of standardization, and poor reproducibility in specific organs remain a major challenge. USE demonstrates significant potential for noninvasive diagnostics in pediatric care, especially in reducing invasive procedures and improving patient follow-up. However, further studies are needed to establish standardized protocols, reliable cut-off values, and broader applications across different organ systems. Integration of USE with other imaging modalities and utilizing advancements in artificial intelligence may enhance its diagnostic yield.