Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

Abstract

Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions.

Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions.

Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions.

Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

Zusammenfassung

Ziel Die Leber-Elastografie wird zunehmend zur Früherkennung und Verlaufskontrolle von pädiatrischen Lebererkrankungen eingesetzt und korreliert nachweislich gut mit dem Fibrose-Staging durch Leberbiopsie. Da bei der Untersuchung von Kindern der Zeitfaktor von entscheidender Bedeutung ist, wollten wir prüfen, ob mit weniger Messungen ein zuverlässiges Ergebnis erzielt werden kann.

Material und Methoden 243 gesunde Kinder im Alter von 4–17 Jahren wurden nach 3 Stunden Fasten untersucht. Die Teilnehmer wurden in 4 Altersgruppen eingeteilt: 4–7 Jahre, 8–11 Jahre, 12–14 Jahre und 15–17 Jahre. Sowohl die 2-dimensionale Scherwellen-Elastografie (2D-SWE; GE Logiq E9) als auch die Punktscherwellen-Elastografie (pSWE; Samsung RS80A mit Prestige) wurden bei allen Teilnehmern durchgeführt, während die transiente Elastografie (TE, Fibroscan) bei einer Untergruppe von 87 Kindern im Alter von 8–17 Jahren durchgeführt wurde. Mediane Werte der Lebersteifigkeitsmessung (LSM) von 3, 4, 5, 6, 7 und 8 Messungen wurden mit dem Median aus 10 Messungen (Referenzstandard) verglichen. Der Vergleich wurde sowohl für alle Teilnehmer zusammen als auch innerhalb jeder spezifischen Altersgruppe durchgeführt. Wir untersuchten sowohl den Intraklassen-Korrelationskoeffizienten (ICC) mit absoluter Übereinstimmung als auch alle Ausreißer, die mehr als 10 %, 20 % bzw. ≥ 0,5 oder 1,0 kPa vom Median aus 10 Messungen abwichen.

Ergebnisse Bei allen 3 Systemen gab es keinen signifikanten Unterschied zwischen 3 und 10 Messungen mit ICCs ≥ 0,97. Alle Systeme benötigten 4 Messungen, um zu erreichen, dass der LSN nicht ≥ 1,0kPa vom Median aus 10 Messungen abwich. Um eine Abweichung von ≥ 20 % vom Median aus 10 Messungen zu vermeiden, waren 4 pSWE- und TE-Messungen und 6 2D-SWE-Messungen erforderlich.

Schlussfolgerung Unsere Ergebnisse widersprechen den Empfehlungen, die 10 Messungen für pSWE und TE und nur 3 Messungen für 2D-SWE vorschlagen.

Key words

pediatrics - abdomen - gastrointestinal tract

Publication History

Received: 31 March 2020

Accepted: 25 August 2020

Article published online:
21 December 2020

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