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EVALUATION OF LIVER ELASTICITY USING pSWE AND 2D-SWE TECHNIQUES IN HEALTHY CHILDREN

Year 2023, Volume: 30 Issue: 1, 69 - 77, 14.03.2023

Hüseyin Aydın Fatma İssi

https://doi.org/10.17343/sdutfd.1252498

Abstract

Objective
Shear wave elastography (SWE) is a new
ultrasonography technique that can non-invasively
evaluate liver stiffness. The efficacy of SWE in adults
has been demonstrated by numerous studies, but
there are few SWE studies of pediatric groups. Since
the liver stiffness values (LSV) vary according to the
device and the SWE method used, standard reference
values have not been established as yet. The aim of
this study was to establish the reference values of
normal liver stiffness in healthy children according to
the two SWE methods.
Materials and Method
Liver stiffness values were measured using the two
different SWE methods of point SWE (pSWE) and
2-dimensional SWE (2D-SWE) in 107 healthy children
aged 8-18 years with no liver disease. The pSWE
(EPQ) and 2D-SWE (EQI) measurements were taken
in one session on the same device (Philips Epiq Elite)
and after at least 4 hours of fasting. The effects on
liver elasticity values were investigated of gender,
age, body mass index (BMI), some biochemical
markers (such as fasting blood glucose, aspartate
aminotransferase (AST), alanine aminotransferase
(ALT), albumin, platelet, INR) and liver size.
Results
The mean LSV was 4.04±0.84kPa ((95% confidence
interval (CI):3.67-4.42)) on pSWE and 4.41±0.71kPa
(95% CI:4.09-4.72) on 2D-SWE. The upper limit LSVs
were found to be 4.42kPa and 4.72kPa, respectively.
The LSVs measured on 2D-SWE were found to be
higher than on pSWE ((median; min-max, 4.34kPa;
2.82-6kPa and 3.86kPa; 2.55–5.78, respectively,
(r=0.59, p<0.001)). A low-level significant positive
correlation was determined between LSV and age
(r=0.267; p=0.006). No significant association was
determined between LSV and hepatic size, gender,
BMI and biochemical markers.
Conclusion
In healthy children aged 8-18 years, the mean liver
stiffness reference values obtained on the Philips Epiq
Elite ultrasound device were 4.04±0.84kPa using the
pSWE method and 4.41±0.71kPa using the 2D-SWE
method.These reference values will help the SWE
method to be used more effectively in the evaluation
of liver parenchyma in chronic liver diseases.

Keywords

Children liver stiffness ultrasound shear wave elastography two-dimensional shear wave imaging

Supporting Institution

None

References

  • 1. Selmi B, Engelmann G, Teufel U, El Sakka S, Dadrich M, Schenk J-P. Normal values of liver elasticity measured by real-time tissue elastography (RTE) in healthy infants and children. J Med Ultrason. 2014;41(1):31–8.
  • 2. Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41(5):1126–47.
  • 3. Sharma S, Khalili K, Nguyen GC. Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol WJG. 2014;20(45):16820.
  • 4. Zhou H, Zhou Y, Ding J, Chen Y, Wen J, Zhao L, et al. Clinical evaluation of grayscale and linear scale hepatorenal indices for fatty liver quantification: a prospective study of a native Chinese population. Abdom Radiol. 2022;47(4):1321–32.
  • 5. Ferraioli G, Wong VW-S, Castera L, Berzigotti A, Sporea I, Dietrich CF, et al. Liver ultrasound elastography: an update to the world federation for ultrasound in medicine and bi- ology guidelines and recommendations. Ultrasound Med Biol. 2018;44(12):2419–40.
  • 6. Belei O, Sporea I, Gradinaru-Tascau O, Olariu L, Popescu A, Simedrea I, et al. Comparison of three ultrasound based elastographic techniques in children and adolescents with chronic diffuse liver diseases. Med Ultrason. 2016;18(2):145–50.
  • 7. Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C, et al. Accuracy of real‐time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology. 2012;56(6):2125–33.
  • 8. Tutar O, Beser ÖF, Adaletli I, Tunc N, Gulcu D, Kantarci F, et al. Shear wave elastography in the evaluation of liver fibrosis in children. J Pediatr Gastroenterol Nutr. 2014;58(6):750–5.
  • 9. Altay C, Seçil M. Sonoelastografinin Temel İlkeleri. 2019;
  • 10. Tran LC, Ley D, Bourdon G, Coopman S, Lerisson H, Tillaux C, et al. Noninvasive Pediatric Liver Fibrosis Measurement: Two-Dimensional Shear Wave Elastography Compared With Transient Elastography. Front Pediatr. 2022;10.
  • 11. Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A. Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr. 2013;56(1):72–6.
  • 12. Xie L-T, Yan C-H, Zhao Q-Y, He M-N, Jiang T-A. Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography. World J Gastroenterol. 2018;24(9):957.
  • 13. Shin HJ, Kim M-J, Kim HY, Roh YH, Lee M-J. Optimal acquisition number for hepatic shear wave velocity measurements in children. PLoS One. 2016;11(12):e0168758.
  • 14. Franchi-Abella S, Corno L, Gonzales E, Antoni G, Fabre M, Ducot B, et al. Feasibility and diagnostic accuracy of supersonic shear-wave elastography for the assessment of liver stiffness and liver fibrosis in children: a pilot study of 96 patients. Radiology. 2016;278(2):554–62.
  • 15. Galina P, Alexopoulou E, Zellos A, Grigoraki V, Siahanidou T, Kelekis NL, et al. Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children. Pediatr Radiol. 2019;49(1):91–8.
  • 16. Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, et al. Elastography assessment of liver fibrosis: society of radiologists in ultrasound consensus conference statement. Ultrasound Q. 2016;32(2):94–107.
  • 17. Fang C, Jaffer OS, Yusuf GT, Konstantatou E, Quinlan DJ, Agarwal K, et al. Reducing the number of measurements in liver point shear-wave elastography: factors that influence the number and reliability of measurements in assessment of liver fibrosis in clinical practice. Radiology. 2018;287(3):844–52.
  • 18. Jung C, Groth M, Petersen KU, Hammel A, Brinkert F, Grabhorn E, et al. Hepatic shear wave elastography in children under free-breathing and breath-hold conditions. Eur Radiol. 2017;27(12):5337–43.
  • 19. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall der Medizin-European J Ultrasound. 2017;38(04):e16–47.
  • 20. Mărginean CO, Meliţ LE, Ghiga DV, Săsăran MO. Reference values of normal liver stiffness in healthy children by two methods: 2D shear wave and transient elastography. Sci Rep. 2020;10(1):1–10.
  • 21. Mjelle AB, Mulabecirovic A, Havre RF, Rosendahl K, Juliusson PB, Olafsdottir E, et al. Normal liver stiffness values in children: a comparison of three different elastography methods. J Pediatr Gastroenterol Nutr. 2019;68(5):706.
  • 22. Mulabecirovic A, Mjelle AB, Gilja OH, Vesterhus M, Havre RF. Liver elasticity in healthy individuals by two novel shear-wave elastography systems—Comparison by age, gender, BMI and number of measurements. PLoS One. 2018;13(9):e0203486.
  • 23. Tokuhara D, Cho Y, Shintaku H. Transient elastography-based liver stiffness age-dependently increases in children. PLoS One. 2016;11(11):e0166683.
  • 24. Lewindon PJ, Balouch F, Pereira TN, Puertolas‐Lopez M V, Noble C, Wixey JA, et al. Transient liver elastography in unsedated control children: Impact of age and intercurrent illness. J Paediatr Child Health. 2016;52(6):637–42.
  • 25. Engelmann G, Gebhardt C, Wenning D, Wühl E, Hoffmann GF, Selmi B, et al. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr. 2012;171:353– 60.
  • 26. Huang Z, Zheng J, Zeng J, Wang X, Wu T, Zheng R. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. Ultrasound Med Biol. 2014;40(11):2549–55.
  • 27. Fang C, Sidhu PS. Ultrasound-based liver elastography: current results and future perspectives. Abdom Radiol. 2020;45:3463– 72.
  • 28. Sirli R, Sporea I, Tudora A, Deleanu A, Popescu A. Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness. J Gastrointestin Liver Dis. 2009;18(1):57–60.
  • 29. Corpechot C, Naggar EA, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex? Hepatology. 2006;44(2):513–4.
  • 30. Goldschmidt I, Streckenbach C, Dingemann C, Pfister ED, di Nanni A, Zapf A, et al. Application and limitations of transient liver elastography in children. J Pediatr Gastroenterol Nutr. 2013;57(1):109–13.
  • 31. Son CY, Kim SU, Han WK, Choi GH, Park H, Yang SC, et al. Normal liver elasticity values using acoustic radiation force impulse imaging: a prospective study in healthy living liver and kidney donors. J Gastroenterol Hepatol. 2012;27(1):130–6.
  • 32. Horster S, Mandel P, Zachoval R, Clevert DA. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin Hemorheol Microcirc. 2010;46(2–3):159–68.
  • 33. Madhok R, Tapasvi C, Prasad U, Gupta AK, Aggarwal A. Acoustic radiation force impulse imaging of the liver: measurement of the normal mean values of the shearing wave velocity in a healthy liver. J Clin diagnostic Res JCDR. 2013;7(1):39.
  • 34. Bailey SS, Youssfi M, Patel M, Hu HH, Shaibi GQ, Towbin RB. Shear-wave ultrasound elastography of the liver in normal-weight and obese children.Acta radiol.2017;58(12):1511–8.

SAĞLIKLI ÇOCUKLARDA KARACİĞER ELASTİKİYETİNİN pSWE VE 2D-SWE TEKNİKLERİ İLE DEĞERLENDİRİLMESİ

Year 2023, Volume: 30 Issue: 1, 69 - 77, 14.03.2023

Hüseyin Aydın Fatma İssi

https://doi.org/10.17343/sdutfd.1252498

Abstract

Amaç
Share wave elastografi (SWE), karaciğer sertliğini
non-invaziv olarak değerlendirebilen yeni bir ultrasonografi
tekniğidir. Yetişkinlerde SWE'nin etkinliği çok
sayıda çalışmayla gösterilmiştir, ancak pediatrik gruplarda
çok az SWE çalışması vardır. Karaciğer sertliği
değerleri (KSD), cihaza ve kullanılan SWE yöntemine
göre değişiklik gösterdiğinden, standart referans değerleri
henüz oluşturulmamıştır. Bu çalışmanın amacı,
iki farklı SWE yöntemine göre, sağlıklı çocuklarda
normal karaciğerin referans sertlik değerlerini belirlemekti.
Gereç ve Yöntem
Karaciğer sertliği değerleri, 8-18 yaş arası 107 sağlıklı
çocukta, iki farklı SWE yöntemi olan point SWE
(pSWE) ve 2-dimentional SWE (2D-SWE) ile ölçüldü.
pSWE (EPQ) ve 2D-SWE (EQI) ölçümleri aynı cihaz
(Philips Epiq Elite) ile, tek seansta ve en az 4 saat
aç kaldıktan sonra alındı. Cinsiyet, yaş, vücut kitle indeksi
(VKİ), bazı biyokimyasal belirteçler ((açlık kan
şekeri, aspartat aminotransferaz (AST), alanin aminotransferaz
(ALT), albümin, trombosit, INR gibi)) ve
karaciğer boyutunun, KSD’ye etkisi araştırıldı.
Bulgular
Ortalama KSD, pSWE ile 4,04±0,84kPa ((%95 güven
aralığı (CI):3,67-4,42)) ve 2D-SWE ile 4,41±0,71kPa
(%95 CI:4,09-4,72) bulundu. Üst sınır KSD'ler sırasıyla
4,42kPa ve 4,72kPa idi. 2D-SWE'de ölçülen
KSD'ler, pSWE'den daha yüksekti ((sırasıyla medyan;
min-maks, 4,34kPa; 2,82-6kPa ve 3,86kPa; 2,55–
5,78, (r=0,59, p<0,001)). KSD ile yaş arasında düşük
düzeyde anlamlı pozitif korelasyon saptandı (r=0,267;
p=0,006). Fakat karaciğer büyüklüğü, cinsiyet, VKİ ve
biyokimyasal belirteçler ile KDS arasında anlamlı ilişki
saptanmadı.
Sonuç
8-18 yaş arası sağlıklı çocuklarda ortalama karaciğer
sertliği referans değerleri, Philips Epiq Elite ultrason
cihazı ile yapılan ölçümlerde, pSWE yöntemi ile
4,04±0,84kPa ve 2D-SWE yöntemi ile 4,41±0,71kPa
olarak bulundu. Bu referans değerleri, kronik karaciğer
hastalıklarında karaciğer parankiminin değerlendirilmesinde
SWE yönteminin daha etkin kullanılmasına
yardımcı olacaktır.

Keywords

Çocuk karaciğer sertliği ultrason shear wave elastografi iki boyutlu-shear wave elastografi.

References

  • 1. Selmi B, Engelmann G, Teufel U, El Sakka S, Dadrich M, Schenk J-P. Normal values of liver elasticity measured by real-time tissue elastography (RTE) in healthy infants and children. J Med Ultrason. 2014;41(1):31–8.
  • 2. Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41(5):1126–47.
  • 3. Sharma S, Khalili K, Nguyen GC. Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol WJG. 2014;20(45):16820.
  • 4. Zhou H, Zhou Y, Ding J, Chen Y, Wen J, Zhao L, et al. Clinical evaluation of grayscale and linear scale hepatorenal indices for fatty liver quantification: a prospective study of a native Chinese population. Abdom Radiol. 2022;47(4):1321–32.
  • 5. Ferraioli G, Wong VW-S, Castera L, Berzigotti A, Sporea I, Dietrich CF, et al. Liver ultrasound elastography: an update to the world federation for ultrasound in medicine and bi- ology guidelines and recommendations. Ultrasound Med Biol. 2018;44(12):2419–40.
  • 6. Belei O, Sporea I, Gradinaru-Tascau O, Olariu L, Popescu A, Simedrea I, et al. Comparison of three ultrasound based elastographic techniques in children and adolescents with chronic diffuse liver diseases. Med Ultrason. 2016;18(2):145–50.
  • 7. Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C, et al. Accuracy of real‐time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology. 2012;56(6):2125–33.
  • 8. Tutar O, Beser ÖF, Adaletli I, Tunc N, Gulcu D, Kantarci F, et al. Shear wave elastography in the evaluation of liver fibrosis in children. J Pediatr Gastroenterol Nutr. 2014;58(6):750–5.
  • 9. Altay C, Seçil M. Sonoelastografinin Temel İlkeleri. 2019;
  • 10. Tran LC, Ley D, Bourdon G, Coopman S, Lerisson H, Tillaux C, et al. Noninvasive Pediatric Liver Fibrosis Measurement: Two-Dimensional Shear Wave Elastography Compared With Transient Elastography. Front Pediatr. 2022;10.
  • 11. Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A. Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr. 2013;56(1):72–6.
  • 12. Xie L-T, Yan C-H, Zhao Q-Y, He M-N, Jiang T-A. Quantitative and noninvasive assessment of chronic liver diseases using two-dimensional shear wave elastography. World J Gastroenterol. 2018;24(9):957.
  • 13. Shin HJ, Kim M-J, Kim HY, Roh YH, Lee M-J. Optimal acquisition number for hepatic shear wave velocity measurements in children. PLoS One. 2016;11(12):e0168758.
  • 14. Franchi-Abella S, Corno L, Gonzales E, Antoni G, Fabre M, Ducot B, et al. Feasibility and diagnostic accuracy of supersonic shear-wave elastography for the assessment of liver stiffness and liver fibrosis in children: a pilot study of 96 patients. Radiology. 2016;278(2):554–62.
  • 15. Galina P, Alexopoulou E, Zellos A, Grigoraki V, Siahanidou T, Kelekis NL, et al. Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children. Pediatr Radiol. 2019;49(1):91–8.
  • 16. Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, et al. Elastography assessment of liver fibrosis: society of radiologists in ultrasound consensus conference statement. Ultrasound Q. 2016;32(2):94–107.
  • 17. Fang C, Jaffer OS, Yusuf GT, Konstantatou E, Quinlan DJ, Agarwal K, et al. Reducing the number of measurements in liver point shear-wave elastography: factors that influence the number and reliability of measurements in assessment of liver fibrosis in clinical practice. Radiology. 2018;287(3):844–52.
  • 18. Jung C, Groth M, Petersen KU, Hammel A, Brinkert F, Grabhorn E, et al. Hepatic shear wave elastography in children under free-breathing and breath-hold conditions. Eur Radiol. 2017;27(12):5337–43.
  • 19. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall der Medizin-European J Ultrasound. 2017;38(04):e16–47.
  • 20. Mărginean CO, Meliţ LE, Ghiga DV, Săsăran MO. Reference values of normal liver stiffness in healthy children by two methods: 2D shear wave and transient elastography. Sci Rep. 2020;10(1):1–10.
  • 21. Mjelle AB, Mulabecirovic A, Havre RF, Rosendahl K, Juliusson PB, Olafsdottir E, et al. Normal liver stiffness values in children: a comparison of three different elastography methods. J Pediatr Gastroenterol Nutr. 2019;68(5):706.
  • 22. Mulabecirovic A, Mjelle AB, Gilja OH, Vesterhus M, Havre RF. Liver elasticity in healthy individuals by two novel shear-wave elastography systems—Comparison by age, gender, BMI and number of measurements. PLoS One. 2018;13(9):e0203486.
  • 23. Tokuhara D, Cho Y, Shintaku H. Transient elastography-based liver stiffness age-dependently increases in children. PLoS One. 2016;11(11):e0166683.
  • 24. Lewindon PJ, Balouch F, Pereira TN, Puertolas‐Lopez M V, Noble C, Wixey JA, et al. Transient liver elastography in unsedated control children: Impact of age and intercurrent illness. J Paediatr Child Health. 2016;52(6):637–42.
  • 25. Engelmann G, Gebhardt C, Wenning D, Wühl E, Hoffmann GF, Selmi B, et al. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr. 2012;171:353– 60.
  • 26. Huang Z, Zheng J, Zeng J, Wang X, Wu T, Zheng R. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. Ultrasound Med Biol. 2014;40(11):2549–55.
  • 27. Fang C, Sidhu PS. Ultrasound-based liver elastography: current results and future perspectives. Abdom Radiol. 2020;45:3463– 72.
  • 28. Sirli R, Sporea I, Tudora A, Deleanu A, Popescu A. Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness. J Gastrointestin Liver Dis. 2009;18(1):57–60.
  • 29. Corpechot C, Naggar EA, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex? Hepatology. 2006;44(2):513–4.
  • 30. Goldschmidt I, Streckenbach C, Dingemann C, Pfister ED, di Nanni A, Zapf A, et al. Application and limitations of transient liver elastography in children. J Pediatr Gastroenterol Nutr. 2013;57(1):109–13.
  • 31. Son CY, Kim SU, Han WK, Choi GH, Park H, Yang SC, et al. Normal liver elasticity values using acoustic radiation force impulse imaging: a prospective study in healthy living liver and kidney donors. J Gastroenterol Hepatol. 2012;27(1):130–6.
  • 32. Horster S, Mandel P, Zachoval R, Clevert DA. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin Hemorheol Microcirc. 2010;46(2–3):159–68.
  • 33. Madhok R, Tapasvi C, Prasad U, Gupta AK, Aggarwal A. Acoustic radiation force impulse imaging of the liver: measurement of the normal mean values of the shearing wave velocity in a healthy liver. J Clin diagnostic Res JCDR. 2013;7(1):39.
  • 34. Bailey SS, Youssfi M, Patel M, Hu HH, Shaibi GQ, Towbin RB. Shear-wave ultrasound elastography of the liver in normal-weight and obese children.Acta radiol.2017;58(12):1511–8.
There are 34 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Araştırma Makaleleri
Authors

Hüseyin Aydın 0000-0003-4704-4759

Fatma İssi 0000-0002-3182-1990

Publication Date March 14, 2023
Submission Date February 17, 2023
Acceptance Date February 27, 2023
Published in Issue Year 2023 Volume: 30 Issue: 1

Cite

Vancouver Aydın H, İssi F. EVALUATION OF LIVER ELASTICITY USING pSWE AND 2D-SWE TECHNIQUES IN HEALTHY CHILDREN. Med J SDU. 2023;30(1):69-77.
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