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Real-time tissue elastography (RTE) for noninvasive evaluation of fibrosis in liver diseases in children in comparison to liver biopsy

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Abstract

Purpose

To determine the value of real-time tissue elastography (RTE) in pediatric liver diseases in comparison to liver biopsy.

Methods

RTE was performed on 34 patients (♀, n = 17; ♂, n = 17; range 0–21 years) with various acute and chronic liver diseases: autoimmune hepatitis (n = 5), liver transplantation (n = 5), Wilson’s disease (n = 4), hepatopathy of unknown origin (n = 4), unclear cholestatic hepatitis (n = 2), thalassemia major (n = 2), glycogenosis (n = 2), hereditary fructose intolerance (n = 1), alpha-1-antitrypsin deficiency (n = 1), diabetes mellitus type 1 (n = 1), chronic intestinal pseudo-obstruction (n = 1), primary sclerosing cholangitis (n = 1), hepatitis B (n = 1), cirrhosis of unknown origin (n = 1), drug-induced hepatopathy (n = 1), unexplained transaminase elevation (n = 1), and nonalcoholic steatohepatitis (n = 1). Included children were biopsied. RTE was performed on a control group (n = 30; ♀, n = 15; ♂, n = 15). The mean value of strain (MEAN) in arbitrary units and the ratio of blue color-coded harder tissue (AREA) were calculated based on an elasticity histogram of the selected region of interest in liver parenchyma. They were compared with the histologically defined grade of liver fibrosis.

Results

In comparison to the scoring systems, a moderate correlation was observed for MEAN and AREA by excluding the F0 patients [MEAN r = −0.575 to −0.645, AREA r = 0.545–0.607 (p < 0.05)]. Differentiation of the control group and low-grade fibrosis (F1) from high-grade fibrosis (F2–4) was significantly possible (p values <0.001 at 5 % significance level).

Conclusion

RTE parameters enable a possible differentiation of high fibrosis; however, their correlation with fibrosis stage was moderate. RTE seems to be a promising method in liver fibrosis grading in children.

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Acknowledgments

This study was generously funded by the Dietmar Hopp Stiftung. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Jens-Peter Schenk, Buket Selmi, Christa Flechtenmacher, Saroa El Sakka, Ulrike Teufel, and Guido Engelmann declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg INF 430, 69120, Heidelberg, Germany

    Jens-Peter Schenk, Buket Selmi & Saroa El Sakka

  2. Institute of Pathology, University Hospital of Heidelberg, Heidelberg, Germany

    Christa Flechtenmacher

  3. Department of General Pediatrics, University Hospital of Heidelberg, Heidelberg, Germany

    Ulrike Teufel & Guido Engelmann

Authors
  1. Jens-Peter Schenk
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  2. Buket Selmi
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  3. Christa Flechtenmacher
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  4. Saroa El Sakka
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  5. Ulrike Teufel
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  6. Guido Engelmann
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Corresponding author

Correspondence to Buket Selmi.

Additional information

Schenk JP and Selmi B have equally contributed to the study.

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Schenk, JP., Selmi, B., Flechtenmacher, C. et al. Real-time tissue elastography (RTE) for noninvasive evaluation of fibrosis in liver diseases in children in comparison to liver biopsy. J Med Ultrasonics 41, 455–462 (2014). https://doi.org/10.1007/s10396-014-0542-z

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  • DOI: https://doi.org/10.1007/s10396-014-0542-z

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