European Radiology

, Volume 27, Issue 12, pp 5337–5343 | Cite as

Hepatic shear wave elastography in children under free-breathing and breath-hold conditions

  • Caroline Jung
  • Michael Groth
  • Kay Uwe Petersen
  • Anna Hammel
  • Florian Brinkert
  • Enke Grabhorn
  • Sören Alexander Weidemann
  • Jasmin Busch
  • Gerhard Adam
  • Jochen Herrmann



To compare hepatic 2D shear wave elastography (2D SWE) in children between free-breathing and breath-hold conditions, in terms of measurement agreement and time expenditure.


A cohort of 57 children (12.7±4.3 years) who underwent standardized 2D SWE between May and October 2015 were retrospectively evaluated. Liver elastograms were obtained under free-breathing and breath-hold conditions and time expenditure was measured. Median stiffness, interquartile range (IQR), and IQR/median ratio were calculated based on 12, six, and three elastograms. Results were compared using Pearson correlation coefficient, intraclass correlation coefficient (ICC), Bland-Altman analysis, and Student’s t.


Median liver stiffness under free-breathing and breath-hold conditions correlated strongly (7.22±4.5kPa vs. 7.21±4.11kPa; r=0.97, P<0.001). Time to acquire 12 elastograms with free-breathing was lower than that with breath-holding (79.3±32.5sec vs. 143.7±51.8sec, P<0.001). Results for median liver stiffness based of 12, six, and three elastograms demonstrated very high agreement for free-breathing (ICC 0.993) and for breath-hold conditions (ICC 0.994).


Hepatic 2D SWE performed with free-breathing yields results similar to the breath-hold condition. With a substantially lower time requirement, which can be further reduced by lowering the number of elastograms, the free-breathing technique may be suitable for infants and less cooperative children not capable of breath-holding.

Key Points

Hepatic 2D SWE performed with free-breathing yields results similar to breath-hold condition.

• Benefit of the free-breathing approach is the substantially lower time requirement.

• Lowering the number of elastograms can further reduce time expenditure.

• Free-breathing 2D SWE is suitable in children with suspected liver disease.


Liver elastography Ultrasound Shear wave Free-breathing Children 



Two dimensional shear wave elastography


Intraclass correlation coefficient


Interquartile range


Standard deviation


Magnetic resonance imaging


Region of interest


Transient elastography


Compliance with ethical standards


The scientific guarantor of this publication is PD Dr. med Jochen Herrmann.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, that have products or services may be related to the subject matter of the article.


The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.


• retrospective

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Caroline Jung
    • 1
  • Michael Groth
    • 2
  • Kay Uwe Petersen
    • 3
  • Anna Hammel
    • 1
  • Florian Brinkert
    • 4
  • Enke Grabhorn
    • 4
  • Sören Alexander Weidemann
    • 5
  • Jasmin Busch
    • 2
  • Gerhard Adam
    • 1
  • Jochen Herrmann
    • 2
  1. 1.Department of Diagnostic and Interventional Radiology and Nuclear MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Section of Pediatric Radiology, Department of Diagnostic and Interventional Radiology and Nuclear MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Section for Addiction Research and TherapyUniversity Department for Psychiatry and PsychotherapyTübingenGermany
  4. 4.Department of Pediatric GastroenterologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  5. 5.Institute of Pathology, University Medical Center Hamburg-EppendorfHamburgGermany

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