Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3463-3473
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3463
Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology
Pei-Xuan Sun, Yu-Yang Tong, Jing Shi, Huan Zhang, Shi-Jian Liu, Jun Du
Pei-Xuan Sun, Jing Shi, Huan Zhang, Jun Du, Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Yu-Yang Tong, Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
Shi-Jian Liu, Department of Clinical Epidemiology and Biostatistics, Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Author contributions: All authors helped to perform the study; Sun PX and Tong YY contributed equally to the manuscript; Sun PX, Tong YY, and Du J contributed to the study conception and design; Sun PX, Shi J, and Zhang H contributed to performing the procedures and collecting the data; Liu SJ participated in the protocol design and statistical analysis; all authors approved the final version of the manuscript.
Supported by Science and Technology Foundation of Pudong New District, No. PKJ2015-Y05); Medical and Industrial Interdisciplinary Fund of Shanghai Jiao Tong University, No. YG2016MS30; General Program of Shanghai Health and Family Planning Commission, No. 201740095; Guiding Project of Shanghai Science and Technology Commission, No. 19411965400.
Institutional review board statement: The study was approved by the institutional ethics committee of Shanghai Children’s Medical Center.
Clinical trial registration statement: This study is registered at https://register.clinicaltrials.gov/. The registration identification number is NCT03645655.
Informed consent statement: Parental informed consent was obtained in all cases.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Du, MD, Associate Professor, Director, Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, No. 1678, Dongfang Road, Pudong District, Shanghai 200127, China. scmcdujun@163.com
Telephone: +86-18930830855 Fax: +86-21-38626161
Received: June 15, 2019
Peer-review started: June 18, 2019
First decision: August 1, 2019
Revised: September 25, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 6, 2019
ARTICLE HIGHLIGHTS
Research background

Non-invasive assessment of liver stiffness in children with chronic liver disease plays a critical role in clinical evaluation of liver fibrosis. Virtual touch imaging quantification (VTIQ) based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.

Research motivation

Given the diversity of children in all aspects, a normal range of liver stiffness measurements must be established in children to differentiate the normal liver from abnormalities.

Research objectives

To determine the standard shear wave velocity (SWV) values in healthy children, and to identify possible factors that might influence the VTIQ measurement.

Research methods

We conducted a prospective study. After exclusion, a total of 202 children between 1 mo and 15 years old were included in this study. None of them had any liver or systematic diseases. All children had a normal ultrasound scan and normal body mass index (BMI) range. The subjects were divided into four age and BMI groups. The effects of gender, age, liver lobe, measurement depth, and BMI on liver elasticity were investigated.

Research results

A significant correlation was found between age and SWV values. At measurement depths of 1.5 cm and 2.0 cm in the left lobe, there were significant differences among the four age groups. Negative correlations were found between the measurement depth and SWV values. Gender, liver lobe, and BMI showed no significant effect on the SWV values. Age and BMI may influence the quality of the elastogram.

Research conclusions

As a recently developed noninvasive technique, VTIQ is feasible for physicians to measure liver stiffness in children. Lower SWV values are expected in younger children, and at a deeper measurement depth. Liver elasticity is not affected by gender, BMI, and the location of measurement. Therefore, when available, the VTIQ measurement at deep regions in the right lobe of the liver is preferably suggested.

Research perspectives

The results of this study provide a range of normal reference values for measuring the liver elasticity in normal children. In the future, more subjects should be incorporated to further confirm the results of this study, and the consistency between observers needs to be evaluated so that VTIQ technology can be better applied to clinical practice. More importantly, with the reliable normal reference value, this noninvasive method can widely be used to detect and evaluate liver fibrosis in children.