|
1
|
Debnath P, Morin CE, Bonn J, Thapaliya S, Smith CA, Dillman JR, Trout AT. Effect of maneuvers, diuresis, and fluid administration on ultrasound-measured liver stiffness after Fontan. Hepatol Commun 2024; 8:e0527. [PMID: 39292183 PMCID: PMC11412719 DOI: 10.1097/hc9.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/18/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND To determine the effect of stress maneuvers/interventions on ultrasound liver stiffness measurements (LSMs) in patients with Fontan circulation and healthy controls. METHODS In this prospective, IRB-approved study of 10 patients after Fontan palliation and 10 healthy controls, ultrasound 2D shear-wave elastography LSMs were acquired at baseline and after maximum inspiration, expiration, standing, handgrip, aerobic exercise, i.v. fluid (500 mL normal saline) administration, and i.v. furosemide (20 mg) administration. Absolute and percent change in LSM were compared between baseline and each maneuver, and then from fluid infusion to after diuresis. RESULTS Median ages were 25.5 and 26 years in the post-Fontan and control groups (p = 0.796). LSMs after Fontan were higher at baseline (2.6 vs. 1.3 m/s) and with all maneuvers compared to controls (all p < 0.001). Changes in LSM with maneuvers, exercise, fluid, or diuresis were not significant when compared to baseline in post-Fontan patients. LSM in controls increased with inspiration (+0.02 m/s, 1.6%, p = 0.03), standing (+0.07 m/s, 5.5%, p = 0.03), and fluid administration (+0.10 m/s, 7.8%, p = 0.002), and decreased 60 minutes after diuretic administration (-0.05 m/s, -3.9%, p = 0.01) compared to baseline. LSM after diuretic administration significantly decreased when compared to after i.v. fluid administration at 30 minutes (-0.79 m/s, -26.5%, p = 0.004) and 60 minutes (-0.78 m/s, -26.2%, p = 0.017) for patients after Fontan and controls at 15 minutes (-0.12 m/s, -8.70%, p = 0.002), 30 minutes (-0.15 m/s, -10.9%, p = 0.003), and 60 minutes (-0.1 m/s, -10.9%, p = 0.005). CONCLUSIONS LSM after Fontan is higher with more variability compared to controls. Diuresis is associated with significantly decreased liver stiffness in both patients after Fontan and controls, with the suggestion of a greater effect in Fontan patients.
Collapse
Affiliation(s)
- Pradipta Debnath
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julie Bonn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Samjhana Thapaliya
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Clayton A. Smith
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Cardiology, Cincinnati Children’s Hospital Heart Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R. Dillman
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
|
2
|
Ahmad MF, Solanki S, Kanojia RP, Bhatia A, Lal SB, Saxena AK, Gupta K. Evaluation of Hepatic Shear Wave Elastography to Assess Liver Fibrosis in Biliary Atresia Patients and Its Correlation with Liver Histology and Surgical Outcomes: A Prospective Observational Study. Indian J Radiol Imaging 2024; 34:646-652. [PMID: 39318570 PMCID: PMC11419772 DOI: 10.1055/s-0044-1787668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
Introduction The native liver survival in biliary atresia (BA) depends on various factors, and one of the crucial factors is the rate of progression of liver fibrosis after portoenterostomy, but there is no reliable investigation to assess it. This study evaluated shear wave elastography (SWE) to detect liver fibrosis in BA patients and assess its utility during follow-up. Materials and Methods This was an observational study; SWE was done preoperatively and postoperatively at 3 and 6 months. The SWE values were analyzed to determine their correlations with preoperative liver histology as well as with postoperative SWE variation between different postoperative outcomes. Results Twenty-one patients were included in the study; the preoperative SWE values were strongly correlated with liver biopsy grading ( p < 0.001). At the 3 months postoperatively, SWE was done for 18 children: 12 in group A (patent bilioenteric drainage on hepatobiliary iminodiacetic acid scan) and 6 (nonpatent) in group B; mean SWE value was 12.8 and 17.3 kPa, respectively ( p < 0.001). Ten children from group A underwent SWE 6 months postoperatively, and the mean value was 13.23 kPa. Conclusion The SWE values correlate with liver histology grading, suggesting a reliable alternative to biopsy. Additionally, the baseline SWE values and their trend during follow-up can provide information on the disease's progression.
Collapse
Affiliation(s)
- Md Fahim Ahmad
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Solanki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Prakash Kanojia
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sadhna B. Lal
- Division of Pediatric, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K. Saxena
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
|
3
|
Ferraioli G, Barr RG, Berzigotti A, Sporea I, Wong VWS, Reiberger T, Karlas T, Thiele M, Cardoso AC, Ayonrinde OT, Castera L, Dietrich CF, Iijima H, Lee DH, Kemp W, Oliveira CP, Sarin SK. WFUMB Guideline/Guidance on Liver Multiparametric Ultrasound: Part 1. Update to 2018 Guidelines on Liver Ultrasound Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1071-1087. [PMID: 38762390 DOI: 10.1016/j.ultrasmedbio.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 05/20/2024]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) endorsed the development of this document on multiparametric ultrasound. Part 1 is an update to the WFUMB Liver Elastography Guidelines Update released in 2018 and provides new evidence on the role of ultrasound elastography in chronic liver disease. The recommendations in this update were made and graded using the Oxford classification, including level of evidence (LoE), grade of recommendation (GoR) and proportion of agreement (Oxford Centre for Evidence-Based Medicine [OCEBM] 2009). The guidelines are clinically oriented, and the role of shear wave elastography in both fibrosis staging and prognostication in different etiologies of liver disease is discussed, highlighting advantages and limitations. A comprehensive section is devoted to the assessment of portal hypertension, with specific recommendations for the interpretation of liver and spleen stiffness measurements in this setting.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Richard Gary Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ioan Sporea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ana Carolina Cardoso
- Hepatology Division, School of Medicine, Federal University of Rio de Janeiro, Clementino, Fraga Filho Hospital, Rua Prof. Rodolpho Paulo Rocco, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Oyekoya Taiwo Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Medical School, University of Western Australia, Crawley, Western Australia, Australia; Curtin Medical School, Curtin University, Kent Street, Bentley, Western Australia, Australia
| | - Laurent Castera
- Université Paris-Cité, Inserm UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Hyogo, Japan; Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Claudia P Oliveira
- Gastroenterology Department, Laboratório de Investigação (LIM07), Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| |
Collapse
|
|
4
|
Medyńska-Przęczek A, Stochel-Gaudyn A, Wędrychowicz A. Liver fibrosis assessment in pediatric population - can ultrasound elastography be an alternative method to liver biopsy? A systematic review. Adv Med Sci 2024; 69:8-20. [PMID: 38198895 DOI: 10.1016/j.advms.2023.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Liver diseases of various etiologies are becoming increasingly common in the pediatric population. So far, the gold diagnostic standard in these disorders is liver biopsy. This procedure is invasive, painful and requires general anesthesia in this group of patients. Due to the continuous development of new research techniques, such as liver elastography, it is necessary to evaluate them in the context of their diagnostic usefulness. Ultrasound elastography, as a quick and effective method, is being used more and more often in the assessment and monitoring of liver dysfunction in both adults and children. There are several techniques of liver elastography, such as transient elastography, shear wave elastography consisting of various subtypes such as two-dimensional shear wave elastography, acoustic radiation force impulse and point shear wave elastography, which differ in terms of the measurement technique and the achieved results. The purpose of our review was to determine whether techniques of liver elastography could replace liver biopsy. Although now, based on the analyzed papers, elastography cannot replace liver biopsy, in our opinion, the role of this tool in monitoring pediatric patients with liver diseases will grow in the coming years.
Collapse
Affiliation(s)
- Aleksandra Medyńska-Przęczek
- School of Medical and Health Sciences, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 31-530, Poland.
| | - Anna Stochel-Gaudyn
- Department of Paediatrics, Gastroenterology and Nutrition, Pediatric Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-663, Poland
| | - Andrzej Wędrychowicz
- Department of Paediatrics, Gastroenterology and Nutrition, Pediatric Institute, Faculty of Medicine, Jagiellonian University Medical College, Krakow, 30-663, Poland
| |
Collapse
|
|
5
|
Derinkuyu BE, Dillman JR, Lubert AM, Palermo JJ, Opotowsky AR, Trout AT. Associations of Liver Stiffness Measured by Ultrasound Shear-Wave Elastography With Portal Hypertension and Circulatory Failure in Individuals With Fontan Circulation. AJR Am J Roentgenol 2024; 222:e2329640. [PMID: 37530396 DOI: 10.2214/ajr.23.29640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND. The Fontan operation palliates single-ventricle congenital heart disease but causes hepatic congestion with associated progressive hepatic fibrosis. OBJECTIVE. The purpose of this study was to evaluate associations between liver stiffness measured using ultrasound (US) shear-wave elastography (SWE) in patients with Fontan palliation and the occurrence of portal hypertension and Fontan circulatory failure during follow-up. METHODS. This retrospective study included 119 individuals 10 years old or older (median age, 19.1 years; 61 female patients, 58 male patients) with Fontan circulation who underwent liver US with 2D SWE from January 1, 2015, to January 1, 2022, and had 1 year or more of clinical follow-up (unless experiencing earlier outcome-related events). Median liver stiffness from the initial US examination was documented. Varices, ascites, splenomegaly, and thrombocytopenia (VAST) scores (range, 0-4) were determined as a marker of portal hypertension on initial US examination and 1 year or more of follow-up imaging (US, CT, or MRI). Composite clinical outcome for Fontan circulatory failure (death, mechanical circulatory support, cardiac transplant, or unexpected Fontan circulation-related hospitalization) was assessed. Analysis included the Wilcoxon rank sum test, logistic regression analysis with stepwise variable selection, and ROC analysis. RESULTS. Median initial liver stiffness was 2.22 m/s. Median initial VAST score was 0 (IQR, 0-1); median follow-up VAST score was 1 (IQR, 0-2) (p = .004). Fontan circulatory failure occurred in 37 of 119 (31%) patients (median follow-up, 3.4 years). Initial liver stiffness was higher in patients with a follow-up VAST score of 1 or greater (2.37 m/s) than in those with a follow-up VAST score of 0 (2.08 m/s) (p = .005), and initial liver stiffness was higher in patients with (2.43 m/s) than without (2.10 m/s) Fontan circulatory failure during follow-up (p < .001). Initial liver stiffness was the only significant independent predictor of Fontan circulatory failure (OR = 3.76; p < .001); age, sex, Fontan operation type, dominant ventricular morphology, and initial VAST score were not independent predictors. Initial liver stiffness had an AUC of 0.70 (sensitivity, 79%; specificity, 57%; threshold, > 2.11 m/s) for predicting a follow-up VAST score of 1 or greater and an AUC of 0.74 (sensitivity, 84%; specificity, 52%; threshold, > 2.12 m/s) for predicting Fontan circulatory failure. CONCLUSION. In patients with Fontan circulation, increased initial liver stiffness was associated with portal hypertension and circulatory failure during follow-up, although it had moderate performance in predicting these outcomes. CLINICAL IMPACT. US SWE may play a role in post-Fontan surveillance, supporting tailored medical and surgical care.
Collapse
Affiliation(s)
- Betul E Derinkuyu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Adam M Lubert
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph J Palermo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alexander R Opotowsky
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
|
6
|
Ozdogan E, Arikan C. Liver fibrosis in children: a comprehensive review of mechanisms, diagnosis, and therapy. Clin Exp Pediatr 2023; 66:110-124. [PMID: 36550776 PMCID: PMC9989719 DOI: 10.3345/cep.2022.00367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
Chronic liver disease incidence is increasing among children worldwide due to a multitude of epidemiological changes. Most of these chronic insults to the pediatric liver progress to fibrosis and cirrhosis to different degrees. Liver and immune physiology differs significantly in children from adults. Because most of pediatric liver diseases have no definitive therapy, a better understanding of population and disease-specific fibrogenesis is mandatory. Furthermore, fibrosis development has prognostic significance and often guide treatment. Evaluation of liver fibrosis continues to rely on the gold-standard liver biopsy. However, many high-quality studies put forward the high diagnostic accuracy of numerous diagnostic modalities in this setting. Herein, we summarize and discuss the recent literature on fibrogenesis with an emphasis on pediatric physiology along with a detailed outline of disease-specific signatures, noninvasive diagnostic modalities, and the potential for antifibrotic therapies.
Collapse
Affiliation(s)
- Elif Ozdogan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Cigdem Arikan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
|
7
|
Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111676. [PMID: 36360404 PMCID: PMC9688715 DOI: 10.3390/children9111676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
The early diagnosis of biliary atresia (BA) in cholestatic infants is critical to the success of the treatment. Intraoperative cholangiography (IOC), an invasive imaging technique, is the current strategy for the diagnosis of BA. Ultrasonography has advanced over recent years and emerging techniques such as shear wave elastography (SWE) have the potential to improve BA diagnosis. This review sought to evaluate the diagnostic efficacy of advanced ultrasonography techniques in the diagnosis of BA. Six databases (CINAHL, Medline, PubMed, Google Scholar, Web of Science (core collection), and Embase) were searched for studies assessing the diagnostic performance of advanced ultrasonography techniques in differentiating BA from non-BA causes of infantile cholestasis. The meta-analysis was performed using Meta-DiSc 1.4 and Comprehensive Meta-analysis v3 software. Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Fifteen studies consisting of 2185 patients (BA = 1105; non-BA = 1080) met the inclusion criteria. SWE was the only advanced ultrasonography technique reported and had a good pooled diagnostic performance (sensitivity = 83%; specificity = 77%; AUC = 0.896). Liver stiffness indicators were significantly higher in BA compared to non-BA patients (p < 0.000). SWE could be a useful tool in differentiating BA from non-BA causes of infantile cholestasis. Future studies to assess the utility of other advanced ultrasonography techniques are recommended.
Collapse
|
|
8
|
Hebelka H, de Lange C, Boström H, Ekvall N, Lagerstrand K. Shear Wave Elastography in the Differentiation of Nonfibrotic Versus Fibrotic Liver Disease in Children: A Prospective Study With Histological Correlation. JPGN REPORTS 2022; 3:e156. [PMID: 37168740 PMCID: PMC10158420 DOI: 10.1097/pg9.0000000000000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 05/13/2023]
Abstract
To evaluate the diagnostic accuracy of ultrasound shear wave elastography (SWE) prospectively and to determine cutoff value for nonfibrotic liver tissue in children with suspected or established liver disease. Methods In 90 consecutive pediatric patients, standardized 2D-SWE was performed during general anesthesia and free breathing. Liver stiffness was estimated with SWE followed by a percutaneous biopsy from the corresponding area. SWE values were compared with histology with fibrosis scored according to Batts & Ludwig classification (grade 0-4 = F0-F4) and to hepatic biomarkers. Results Four patients with SWE interquartile range (IQR)/median ≥ 30% kPa were excluded. The remaining 86 children (59% males) had a mean age = 10.2 years (0.1-18). The distribution of individuals with median (min;max) SWE values (kPa) within each fibrosis grade were; F0[n = 10; 5.0(3.4;6.3)], F1[n = 24; 5.0(3.6;8.7)], F2[n = 32; 5.8(3.5;13.4)], F3[n = 12, 7.5(4.0;14.4)], and F4[n = 8; 12.5(6.6;21.0)]. There was a significant difference between fibrosis grades (0.03 > P < 0.002) except between F0 and F1 respectively between F1 and F2. The AuROC differentiating F0-1 from F2-4 was 0.77(95% CI: 0.67-0.87). A cutoff SWE value of ≤4.5 kPa yielded 90% sensitivity and 68% specificity to rule out significant fibrosis (F2-F4). Out of the 18 children (21%) with SWE value ≤4.5 kPa, 12 had grade F0-1 and 6 had F2, although including some confounders for increased SWE measurements as steatosis/hepatitis/cholestasis. Conclusions 2D-SWE ultrasound can reliably distinguish no/mild (F0/F1) from moderate/severe (F2-F4) fibrosis in children with suspected/established liver disease with good sensitivity and acceptable specificity. Our results show that in pediatric patients, when the indication for biopsy is to rule out significant fibrosis, SWE can be considered an alternative.
Collapse
Affiliation(s)
- Hanna Hebelka
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte de Lange
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Boström
- From the Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Ekvall
- Department of Pediatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
|
9
|
Diagnosis of liver cirrhosis with two-dimensional shear wave elastography in biliary atresia before Kasai portoenterostomy. Pediatr Surg Int 2022; 38:209-215. [PMID: 34850287 DOI: 10.1007/s00383-021-05044-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE To evaluate the application value of two-dimensional shear wave elastography (2D-SWE) for non-invasive diagnosis of liver cirrhosis (LC) in patients with biliary atresia (BA) before Kasai portoenterostomy (KP), and the cutoff value of liver stiffness measurement (LSM) for diagnosing LC. METHODS The clinical data of 51 patients with BA who were diagnosed via surgery and pathological results from May 2017 to December 2018 in the department of general surgery, Beijing Children's Hospital, Capital Medical University, were retrospectively analyzed. The liver tissue specimens obtained during KP were evaluated according to the METAVIR criteria. The LSM was obtained using the 2D-SWE technique before KP. RESULTS There was a grade positive correlation between LSM and METAVIR staging, and the Spearman correlation coefficient was 0.432 (P = 0.002). The AUC for 2D-SWE diagnosing LC (METAVIR score S = 4) in patients with BA before KP was 0.843 (95% confidence interval 0.736 ~ 0.950). The best cutoff value was 16.05 kPa, and the corresponding sensitivity was 75.0%, specificity was 83.7%, positive predictive value (PPV) was 46.1%, negative predictive value (NPV) was 94.7%, and the accuracy was 82.4%. CONCLUSION 2D-SWE can be used to noninvasively diagnose LC in patients with BA before KP, and the cutoff value is 16.05 kPa.
Collapse
|
|
10
|
Corica D, Bottari A, Aversa T, Morabito LA, Curatola S, Alibrandi A, Ascenti G, Wasniewska M. Prospective assessment of liver stiffness by shear wave elastography in childhood obesity: a pilot study. Endocrine 2022; 75:59-69. [PMID: 34302259 DOI: 10.1007/s12020-021-02828-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The increased incidence of childhood obesity and related non-alcoholic fatty liver disease (NAFLD) has determined the need to identify a non-invasive technique to diagnose and monitor NAFLD. Two-dimensional shear wave elastography (2D-SWE) has emerged as a reliable, non-invasive, tool to evaluate liver tissue elasticity in clinical practice. Aims of this study were to longitudinally evaluate 2D-SWE changes in relation to weight loss, metabolic profile, and body composition modifications and to investigate the correlation between 2D-SWE variation and clinical and biochemical indices of cardio-metabolic risk in obese children. METHODS Thirty-three children underwent anthropometric, bioimpedenziometric, fasting biochemical assessments, ultrasound, and SWE evaluations, at baseline (V0) and after a 12-months of follow-up (V12). Diet and physical activity programs have been prescribed to all patients according to European Society of Endocrinology and Pediatric Endocrine Society recommendations. Adherence to the prescribed diet and physical activity program was checked every 3 months during the 12-month of follow-up. Variation of all parameters was evaluated in intragroup and intergroup comparison analysis in children, who had not lost weight (Group A) and those who had lost weight (Group B) at V12. Study population was also analyzed dividing it into two groups with respect to 2D-SWE liver elasticity value ≤10.6 kPa or >10.6 kPa. RESULTS A significant reduction of mean 2D-SWE value was demonstrated both in the entire cohort (p = 0.002) and in Group B children (p = 0.004). Intragroup comparison analysis, between V0 and V12, documented a significant decrease of 2D-SWE and BMI SDS and a significant improvement of metabolic profile (decrease of HOMA-IR, HbA1c, oral glucose tolerance test 120-min glucose and insulin, triglycerides, triglycerides/HDL-ratio, transaminases, uric acid, and increase of Matsuda-index and HDL) in children of Group B but not in those of Group A. Intergroup comparison analysis showed significant differences for BMI, BMI SDS, transaminases and several parameters of glucose and lipid metabolism, between Group A and Group B children after 12-months of follow-up. No significant differences were documented with regard to clinical and biochemical variables by dividing the population in accordance with the 2D-SWE cut-off of 10.6 kPa. CONCLUSIONS These results suggested a relation between weight loss, metabolic profile improvement and 2D-SWE value reduction. SWE could play a significant role in the non-invasive assessment of NAFLD in children and adolescents with obesity.
Collapse
Affiliation(s)
- Domenico Corica
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.
| | - Antonio Bottari
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Tommaso Aversa
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Letteria Anna Morabito
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Selenia Curatola
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | | | - Giorgio Ascenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| |
Collapse
|
|
11
|
Özdemir Çiçek S, Karaman ZF, Şahin N, Paç Kısaarslan A, Poyrazoğlu MH, Düşünsel R. Evaluation of liver elasticity with shear-wave elastography in juvenile idiopathic arthritis patients receiving methotrexate. Pediatr Int 2022; 64:e15239. [PMID: 36217648 DOI: 10.1111/ped.15239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/21/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Methotrexate (MTX) is the first-choice disease-modifying drug in juvenile idiopathic arthritis (JIA) treatment. Methotrexate is metabolized in the liver and can cause liver toxicity and fibrosis with long-term use. Ultrasound shear wave elastography (SWE) is a non-invasive method and can detect liver fibrosis by evaluating the liver elasticity. The aim of this study was to assess liver stiffness and detect if there is an increase in liver stiffness or fibrosis findings with the non-invasive SWE method in JIA patients under MTX treatment. METHOD The study included 49 JIA patients under MTX treatment and 48 healthy controls, matched for age and sex with a body mass index below the 95th percentile. The demographic data and clinical characteristics of patients were obtained from medical records. Liver function tests were evaluated, and liver tissue stiffness measurements were performed with SWE. RESULTS Of the 49 patients, 67.35% were girls and the mean age was 10.69 (±4.33) years. The duration of MTX treatment was 23.00 (1-80) months, and the cumulative dose of MTX was 1,280.867 mg (±934.2) in the patient group. There was no statistically significant difference in liver stiffness between patients receiving MTX and healthy controls (P = 0.313). There was no relationship between MTX duration, cumulative dose, route of administration, and liver stiffness. Only gamma glutamyl transferase values were weakly correlated with liver stiffness (P = 0.029). CONCLUSIONS We did not detect an increase in liver tissue stiffness in JIA patients using methotrexate in comparison with controls.
Collapse
Affiliation(s)
| | - Zehra Filiz Karaman
- Department of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Bursa City Hospital, Bursa, Turkey
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | | | - Ruhan Düşünsel
- Department of Pediatric Rheumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
|
12
|
Caruso M, Ricciardi C, Delli Paoli G, Di Dato F, Donisi L, Romeo V, Petretta M, Iorio R, Cesarelli G, Brunetti A, Maurea S. Machine Learning Evaluation of Biliary Atresia Patients to Predict Long-Term Outcome after the Kasai Procedure. Bioengineering (Basel) 2021; 8:152. [PMID: 34821718 PMCID: PMC8615125 DOI: 10.3390/bioengineering8110152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Kasai portoenterostomy (KP) represents the first-line treatment for biliary atresia (BA). The purpose was to compare the accuracy of quantitative parameters extracted from laboratory tests, US imaging, and MR imaging studies using machine learning (ML) algorithms to predict the long-term medical outcome in native liver survivor BA patients after KP. Twenty-four patients were evaluated according to clinical and laboratory data at initial evaluation (median follow-up = 9.7 years) after KP as having ideal (n = 15) or non-ideal (n = 9) medical outcomes. Patients were re-evaluated after an additional 4 years and classified in group 1 (n = 12) as stable and group 2 (n = 12) as non-stable in the disease course. Laboratory and quantitative imaging parameters were merged to test ML algorithms. Total and direct bilirubin (TB and DB), as laboratory parameters, and US stiffness, as an imaging parameter, were the only statistically significant parameters between the groups. The best algorithm in terms of accuracy, sensitivity, specificity, and AUCROC was naive Bayes algorithm, selecting only laboratory parameters (TB and DB). This preliminary ML analysis confirms the fundamental role of TB and DB values in predicting the long-term medical outcome for BA patients after KP, even though their values may be within the normal range. Physicians should be alert when TB and DB values change slightly.
Collapse
Affiliation(s)
- Martina Caruso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy;
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, 82037 Telese Terme, Italy;
| | - Gregorio Delli Paoli
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
| | - Fabiola Di Dato
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.D.); (M.P.); (R.I.)
| | - Leandro Donisi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, 82037 Telese Terme, Italy;
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
| | - Mario Petretta
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.D.); (M.P.); (R.I.)
| | - Raffaele Iorio
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (F.D.D.); (M.P.); (R.I.)
| | - Giuseppe Cesarelli
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, 82037 Telese Terme, Italy;
- Department of Chemical, Materials and Production Engineering, University of Naples “Federico II”, 80125 Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.D.P.); (L.D.); (V.R.); (A.B.); (S.M.)
| |
Collapse
|
|
13
|
Güngörer V, Öztürk M, Özlü MY, Arslan Ş. What is the impact of methotrexate on liver in patients with juvenile idiopathic arthritis? Results of liver SWE performed in a single centre. Mod Rheumatol 2021; 32:776-782. [PMID: 34918139 DOI: 10.1093/mr/roab064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Long-term therapy with low-dose methotrexate (MTX) is widely used in treatment of rheumatic diseases, in children. The purpose of this study was to evaluate liver elasticity in patients with juvenile idiopathic arthritis (JIA) who received MTX and compare the results with control group. METHODS Liver elasticity was evaluated with shear wave elastography (SWE) technique in 25 patients aged 3-17 years who were followed up with JIA and received MTX and compared with 25 healthy controls of the same age and weight. Factors that had an effect on liver elasticity were examined. RESULTS The mean SWE value of patients was 2.64 ± 2.13 m/s and 24.10 ± 18.50 kPa, whereas 1.83 ± 0.16 m/s and 10.09 ± 1.83 kPa in control group. There was a significant difference in liver elasticity in the patient and control groups. When the patients were evaluated as Group 1 (< 1000 mg) and Group 2 (≥ 1000 mg) according to the cumulative MTX dose, no significant difference was obtained. There was positive correlation between liver elasticity and weekly MTX dose and age. CONCLUSIONS Our study revealed that liver elasticity significantly decreased in patients who received MTX when compared with the control group. The elastography technique will be understood better over time and used safely in many areas.
Collapse
Affiliation(s)
- Vildan Güngörer
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Öztürk
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Yasir Özlü
- Department of Radiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Şükrü Arslan
- Department of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| |
Collapse
|
|
14
|
Galina P, Alexopoulou E, Mentessidou A, Mirilas P, Zellos A, Lykopoulou L, Patereli A, Salpasaranis K, Kelekis NL, Zarifi M. Diagnostic accuracy of two-dimensional shear wave elastography in detecting hepatic fibrosis in children with autoimmune hepatitis, biliary atresia and other chronic liver diseases. Pediatr Radiol 2021; 51:1358-1368. [PMID: 33755748 DOI: 10.1007/s00247-020-04959-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/13/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although fibrosis is the main determinant of liver stiffness, other disease-related factors usually disregarded in studies on liver elastography, such as inflammation and cholestasis, may influence liver stiffness. OBJECTIVE To evaluate the accuracy of two-dimensional (2-D) shear wave elastography in assessing liver fibrosis in children with chronic liver disease by controlling for the confounding role of several disease- and patient-related factors. MATERIALS AND METHODS Three disease groups were studied: 1) various chronic liver diseases, 2) autoimmune hepatitis and 3) biliary atresia. The METAVIR (meta-analysis of histological data in viral hepatitis) score was used for fibrosis staging and grading of necroinflammatory activity. Multiple linear regression was used to evaluate the relationship between liver stiffness measurements and disease-related factors. The diagnostic accuracy of elastography for predicting fibrosis stages was assessed by calculating the area under the receiver operating characteristic curves. RESULTS The various chronic liver diseases group (n=32; 7.1±4.9 [mean±standard deviation] years) showed liver stiffness of 8.9±5.0 (mean±standard deviation) kPa, the autoimmune hepatitis group (n=33; 8.1±4.4 years) of 7.1±2.7 kPa, and the biliary atresia group (n=19; 0.2±0.1 years) of 19.7±15.2 kPa. Liver stiffness measurements differed across METAVIR fibrosis categories in all disease groups. The highest values were found in biliary atresia, at fibrosis stages ≥F2 (F2: 12.4±1.6 kPa, F3: 17.8±2 kPa, F4: 41.5±12.4 kPa). Liver stiffness was strongly associated only with fibrosis (P<0.0001) in various chronic liver diseases, but with necroinflammatory activity (P<0.0001) and fibrosis (P=0.002) in autoimmune hepatitis, and with age (P<0.0001), fibrosis (P<0.0001) and cholestasis (P=0.009) in biliary atresia. Optimal cutoffs for detecting advanced fibrosis (≥F3) were 16 kPa (area under curve: 0.98; sensitivity: 87.5%; specificity: 96.7%) in biliary atresia and 8.7 kPa (area under curve: 0.98; sensitivity: 93.8%; specificity: 96.1%) in other chronic liver diseases. CONCLUSION Two-dimensional shear wave elastography is reliable in assessing liver fibrosis in children with chronic liver diseases.
Collapse
Affiliation(s)
- Paraskevi Galina
- Department of Radiology, Aghia Sofia General Children's Hospital, Thivon St. & Papadiamantopoulou St., Goudi, 115 27, Athens, Greece. .,2nd Department of Radiology, General University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, General University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Mentessidou
- Department of Pediatric Surgery, Aghia Sofia General Children's Hospital, Athens, Greece
| | - Petros Mirilas
- Department of Pediatric Surgery, Aghia Sofia General Children's Hospital, Athens, Greece
| | - Aglaia Zellos
- 1st Department of Pediatrics, Aghia Sofia General Children's Hospital, Athens, Greece
| | - Lilia Lykopoulou
- 1st Department of Pediatrics, Aghia Sofia General Children's Hospital, Athens, Greece
| | - Amalia Patereli
- Department of Pathology, Aghia Sofia General Children's Hospital, Athens, Greece
| | | | - Nikolaos L Kelekis
- 2nd Department of Radiology, General University Hospital Attikon, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Zarifi
- Department of Radiology, Aghia Sofia General Children's Hospital, Thivon St. & Papadiamantopoulou St., Goudi, 115 27, Athens, Greece
| |
Collapse
|
|
15
|
Ferraioli G, Barr RG, Dillman JR. Elastography for Pediatric Chronic Liver Disease: A Review and Expert Opinion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:909-928. [PMID: 32881048 DOI: 10.1002/jum.15482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Department of Clinical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
|
16
|
Liu YF, Ni XW, Pan Y, Luo HX. Comparison of the diagnostic value of virtual touch tissue quantification and virtual touch tissue imaging quantification in infants with biliary atresia. Int J Clin Pract 2021; 75:e13860. [PMID: 33236451 DOI: 10.1111/ijcp.13860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to compare the diagnostic performance of vital touch tissue quantification (VTQ) and virtual touch tissue imaging quantification (VTIQ) in diagnosing infants with biliary atresia (BA) from jaundiced infants. METHODS In this study, 26 jaundiced infants with BA, 33 jaundiced infants without BA, and 40 normal infants were enrolled. The hepatic shear wave velocity (SWV) of each infant was determined by VTQ and VTIQ examinations, respectively. Then, the receiver operating characteristic (ROC) curves were drawn and the area under the curve (AUC) and optimal cut-off values were calculated to evaluate the sensitivities and specificities of VTIQ and VTQ for BA. RESULTS The mean values of SWV of the control group measured by VTQ and VTIQ were (1.09 ± 0.18) m/s and (1.36 ± 0.21) m/s, respectively. The mean values of SWV of the non-BA group measured by VTQ and VTIQ were (1.30 ± 0.28) m/s and (1.52 ± 0.29) m/s, respectively. The mean values of SWV of the BA group measured by VTQ and VTIQ were (2.36 ± 0.36) m/s and (2.43 ± 0.29) m/s, respectively. The diagnostic threshold of VTQ and VTIQ to diagnose BA was 1.77 and 1.92 m/s. The sensitivities of VTQ and VTIQ to diagnose BA were 90.9% and 95.5%. The specificities of VTQ and VTIQ to diagnose BA were 68.4% and 78.9%. CONCLUSION Vital touch tissue quantification and VTIQ could help distinguish infants with BA from jaundiced infants by measuring the liver SWV values. VTIQ has higher sensitivity and specificity than VTQ.
Collapse
Affiliation(s)
- Yong-Fang Liu
- The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xian-Wei Ni
- The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yin Pan
- The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Hong-Xia Luo
- The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| |
Collapse
|
|
17
|
Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
Collapse
Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| |
Collapse
|
|
18
|
DeepLiverNet: a deep transfer learning model for classifying liver stiffness using clinical and T2-weighted magnetic resonance imaging data in children and young adults. Pediatr Radiol 2021; 51:392-402. [PMID: 33048183 PMCID: PMC8675279 DOI: 10.1007/s00247-020-04854-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although MR elastography allows for quantitative evaluation of liver stiffness to assess chronic liver diseases, it has associated drawbacks related to additional scanning time, patient discomfort, and added costs. OBJECTIVE To develop a machine learning model that can categorically classify the severity of liver stiffness using both anatomical T2-weighted MRI and clinical data for children and young adults with known or suspected pediatric chronic liver diseases. MATERIALS AND METHODS We included 273 subjects with known or suspected chronic liver disease. We extracted data including axial T2-weighted fast spin-echo fat-suppressed images, clinical data (e.g., demographic/anthropomorphic data, particular medical diagnoses, laboratory values) and MR elastography liver stiffness measurements. We propose DeepLiverNet (a deep transfer learning model) to classify patients into one of two groups: no/mild liver stiffening (<3 kPa) or moderate/severe liver stiffening (≥3 kPa). We conducted internal cross-validation using 178 subjects, and external validation using an independent cohort of 95 subjects. We assessed diagnostic performance using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AuROC). RESULTS In the internal cross-validation experiment, the combination of clinical and imaging data produced the best performance (AuROC=0.86) compared to clinical (AuROC=0.83) or imaging (AuROC=0.80) data alone. Using both clinical and imaging data, the DeepLiverNet correctly classified patients with accuracy of 88.0%, sensitivity of 74.3% and specificity of 94.6%. In our external validation experiment, this same deep learning model achieved an accuracy of 80.0%, sensitivity of 61.1%, specificity of 91.5% and AuROC of 0.79. CONCLUSION A deep learning model that incorporates clinical data and anatomical T2-weighted MR images might provide a means of risk-stratifying liver stiffness and directing the use of MR elastography.
Collapse
|
|
19
|
Pediatric Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
|
20
|
Mingzhu ZMD, Zhaoyan DMD, Xiaoyan NMD, Yuxiu GMD, Cheng ZMD. Ultrasound Elastography in Liver Tissue: Current Status. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
|
21
|
Caruso M, Cuocolo R, Di Dato F, Mollica C, Vallone G, Romeo V, Petretta M, Liuzzi R, Mainenti PP, Iorio R, Brunetti A, Maurea S. Ultrasound, shear-wave elastography, and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment. Acta Radiol 2020; 61:1300-1308. [PMID: 32008344 DOI: 10.1177/0284185120902379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biliary atresia (BA) is a rare obliterative cholangiopathy and Kasai portoenterostomy (KP) represents its first-line treatment; clinical and laboratory parameters together with abdominal ultrasound (US) are usually performed during the follow-up. Shear-wave elastography (SWE) is able to evaluate liver parenchyma stiffness; magnetic resonance imaging (MRI) has also been proposed to study these patients. PURPOSE To correlate US, SWE, and MRI imaging findings with medical outcome in patients with BA who are native liver survivors after KP. MATERIAL AND METHODS We retrospectively enrolled 24 patients. They were divided in two groups based on "ideal" (n = 15) or "non-ideal" (n = 9) medical outcome. US, SWE, and MRI exams were analyzed qualitatively and quantitatively for imaging signs suggestive of chronic liver disease (CLD). RESULTS Significant differences were found in terms of liver surface (P = 0.007) and morphology (P = 0.013), portal vein diameter (P = 0.012) and spleen size (P = 0.002) by US, liver signal intensity (P = 0.013), portal vein diameter (P = 0.010), presence of portosystemic collaterals (P = 0.042), and spleen size (P = 0.001) by MRI. The evaluation of portal vein diameter (moderate, κ = 0.44), of portosystemic collaterals (good, κ = 0.78), and spleen size (very good, κ = 0.92) showed the best agreement between US and MRI. A significant (P = 0.01) difference in liver parenchyma stiffness by SWE was also found between the two groups (cut-off = 9.6 kPa, sensitivity = 55.6%, specificity = 100%, area under the ROC curve = 0.82). CONCLUSION US, SWE, and MRI findings correlate with the medical outcome in native liver survivor patients with BA treated with KP.
Collapse
Affiliation(s)
- Martina Caruso
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| | - Fabiola Di Dato
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Carmine Mollica
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Gianfranco Vallone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Raffaele Liuzzi
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Bio-Structures and Bio-Imaging of the National Research Council (CNR), Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II," Naples, Italy
| |
Collapse
|
|
22
|
Two-dimensional ultrasound shear wave elastography for identifying and staging liver fibrosis in pediatric patients with known or suspected liver disease: a clinical effectiveness study. Pediatr Radiol 2020; 50:1255-1262. [PMID: 32588095 DOI: 10.1007/s00247-020-04720-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ultrasound shear wave elastography (SWE) measures liver stiffness noninvasively, but few studies have defined cutoff values for detecting liver fibrosis in pediatric patients using 2-D ultrasound SWE. OBJECTIVE To evaluate the diagnostic performance of 2-D ultrasound SWE and define cutoff values for liver fibrosis in pediatric patients, using Canon (Toshiba) Aplio ultrasound systems. MATERIALS AND METHODS This was an institutional review board-approved retrospective study of patients (≤18 years old) who had undergone both liver 2-D ultrasound SWE and percutaneous liver biopsy within 6 months. Liver biopsies were staged using the METAVIR (fibrosis) scoring system. Continuous data were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance. RESULTS Forty-six patients, with a median age of 11.5 years (interquartile range: 8.0-14.3 years), were included. Twenty-three patients were male (50%). Twenty-seven patients had a METAVIR fibrosis score of F0-1, and 19 patients had a score of F2-4. For differentiating METAVIR F0-1 from F2--4, the area under the ROC (AuROC) was 0.75 (95% confidence interval [CI]: 0.60-0.90). A cutoff of >1.89 m/s yielded sensitivity of 73.7% (95% CI: 51.2-88.2) and specificity of 77.8% (95% CI: 59.2-89.4). For the subset of patients without histological hepatic steatosis (n=35), the AuROC was 0.86 (95% CI: 0.71-1.0). The same cutoff of >1.89 m/s yielded a sensitivity of 80.0% (95% CI: 54.8-93.0) and specificity of 95.0% (95% CI 76.4-99.7). CONCLUSION Two-dimensional ultrasound SWE distinguishes patients with no/mild fibrosis from those with moderate/severe fibrosis with good sensitivity and specificity. Diagnostic performance is comparable to that published for magnetic resonance elastography and is likely adversely impacted by steatosis.
Collapse
|
|
23
|
Yang L, Li J, Ma L, Xiang H, He D, Lu C, Tang L, Luo Y, Chen S. Noninvasive assessment of liver fibrosis in chronic hepatitis B carriers with sound touch elastography: study of surgical pathology specimens. Expert Rev Med Devices 2020; 17:845-853. [PMID: 32686517 DOI: 10.1080/17434440.2020.1798226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of sound touch elastography (STE) for staging liver fibrosis in chronic hepatitis B (CHB) patients using pathological stage of surgical specimens as the reference standard. METHOD 239 CHB patients were included. Liver stiffness measurements (LSMs) on STE and Supersonic shear imaging (SSI), gamma glutamyl transferase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI) and four-factor Fibrosis-4 (FIB-4) index were obtained. Areas under the receiver operating characteristic (ROC) curves (AUCs) for the diagnosis of fibrosis stage were calculated and compared. RESULTS The LSMs obtained by STE and SSI significantly correlated with the fibrosis stages (r = 0.757; r = 0.758, respectively, both p < 0.001). No significant differences in AUCs were observed between STE and SSI in identifying fibrosis ≥stage 1 (0.92 vs. 0.94), ≥stage 2 (0.89 vs. 0.91), ≥stage 3 (0.90 vs. 0.91) or stage 4 (0.92 vs. 0.91). Both STE and SSI had significantly higher AUCs in identifying each fibrosis stage than the GPR (0.68, 0.77, 0.76 and 0.79), APRI (0.53, 0.66, 0.74 and 0.69) and FIB-4 (0.61, 0.77, 0.79 and 0.74). CONCLUSIONS STE is an efficient tool for assessing liver fibrosis in CHB patients, with performance comparable to that of SSI and superior to that of biomarkers.
Collapse
Affiliation(s)
- Lulu Yang
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Jiawu Li
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Lin Ma
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Hongjin Xiang
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Du He
- Department of Pathology, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Changli Lu
- Department of Pathology, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Lin Tang
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University , Chengdu, Sichuan, P.R. China
| | - Shigao Chen
- Department of Radiology, Mayo Clinic , Rochester, MN, USA
| |
Collapse
|
|
24
|
Dardanelli EP, Orozco ME, Lostra J, Laprida C, Lulkin S, Bosaleh AP, Cernadas C, Lipsich JE. Bidimensional shear-wave elastography for assessing liver fibrosis in children: a proposal of reference values that correlate with the histopathological Knodell-Ishak score. Pediatr Radiol 2020; 50:817-826. [PMID: 32072246 DOI: 10.1007/s00247-020-04632-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/10/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A limited number of publications correlate bidimensional shear-wave elastography (2-D SWE) and stages of liver fibrosis in children. OBJECTIVE To correlate liver elastography values using 2-D SWE and liver biopsy classified by Knodell-Ishak score to evaluate fibrosis in pediatric patients with liver disease, and to propose values of 2-D SWE (kPa) correlating with Knodell-Ishak score, which have not been defined in the literature. MATERIALS AND METHODS We conducted a prospective cross-sectional observational study on the performance of diagnostic tests. Between June 2016 and June 2018, elastography was performed in 213 children and young adults who had undergone liver biopsy. B mode, Doppler and 2-D SWE were performed using an Aixplorer (SuperSonic Imagine, Aix-en-Provence, France). Histology samples were classified using the Knodell-Ishak score. We evaluated performance by assessing sensitivity, specificity, positive predictive value and negative predictive value. To determine cut-off points for the continuous variables, we used receiver operating characteristic (ROC) curves. All the cutoff values we established apply only to the SuperSonic Aixplorer system. RESULTS Measurement with 2-D SWE was successful, with a good correlation with fibrosis stage. The area under the curve (AUC) to differentiate between early (Stages 1-2) and moderate (Stages 3-4) fibrosis was 0.91 (95% confidence interval [CI]: 0.87-0.96), with a sensitivity of 92% and specificity of 86%, with a cutoff value 12 kPa (2 m/s). The AUC of severe fibrosis (early stages of cirrhosis; Stage 5) was 0.95 (95% CI: 0.92-0.97), with a sensitivity of 94% and specificity of 90%, with a cutoff value 18.5 kPa (2.48 m/s). In two patients with hematopoietic stem cell transplantation and suspicion of graft versus host disease we found high 2-D SWE values in correlation with the fibrosis stages (Stage 0 with a median of 13 kPa [2.08 m/s] with hemosiderosis Grade 2 in one child and Stage 2 with a median of 46 kPa [3.91 m/s] and hemosiderosis Grade 4 in the other). CONCLUSION Our study shows the usefulness and accuracy of 2-D SWE for detecting liver fibrosis in pediatric patients. We propose reference values for Knodell-Ishak Stages 1 and 5. We found hemosiderosis as a possible confounding factor that hasn't been described with 2-D SWE.
Collapse
Affiliation(s)
- Esteban P Dardanelli
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina.
| | - Maria Eugenia Orozco
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Juliana Lostra
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Clarisa Laprida
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Solange Lulkin
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Andrea P Bosaleh
- Department of Pathology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Buenos Aires, Argentina
| | - Carolina Cernadas
- Department of Research and Development, Hospital de Pediatría J. P. Garrahan Buenos Aires, Buenos Aires, Argentina
| | - José E Lipsich
- Department of Radiology, Hospital de Pediatría J. P. Garrahan Buenos Aires, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| |
Collapse
|
|
25
|
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; 10:7213. [PMID: 32350349 PMCID: PMC7190848 DOI: 10.1038/s41598-020-64320-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/09/2020] [Indexed: 12/03/2022] Open
Abstract
TE and 2D-SWE are well-documented in studies performed on adults, but those on pediatric patients are limited. The aim of this study was to establish pediatric reference values for liver stiffness using two elastography methods: 2D-SWE and TE. We performed an observational study on 206 healthy children. All children underwent anamnesis, clinical exam, laboratory tests, US exam, TE and 2D-SWE for liver stiffness assessment. The mean liver stiffness value by 2D-SWE for all children was 3.72 ± 0.48 kPa. The mean values ranged between 3.603 ± 0.2678 kPa (3–5 years of age) and 3.774 ± 0.4038 kPa (9–11 years). The reference values varied between 4.1386 kPa (3–5 years of age) and 4.88 kPa (12–15 years). The mean liver stiffness value by TE was 3.797 ± 0.4859 kPa. The values ranged between 3.638 ± 0.4088 kPa (6–8 years of age) and 3.961 ± 0.5695 kPa (15–18 years). The cutoff values varied from 4.4064 kPa (3–5 years of age) to 5.1 kPa (15–18 years). We found a significant positive correlation between E Median values by TE and age [95% CI: 0.1160 to 0.3798, r = 0.2526, p = 0.0002]. Our findings revealed that the mean values of liver stiffness for all children on 2D-SWE and TE were almost identical, 3.72 ± 0.48 kPa versus 3.797 ± 0.4859 kPa.
Collapse
Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania.
| | - Dana Valentina Ghiga
- Department of Medical Informatics and Biostatistics, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| | - Maria Oana Săsăran
- Department of Pediatric Cardiology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street no 38, Târgu Mureș, 540136, Romania
| |
Collapse
|
|
26
|
Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems. Invest Radiol 2020; 55:191-199. [DOI: 10.1097/rli.0000000000000627] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
|
27
|
Hwang J, Yoon HM, Jung AY, Lee JS, Cho YA. Comparison of 2-Dimensional Shear Wave Elastographic Measurements Using ElastQ Imaging and SuperSonic Shear Imaging: Phantom Study and Clinical Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:311-321. [PMID: 31392769 DOI: 10.1002/jum.15108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To compare the feasibility and clinical applicability of ElastQ imaging (Philips Healthcare, Best, the Netherlands) with that of SuperSonic shear imaging (SSI; SuperSonic Imagine, Aix-en-Provence, France) using an elastographic phantom and a pilot study of patients. METHODS Two-dimensional shear wave elastography measurement was performed by ElastQ imaging and SSI by 2 radiologists. An elastographic phantom with 5 target elasticities at 2 acquisition depths was used. The coefficients of variation and intraclass correlation coefficients (ICCs) were evaluated for repeatability and interobserver agreement, respectively. The mean elasticities of the systems at each target were compared. The proportions of measurements that were out of the range of expected values and measurement errors were calculated to determine accuracy. Liver stiffness (LS) was measured by both systems in 27 children and young adult patients with various liver diseases. RESULTS Both systems provided high repeatability in elasticity measurements of phantom targets (coefficients of variation, 0.69%-15.82%), and there was excellent interobserver agreement (ICC, 0.992). Most (90%) mean elasticities of targets were significantly different between the techniques (P ≤ .002) and acquisition depths (P ≤ .004). ElastQ imaging had significantly lower proportions of out-of-range measurements and measurement errors (P ≤ .003) than SSI. In patients with liver disease, LS measurements of the systems were strongly correlated (ρ = 0.955; P < .001) and had excellent agreement (ICC, 0.951; P < .001). CONCLUSIONS ElastQ imaging had comparably good results in terms of repeatability, interobserver agreement, and accuracy in the phantom model compared with SSI. The pilot patient study showed strong correlations in LS values between the systems.
Collapse
Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
28
|
Farmakis SG, Buchanan PM, Guzman MA, Hardy AK, Jain AK, Teckman JH. Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease. Pediatr Radiol 2019; 49:1742-1753. [PMID: 31418057 DOI: 10.1007/s00247-019-04493-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/14/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND While liver biopsy remains the gold standard, given the procedure risks and sampling errors, there is a need for reliable noninvasive biomarkers of hepatic fibrosis. OBJECTIVE Determine the accuracy of two-dimensional shear wave elastography (2-D SWE) in predicting the histological severity of liver fibrosis in pediatric patients with known or suspected liver disease. MATERIALS AND METHODS Subjects 0-18 years old with known or suspected liver disease and liver biopsy within 30 days (n=70) were included. Comparisons by 2-D SWE were made to a control group (n=79). Two-dimensional SWE was performed using the GE LOGIQ E9 system. Liver biopsy specimens were scored according to METAVIR and Ishak scoring systems using Spearman's Rho correlation. Receiver operator characteristic (ROC) analysis, Kruskal-Wallis and Mann-Whitney U tests were conducted. RESULTS Control group median 2-D SWE measurements were lower than in subjects with any degree of liver fibrosis (P<0.001). Those with METAVIR F0 and Ishak 0 scores had significantly lower median 2-D SWE measurements (1.35 m/s; 1.36 m/s) than those with more advanced liver disease (F1-F3: 1.49-1.62 m/s; 1-4: 1.45-1.63 m/s) (P<0.05 for all), whereas the 2-D SWE in the higher scores were similar. Results did not differ between METAVIR and Ishak scores for any degree of fibrosis. Fibrosis scores moderately correlated with median 2-D SWE measurements (rs=0.43). The area under the curve for F1 compared to combined control/F0 was 0.89 (95% confidence interval [CI] 0.83-0.95; P<0.001) with sensitivity of 94.6% and specificity of 78.6%. Results for Ishak score 1 were similar. The ideal cutoff value for identifying fibrosis was determined to be 1.29 m/s. CONCLUSION The liver 2-D SWE measurements correlated with the histological liver fibrosis scores, regardless of the histopathological scoring system, although 2-D SWE was better at identifying patients with early fibrosis, not at distinguishing among the individual fibrosis levels. Two-dimensional SWE using the GE LOGIQ US system is useful for identifying pediatric patients at risk for liver fibrosis.
Collapse
Affiliation(s)
- Shannon G Farmakis
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO, 63110, USA.
| | - Paula M Buchanan
- Center of Health Outcomes Research, St. Louis University, St. Louis, MO, USA
| | - Miguel A Guzman
- Department of Pathology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Anna K Hardy
- Department of Radiology, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Ajay K Jain
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| | - Jeffrey H Teckman
- Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital and St. Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
|
29
|
Sun PX, Tong YY, Shi J, Zhang H, Liu SJ, Du J. Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology. World J Clin Cases 2019; 7:3463-3473. [PMID: 31750329 PMCID: PMC6854399 DOI: 10.12998/wjcc.v7.i21.3463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness. 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.
AIM To determine the standard value in healthy children, and to identify possible factors that might influence the VTIQ measurement.
METHODS With the ethical approval, 202 children between 1 month 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.
RESULTS A significant correlation was found between age and shear wave velocity (SWV) value. At measurement depths of 1.5 cm and 2.0 cm in the left lobe, there were significant differences among the age groups. SWV values were significantly negatively correlated with the measurement depth. Gender, liver lobe, and BMI showed no significant effect on the SWV values. Age and BMI may influence the quality of the elastogram.
CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children. The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.
Collapse
Affiliation(s)
- Pei-Xuan Sun
- 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
| | - Jing Shi
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Huan Zhang
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, 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
| | - Jun Du
- Diagnostic Imaging Center, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| |
Collapse
|
|
30
|
Dillman JR, DiPaola FW, Smith SJ, Barth RA, Asai A, Lam S, Campbell KM, Bezerra JA, Tiao GM, Trout AT. Prospective Assessment of Ultrasound Shear Wave Elastography for Discriminating Biliary Atresia from other Causes of Neonatal Cholestasis. J Pediatr 2019; 212:60-65.e3. [PMID: 31253405 DOI: 10.1016/j.jpeds.2019.05.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/12/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To prospectively assess the diagnostic performance of ultrasound shear wave elastography (SWE) and hepatobiliary laboratory biomarkers for discriminating biliary atresia from other causes of neonatal cholestasis. STUDY DESIGN Forty-one patients <3 months of age with neonatal cholestasis (direct bilirubin >2 mg/dL) and possible biliary atresia were prospectively enrolled. Both 2-dimensional (2D) and point ultrasound SWE were performed prior to knowing the final diagnosis. Median 2D (8) and point (10) shear wave speed measurements were calculated for each subject and used for analyses. The Mann-Whitney U test was used to compare shear wave speed and laboratory measurements between patients with and without biliary atresia. Receiver operating characteristic curve analyses and multivariable logistic regression were used to evaluate diagnostic performance. RESULTS Thirteen subjects (31.7%) were diagnosed with biliary atresia, and 28 subjects (68.3%) were diagnosed with other causes of neonatal cholestasis. Median age at the time of ultrasound SWE was 37 days. Median 2D (2.08 vs 1.49 m/s, P = .0001) and point (1.95 vs 1.21 m/s, P = .0014) ultrasound SWE measurements were significantly different between subjects with and without biliary atresia. Using a cut-off value of >1.84 m/s, 2D ultrasound SWE had a sensitivity = 92.3%, specificity = 78.6%, and area under the receiver operating characteristic curve (AuROC) of 0.89 (P < .0001). Using a cut-off value of >320 (U/L), gamma-glutamyl transferase (GGT) had a sensitivity = 100.0%, specificity = 77.8%, and AuROC of 0.85 (P < .0001). Multivariable logistic regression demonstrated an AuROC of 0.93 (P < .0001), with 2 significant covariates (2D ultrasound SWE [OR = 23.06, P = .01]; GGT [OR = 1.003, P = .036]). CONCLUSIONS Ultrasound SWE and GGT can help discriminate biliary atresia from other causes of neonatal cholestasis.
Collapse
Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Frank W DiPaola
- Division of Pediatric Gastroenterology, Department of Pediatrics, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Sally J Smith
- Department of Pediatric Radiology, Nationwide Children's Hospital, Columbus, OH
| | - Richard A Barth
- Department of Radiology, Stanford University, Lucile Packard Children's Hospital, Stanford, CA
| | - Akihiro Asai
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Simon Lam
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kathleen M Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jorge A Bezerra
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gregory M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
|
31
|
Northern NA, Dillman JR, Trout AT. Frequency of technical success of two-dimensional ultrasound shear wave elastography in a large pediatric and young adult cohort: a clinical effectiveness study. Pediatr Radiol 2019; 49:1025-1031. [PMID: 30949727 DOI: 10.1007/s00247-019-04396-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a paucity of available literature describing the frequency of technical success of liver two-dimensional (2-D) ultrasound (US) shear wave elastography (SWE) in children and young adults. OBJECTIVE To determine the frequency of technical success of liver 2-D ultrasound (US) SWE in children and young adults based on the interquartile range (IQR)/median of 10 shear wave speed (SWS) measurements. MATERIALS AND METHODS Clinical 2-D US SWE exams performed between February 2016 and March 2018 were retrospectively identified. Patient age and gender, median/mean liver stiffness (10 SWS measurements), IQR/median, abdominal wall thickness, body mass index (BMI) and serum alanine aminotransferase (ALT) were documented. The number of technically inadequate exams was calculated using three methods: 1) IQR/median >0.3, 2) IQR/median >95th percentile for our study population and 3) statistical outlier identification using the Tukey method. The effect of age, gender, median SWS, abdominal wall thickness, BMI, US transducer and ALT on measurement variability (IQR/median) was assessed using multivariable linear regression. RESULTS During the study period, 573 exams were performed. Mean age was 12.6±7.1 years; 274 (47.8%) exams were in male patients. Average median liver stiffness was 1.75±0.47 m/s. Based on Methods 1, 2 and 3, 29/573 (5.1%), 28/573 (4.9%, IQR/median cutoff value=0.303) and 30/573 (5.2%) exams were technically inadequate. Predictors of IQR/median included age (P=0.03), abdominal wall thickness (P=0.003), median SWS (P<0.0001) and transducer (P<0.0001). CONCLUSION Approximately 95% of liver 2-D US SWE exams are technically successful based on IQR/median in children and young adults.
Collapse
Affiliation(s)
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
|
32
|
Kim DW, Park C, Yoon HM, Jung AY, Lee JS, Jung SC, Cho YA. Technical performance of shear wave elastography for measuring liver stiffness in pediatric and adolescent patients: a systematic review and meta-analysis. Eur Radiol 2019; 29:2560-2572. [PMID: 30617493 DOI: 10.1007/s00330-018-5900-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/26/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the technical performance (proportion of technical failure and unreliable measurements) of shear wave elastography (SWE) for assessing liver stiffness in pediatric and adolescent patients. METHODS We searched Ovid-MEDLINE and EMBASE databases for eligible studies and selected original articles investigating transient elastography (TE), point shear wave elastography (pSWE), or two-dimensional SWE (2D-SWE) for measuring liver stiffness in pediatric and adolescent patients. A quantitative synthesis of studies reporting technical failures and/or unreliable measurements of TE, pSWE, or 2D-SWE is presented. Meta-analytic pooling was conducted using the random effects model. Meta-regression analysis was conducted to explore potential causes of heterogeneity. RESULTS Forty of 69 studies (58%) provided technical performance information. Technical failure data were reported in 3 TE, 6 pSWE, and 8 2D-SWE studies. Unreliable measurement data were provided in 21 TE, 4 pSWE, and 1 2D-SWE study. The pooled proportion of unreliable measurements of TE was 12.1%. Meta-regression analysis showed that the study population size and readers' blinding to pathologic results affected the study's heterogeneity. The pooled proportions of technical failure during pSWE and 2D-SWE were 4.1% and 2.2%, respectively, demonstrating no significant difference between the techniques. CONCLUSIONS We reviewed the technical performance of SWE, especially the rate of unreliable measurements from TE studies and rates of technical failure from pSWE and 2D-SWE studies. Considering the importance of technical performance for clinical validation of SWE, numbers of and reasons for technical failure and unreliable measurements should be reported in future studies. Further efforts are necessary to standardize SWE reliability criteria. KEY POINTS • Most TE studies reported rate of unreliable measurements, whereas pSWE and 2D-SWE studies were likely to report rates of technical failure. • The pooled proportion of unreliable measurements of TE was 12.1%. • The pooled proportions of technical failure during pSWE and 2D-SWE were 4.1% and 2.2%, respectively, demonstrating no significant difference between the techniques.
Collapse
Affiliation(s)
- Dong Wook Kim
- Department of Radiology, Taean-gun Health Center and County Hospital, 1952-16, Seohae-ro, Pyeongcheon-ri, Taean-eup, Taean-gun, Chungcheongnam-do, 32148, Republic of Korea
| | - Chan Park
- Department of Radiology, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| |
Collapse
|
|
33
|
Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children. Pediatr Radiol 2019; 49:91-98. [PMID: 30267166 DOI: 10.1007/s00247-018-4244-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/14/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Two-dimensional (2-D) shear wave elastography is a new sonographic elastography method for noninvasive measurement of liver stiffness. OBJECTIVE The aim of this study was to establish reference values of normal liver stiffness on 2-D shear wave elastography in children. MATERIALS AND METHODS Two-dimensional shear wave elastography values were measured in 202 children with no liver disease from the neonatal period to puberty, who were divided into 4 age groups: newborns and infants, preschoolers, elementary school children and adolescents. We investigated the effects of age, depth of elastography measurement, transducer, number of measurements per child, liver size and Doppler parameters of hepatic blood flow on liver elasticity values. RESULTS The mean normal liver elasticity value in the study population was: 4.29±0.59 kilopascals (kPa). In neonates and infants, mean liver elasticity value was 4.63 (± 0.6) kPa, in preschoolers and elementary school children, 4.05 (± 0.57) kPa and 4.15 (± 0.52) kPa, respectively, and in adolescents, 4.39 (± 0.55) kPa. Values in neonates and infants as well as adolescents were significantly higher than in preschoolers and elementary school children (Kruskal-Wallis, P<0.001; Mann-Whitney U tests, P<0.05). There was no significant association between liver elasticity values and size of the right lobe or Doppler parameters of hepatic blood flow. Different depths and the number of elastography measurements had no effect on liver elasticity values. CONCLUSION Two-dimensional shear wave elastography is achievable in a wide range of age in children. We established the reference values of normal liver stiffness on 2-D shear wave elastography in children.
Collapse
|
|
34
|
Zhao Q, Sun JW, Zhou H, Du LY, Wang XL, Tao L, Jiang ZP, Zhou XL. Pre-operative Conventional Ultrasound and Sonoelastography Evaluation for Predicting Axillary Lymph Node Metastasis in Patients with Malignant Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2587-2595. [PMID: 30174232 DOI: 10.1016/j.ultrasmedbio.2018.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 06/08/2023]
Abstract
The objective of our study was to evaluate the association between the sonoelastography features of breast tumor and axillary lymph node metastasis (ALNM) in patients with breast cancer. In a cohort of 106 women with breast cancer, the conventional ultrasound features and elasticity parameters by elasticity imaging and Virtual Touch Tissue Imaging & Quantification (VTIQ) were retrospectively analyzed. Ultrasound and elastography findings were compared with pathologic axillary lymph node status. Receiver operating characteristic curve analysis was used to evaluate diagnostic performance. Pathologically, the overall incidence of ALNM was 39.6% (42/106) in the final analysis. ALNM was significantly more frequent in tumors with elasticity imaging scores >4.5, maximal shear wave velocity values (Smax) >6.42 m/s and mean shear wave velocity values (Smean) >5.66 m/s, respectively. The sensitivity, specificity and accuracy were 78.6%, 54.7% and 64.2% for elasticity imaging score; 85.7%, 54.7% and 67.0% for Smax; and 59.5%, 79.7% and 71.7% for Smean, respectively Elastography features, including elasticity imaging score and VTIQ, can be used to supplement conventional ultrasound to predict ALNM in patients with breast cancers.
Collapse
Affiliation(s)
- Qing Zhao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Wei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hang Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin-Yao Du
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Lei Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Tao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhao-Peng Jiang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| |
Collapse
|
|
35
|
Hudert CA, Tzschätzsch H, Guo J, Rudolph B, Bläker H, Loddenkemper C, Luck W, Müller HP, Baumgart DC, Hamm B, Braun J, Holzhütter HG, Wiegand S, Sack I. US Time-Harmonic Elastography: Detection of Liver Fibrosis in Adolescents with Extreme Obesity with Nonalcoholic Fatty Liver Disease. Radiology 2018; 288:99-106. [DOI: 10.1148/radiol.2018172928] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Christian A. Hudert
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Heiko Tzschätzsch
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jing Guo
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Birgit Rudolph
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hendrik Bläker
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Christoph Loddenkemper
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Werner Luck
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hans-Peter Müller
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel C. Baumgart
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jürgen Braun
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hermann-Georg Holzhütter
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Susanna Wiegand
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ingolf Sack
- From the Center for Chronically Sick Children (C.A.H., S.W.), Departments of Radiology (H.T., J.G., B.H., I.S.), Pathology (B.R., H.B., C.L.), Pediatric Gastroenterology (W.L.), and Gastroenterology and Hepatology (H.P.M., D.C.B.), and the Institutes for Medical Informatics (J.B.) and Biochemistry (H.G.H.), Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
|
36
|
Pawlowska M, Sobolewska-Pilarczyk M, Domagalski K. Hepatitis C virus infection in children in the era of direct-acting antiviral. World J Gastroenterol 2018; 24:2555-2566. [PMID: 29962813 PMCID: PMC6021773 DOI: 10.3748/wjg.v24.i24.2555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection remains an important global health problem with chronic infection affecting approximately 11 million children worldwide. The emergence of direct-acting antiviral (DAA) therapies and the development of non-invasive methods for the determination of liver fibrosis will significantly improve the management of paediatric patients with chronic HCV infection in subsequent years. For paediatric patients, a new era of highly effective DAA agents is beginning, and the first results of available clinical trials are very promising. In this era, the identification and monitoring of patients continues to be an important issue. The availability of non-invasive serological and imaging methods to measure hepatic fibrosis enables the identification of patients with significant or advanced liver fibrosis stages. This article summarizes the current data on the epidemiology and progress of research aimed to evaluate the new therapies and non-invasive methods for liver injury in paediatric patients with chronic hepatitis C.
Collapse
Affiliation(s)
- Malgorzata Pawlowska
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Malgorzata Sobolewska-Pilarczyk
- Department of Paediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
| | - Krzysztof Domagalski
- Centre For Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń 87-100, Poland
| |
Collapse
|
|
37
|
Mandelia C, Kabbany MN, Conjeevaram Selvakumar PK, Alkhouri N. The search for noninvasive methods to identify liver fibrosis in children with nonalcoholic fatty liver disease. Biomark Med 2018. [PMID: 29517271 DOI: 10.2217/bmm-2017-0038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic. Recent studies have clearly shown that the stage of fibrosis in adults with NAFLD is the most important histological feature in long-term outcomes and the development of liver-related complications. Despite the paucity of data regarding the natural history of pediatric NAFLD, its progression to cirrhosis and end-stage liver disease requiring liver transplantation is well documented. Given the high prevalence of NAFLD in children and adults, there is an urgent need to find safe and cost-effective alternatives to biopsy to determine the stage of liver fibrosis. In this review, we provide a concise overview of different noninvasive methods for diagnosing and staging liver fibrosis in children with NAFLD.
Collapse
Affiliation(s)
- Chetan Mandelia
- Department of Pediatric Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mohammad Nasser Kabbany
- Department of Pediatric Gastroenterology & Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Naim Alkhouri
- Texas Liver Institute, UT Health San Antonio, San Antonio, TX 78215, USA
| |
Collapse
|
|
38
|
Berná-Serna JD, Sánchez-Jiménez R, Velázquez-Marín F, Sainz de Baranda P, Guzmán-Aroca F, Fernández-Hernández C, Doménech-Abellán E, Abellán-Rivero D, Ruiz-Merino G, Madrid-Conesa J, Canteras-Jordana M. Acoustic radiation force impulse imaging for detection of liver fibrosis in overweight and obese children. Acta Radiol 2018; 59:247-253. [PMID: 28475023 DOI: 10.1177/0284185117707359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF). Purpose To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children Material and Methods A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV). Results The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis. Conclusion The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.
Collapse
Affiliation(s)
- Juan D Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | - Regina Sánchez-Jiménez
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | - Francisca Velázquez-Marín
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | | | - Florentina Guzmán-Aroca
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | - Carmen Fernández-Hernández
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | - Ernesto Doménech-Abellán
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | - Dolores Abellán-Rivero
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital- IMIB, Ctra. Madrid-Cartagena, 30120, El Palmar (Murcia), Spain
| | | | - Juan Madrid-Conesa
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | | |
Collapse
|
|
39
|
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; 58:1511-1518. [PMID: 28286981 DOI: 10.1177/0284185117695668] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The identification and subsequent management of liver diseases in children is challenging due to the lack of non-invasive imaging biomarkers. Ultrasound shear-wave elastography (US-SWE) is an emerging imaging technique which can quantitatively assess liver stiffness and may be useful as a tool in the management of liver disease in overweight and obese children. Purpose To evaluate US-SWE velocities of the liver in normal-weight and obese children, to correlate US-SWE findings with age and body-mass-index (BMI), and to compare US-SWE values with qualitative assessment (i.e. normal versus abnormal echogenicity) of the liver by conventional US. Material and Methods A cohort of 300 children (mean age, 9.9 ± 5.3 years; age range, 0.06-18.9 years) were studied, comprising 176 normal-weight and 124 obese participants. In each patient, both US-SWE and conventional US of the liver were obtained. Three pediatric radiologists individually and in consensus determined whether liver parenchyma was of normal or abnormal echogenicity. Results US-SWE velocities differed between normal-weight and obese children (1.08 ± 0.14 versus 1.44 ± 0.39 m/s; P < 0.001), but not by gender. Multivariate linear regression demonstrated US-SWE velocity to be primarily associated with age in normal-weight children ( P < 0.05) and with BMI in obese children ( P < 0.001). In the obese group, mean US-SWE velocity was statistically higher in participants with abnormal echogenic livers than in those with normal-appearing livers (1.53 ± 0.38 vs. 1.17 ± 0.27). The difference was not significant in the normal-weight group. Conclusion US-SWE provides a useful quantitative imaging biomarker for evaluating liver stiffness in children.
Collapse
Affiliation(s)
- Smita Sane Bailey
- Department of Medical Imaging and Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Mostafa Youssfi
- Department of Medical Imaging and Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Mittun Patel
- Department of Medical Imaging and Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Houchun H Hu
- Department of Medical Imaging and Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Richard B Towbin
- Department of Medical Imaging and Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
| |
Collapse
|
|
40
|
Özkan MB, Bilgici MC, Eren E, Caltepe G, Yilmaz G, Kara C, Gun S. Role of Point Shear Wave Elastography in the Determination of the Severity of Fibrosis in Pediatric Liver Diseases With Pathologic Correlations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2337-2344. [PMID: 28586157 DOI: 10.1002/jum.14277] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our aims in this study were as follows: (1) to determine the cutoff value that can distinguish between advanced liver fibrosis and normal liver tissue for two different elastographic techniques; (2) to determine the cutoff value that can distinguish mild liver fibrosis from normal liver tissue for the techniques; and (3) to assess tissue stiffness in nonalcoholic fatty liver disease (NAFLD). METHODS Seventy-five patients assessed for liver biopsy on the same day were evaluated by point shear wave elastography. Thirty-one healthy children and 11 children with NAFLD were also evaluated. A 9L4 transducer with Virtual Touch quantification (VTQ) and Virtual Touch imaging and quantification (VTIQ) modes (Siemens Medical Solutions, Mountain View, CA) was used for quantification. RESULTS The shear wave speed of the patients with NAFLD was higher than that of the control group. The only predictive factor for VTQ and VTIQ was the histologic fibrosis score (model-adjusted R2 = 0.56 for VTQ and 0.75 for VTIQ). Shear wave speed cutoffs were 1.67 m/s for VTQ and 1.56 m/s for VTIQ in detecting fibrosis or inflammation and 2.09 m/s for VTQ and 2.17 m/s for VTIQ in discriminating children with low and high histologic liver fibrosis scores. CONCLUSIONS The VTQ and VTIQ values reveal high-grade histopathologic fibrosis and have high success rates when distinguishing high- from low-grade fibrosis. However, they have limited success rates when differentiating low-grade fibrosis from normal liver tissue.
Collapse
Affiliation(s)
- Mehmet Burak Özkan
- Department of Pediatric Radiology, Dr Sami Ulus Research and Training Hospital, Ankara, Turkey
| | | | - Esra Eren
- Department of Pediatric Gastroenterology, Omu, Samsun, Turkey
| | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Omu, Samsun, Turkey
| | - Gulay Yilmaz
- Department of Pediatric Endocrinology, Omu, Samsun, Turkey
| | - Cengiz Kara
- Department of Pediatric Endocrinology, Omu, Samsun, Turkey
| | - Seda Gun
- Department of Pathology, Omu, Samsun, Turkey
| |
Collapse
|
|
41
|
The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis. Eur Radiol 2017; 28:1175-1186. [DOI: 10.1007/s00330-017-5078-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/11/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
|
|
42
|
Palabiyik FB, Inci E, Turkay R, Bas D. Evaluation of Liver, Kidney, and Spleen Elasticity in Healthy Newborns and Infants Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2039-2045. [PMID: 28417472 DOI: 10.1002/jum.14202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Elasticity measurements of tissues can be valuable in the diagnosis and management of various diseases. The aim of this study was to determine the elasticity values for normal liver, kidney, and spleen of healthy newborns and infants using shear wave elastography (SWE) imaging. METHODS A total of 50 healthy term newborns and infants (19 girls and 31 boys; mean age 20.1 days, range 1 to 70 days) were examined by an experienced pediatric radiologist using SWE. None of them had any liver, kidney or spleen disease, or any other systemic disease that could affect these organs secondarily. All newborns and infants had a normal abdominal ultrasound scan. RESULTS Age, sex, weight, height, and body mass index had no significant effects on shear wave velocity (SWV) values of liver and spleen. The SWV values of both kidneys decreased with age, weight, height, and body mass index. The mean SWV values were 1.70 m/s (range: 1.23-2.43 m/s) for the liver, 1.69 m/s (range: 0.8-2.40 m/s) for the right kidney, 1.70 m/s (range: 0.9-2.49 m/s) for the left kidney, and 2.03 m/s (range: 1.28-2.48 m/s) for the spleen. CONCLUSIONS Shear wave elastography can be used to measure liver, kidney, and spleen elasticity in newborns and infants. The standard values for abdominal organs allow differentiation of healthy versus pathological tissue. We measured the normal values of SWE in healthy newborns and infants as reference data.
Collapse
Affiliation(s)
- Figen Bakirtas Palabiyik
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Rustu Turkay
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Derya Bas
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
|
43
|
Hong EK, Choi YH, Cheon JE, Kim WS, Kim IO, Kang SY. Accurate measurements of liver stiffness using shear wave elastography in children and young adults and the role of the stability index. Ultrasonography 2017; 37:226-232. [PMID: 29096427 PMCID: PMC6044215 DOI: 10.14366/usg.17025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the usefulness of the stability index (SI) in liver stiffness measurements using shear wave elastography (SWE) in children. Methods A total of 29 children and young adults (mean age, 16.1 years; range, 8 to 28 years; 11 boys and 18 girls) who underwent liver stiffness measurements using SWE under free-breathing and breath-holding conditions were included in our study. Ten SWE measurements were acquired in each of four groups: free-breathing and breath-holding, and with and without using the SI. The failure rate of acquisition of SI values over 90% was calculated in each group. To evaluate variability in the SWE measurements, the standard deviation, coefficient of variation, and percentage of unreliable measurements were compared. Intraobserver agreement and the optimal minimal number of measurements were calculated using intraclass correlation coefficients. Results A failure to acquire SI values over 90% was observed in 17% of the scans in the free-breathing group and in 7% of the scans in the breath-holding group. In both groups, utilizing the SI led to a significantly lower standard deviation and coefficient of variation. When using the SI, the percentage of unreliable measurements decreased from 16.7% to 8.3% in the free-breathing group and 14.8% to 0% in the breath-holding group. With the use of the SI, intraobserver agreement increased and the optimal minimal number of repeated measurements decreased in both the free-breathing and breath-holding groups. Conclusion Utilization of the SI in the measurement of liver SWE in children reduced measurement variability and increased reliability in both free-breathing and breath-holding conditions.
Collapse
Affiliation(s)
- Eun Kyoung Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Sun Young Kang
- Department of Clinical Ultrasound, DongSeo Medicare Co., Ltd., Seongnam, Korea
| |
Collapse
|
|
44
|
Gao F, Chen YQ, Fang J, Gu SL, Li L, Wang XY. Acoustic Radiation Force Impulse Imaging for Assessing Liver Fibrosis Preoperatively in Infants With Biliary Atresia: Comparison With Liver Fibrosis Biopsy Pathology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1571-1578. [PMID: 28407283 DOI: 10.7863/ultra.16.08043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/17/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the diagnostic performance of acoustic radiation force impulse (ARFI) in assessing liver fibrosis preoperatively in infants with biliary atresia (BA). METHODS A total of 50 consecutive infants with BA and 50 healthy infants who underwent ARFI examination were recruited. Siemens Acuson S2000 in Virtual Touch Quantification mode (Siemens Medical Solutions, Mountain View, CA) was used to measure shear wave speeds (SWSs). All infants with BA underwent a liver biopsy within 3 days after ARFI imaging. The liver fibrosis stages of specimens were defined according to the Batts-Ludwig scoring system. The correlation analysis was performed between SWSs and pathological findings. Cut-off values were determined using receiver operating characteristic (ROC) curves. RESULTS The mean SWS in the BA group was significantly higher than controls (mean ± standard deviation): 1.89 ± 0.45 versus 1.12 ± 0.06 m/s; P < .001). A significant correlation was found between the SWSs and fibrosis stages (r = 0.719, P < .001). The cut-off value for predicting significant fibrosis (F ≥ 2), severe fibrosis (F ≥ 3), and cirrhosis (F = 4) was 1.53, 1.80 and 2.16 m/s, respectively, and the area under the ROC curve was 0.823, 0.884 and 0.917, respectively. CONCLUSIONS Acoustic radiation force impulse imaging showed significant correlation with the severity of liver fibrosis by comparing it with liver fibrosis biopsy pathology. It may be an effective method for liver fibrosis assessment, prognosis prediction, and clinical management in infants with BA.
Collapse
Affiliation(s)
- Fen Gao
- Department of Ultrasound, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ya-Qing Chen
- Department of Ultrasound, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Fang
- Department of Ultrasound, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sheng-Li Gu
- Department of Ultrasound, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Luan Li
- Department of Ultrasound, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Ying Wang
- Department of Pathology, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
|
45
|
Chapman T, Dubinsky T, Barr RG. Ultrasound Elastography of the Liver: What the Clinician Needs to Know. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1293-1304. [PMID: 28258611 DOI: 10.7863/ultra.16.08001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Todd Chapman
- University of Washington Medical Center, Seattle, Washington, USA
| | | | - Richard G Barr
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Radiology Consultants, Youngstown, Ohio, USA
| |
Collapse
|
|
46
|
Tang Y, Yan F, Yang Y, Xiang X, Wang L, Zhang L, Qiu L. Value of Shear Wave Elastography in the Diagnosis of Gouty and Non-Gouty Arthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:884-892. [PMID: 28187927 DOI: 10.1016/j.ultrasmedbio.2016.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 02/05/2023]
Abstract
Our aim was to analyze the diagnostic performance of shear wave elastography (SWE) in the diagnosis of gouty arthritis (GA) and non-gouty arthritis (non-GA). Thirty-nine patients in the GA group and 55 patients in the non-GA group were included in the study. Based on the echo intensity of the joint lesions, the GA group was subdivided into hypo-echoic GA, slightly hyper-echoic GA and hyper-echoic GA subgroups. Quantitative SWE features were evaluated and receiver operating characteristic analysis was performed. On the basis of the study, the elastic modulus (Emax), mean elastic modulus (Emean), minimum elastic modulus (Emin) and elastic modulus standard deviation (ESD) were significantly higher in the GA group than in the non-GA group and were highest in the hyper-echoic GA subgroup (p < 0.01 for all). Emin, Emean and Emax were significantly higher in the hyper-echoic GA subgroup than in the hypo-echoic GA subgroup and non-GA group (p < 0.001 for all), and ESD was significantly higher in the hyper-echoic GA subgroup than in the non-GA group (p = 0.001). Emin, Emean, Emax and ESD were higher in the hypo-echoic GA subgroup than in the non-GA group, and the differences were significant (p < 0.001 for all). Based on the hypo-echoic GA subgroup and non-GA group, areas under the receiver operating characteristic curves for the prediction of GA were 0.749 for Emin, 0.877 for Emean, 0.896 for Emax and 0.886 for ESD, with optimal cutoff values of 29.40 kPa for Emin, 45.35 kPa for Emean, 67.54 kPa for Emax and 7.85 kPa for ESD. Our results indicate that SWE can differentially diagnose GA and non-GA, especially when the ultrasound manifestations are not typical.
Collapse
Affiliation(s)
- Yuanjiao Tang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Feng Yan
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Clinical Ultrasound Imaging Drug Research Lab, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yujia Yang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liyun Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lingyan Zhang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
|
47
|
Serai SD, Trout AT, Sirlin CB. Elastography to assess the stage of liver fibrosis in children: Concepts, opportunities, and challenges. Clin Liver Dis (Hoboken) 2017; 9:5-10. [PMID: 30992948 PMCID: PMC6467133 DOI: 10.1002/cld.607] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/29/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | - Claude B. Sirlin
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhio
| |
Collapse
|
|
48
|
Zhou H, Zhou XL, Xu HX, Li DD, Liu BJ, Zhang YF, Xu JM, Bo XW, Li XL, Guo LH, Qu S. Virtual Touch Tissue Imaging and Quantification in the Evaluation of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:251-260. [PMID: 27914177 DOI: 10.7863/ultra.15.12070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate the diagnostic performance of a 2-dimensional shear wave elastographic technique (Virtual Touch tissue imaging and quantification [VTIQ]; Siemens Medical Solutions, Mountain View, CA) for predicting thyroid malignancy. METHODS A total of 302 thyroid nodules underwent conventional sonography and VTIQ before fine-needle aspiration examination or surgery. Compared with histopathologic or cytologic results in combination with follow-up, the diagnostic performance of various shear wave speed (SWS) indices (minimum [SWSmin ], maximum [SWSmax ], and mean [SWSmean ]) on VTIQ as well as conventional sonographic features for predicting thyroid malignancy was evaluated in all of the nodules. RESULTS Sixty-five malignant and 237 benign thyroid nodules were histopathologically or cytologically confirmed. All SWS indices on VTIQ were lower in benign nodules than thyroid malignancy (all P < .001). For discrimination between malignant and benign nodules, all VTIQ SWS indices were better than conventional sonographic features, such as a solid component, a taller-than-wide shape, microcalcification, a poorly defined margin and hypoechogenicity, in predicting thyroid malignancy (all P < .05). By applying a cutoff SWSmean value of 2.60 m/s, VTIQ achieved sensitivity and negative predictive values of 84.6% and 94.3%, respectively, for differentiating nodules. The areas under the receiver operating characteristic curve of SWSmax (0.862 versus 0.717), SWSmin (0.866 versus 0.717), and SWSmean (0.891 versus 0.725) for nodules larger than 10 mm were higher than those for nodules of 10 mm or smaller (all P < .05). Interoperator and intraoperator reproducibility was proven to be excellent, with all interclass correlation coefficient values higher than 0.80 (range, 0.813-0.905) CONCLUSIONS: Virtual Touch tissue imaging and quantification is a useful and reproducible tool for predicting thyroid malignancy.
Collapse
Affiliation(s)
- Hang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Inpatient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Xian-Li Zhou
- Inpatient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
|
49
|
Phelps A, Ramachandran R, Courtier J, Perito E, Rosenthal P, MacKenzie JD. Ultrasound elastography: is there a shear wave speed cutoff for pediatric liver fibrosis and inflammation? Clin Imaging 2017; 41:95-100. [PMID: 27840268 DOI: 10.1016/j.clinimag.2016.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/26/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022]
|
|
50
|
Trout AT, Dillman JR, Xanthakos S, Kohli R, Sprague G, Serai S, Mahley AD, Podberesky DJ. Prospective Assessment of Correlation between US Acoustic Radiation Force Impulse and MR Elastography in a Pediatric Population: Dispersion of US Shear-Wave Speed Measurement Matters. Radiology 2016; 281:544-552. [PMID: 27228332 PMCID: PMC11801518 DOI: 10.1148/radiol.2016152797] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose To evaluate the correlation between ultrasonographic (US) point shear-wave elastography (SWE) and magnetic resonance (MR) elastography liver shear-wave speed (SWS) measurements in a pediatric population and to determine if US data dispersion affects this relationship. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant investigation; informed consent and patient assent (as indicated) were obtained. Patients (age range, 0-21 years) undergoing clinical liver MR elastography between July 2014 and November 2015 were prospectively enrolled. Patients underwent two-dimensional gradient-recalled-echo 1.5-T MR elastography with point SWE performed immediately before or immediately after MR elastography. Spearman rank correlation coefficients were calculated to assess the relationship and agreement between point SWE and MR elastography SWS measurements. Uni- and multivariate logistic regression were performed to identify predictors of US data dispersion, with the best multivariate model selected based on Akaike information criterion. Results A total of 55 patients (24 female) were enrolled (mean age, 14.0 years ± 3.9 (standard deviation) (range, 3.5-21.4 years). There was fair correlation between point SWE and MR elastography SWS values for all patients (ρ = 0.33, P = .016). Correlation was substantial, however, when including only patients with minimal US data dispersion (n = 26, ρ = 0.61, P = .001). Mean body mass index (BMI) was significantly lower in patients with minimal US data dispersion than in those with substantial US data dispersion (25.4 kg/m2 ± 7.8 vs 32.3 kg/m2 ± 8.3, P = .003). At univariate analysis, BMI (odds ratio, 1.12; 95% confidence interval [CI]: 1.03, 1.21; P = .006) and abdominal wall thickness (odds ratio, 2.50; 95% CI: 1.32, 4.74; P = .005) were significant predictors of US data dispersion. In the best multivariate model, BMI was the only significant predictor (odds ratio, 1.11; 95% CI: 1.03, 1.20; P = .009). Conclusion Point SWE and MR elastography liver SWS measurements correlate well in patients with a BMI of less than 30 kg/m2 and minimal US data dispersion; increasing US data dispersion is directly related to a higher BMI. © RSNA, 2016.
Collapse
Affiliation(s)
- Andrew T Trout
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Jonathan R Dillman
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Stavra Xanthakos
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Rohit Kohli
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Garrett Sprague
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Suraj Serai
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Alana D Mahley
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| | - Daniel J Podberesky
- From the Department of Radiology (A.T.T., J.R.D., S.S., A.D.M.) and Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics (S.X., R.K.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; University of Cincinnati College of Medicine, Cincinnati, Ohio (G.S.); Nemours Children's Health System, Nemours Children's Hospital, Orlando, Fla (D.J.P.); University of Central Florida College of Medicine, Orlando, Fla (D.J.P.); and Florida State University College of Medicine, Orlando, Fla (D.J.P.)
| |
Collapse
|