DOI: https://doi.org/10.22141/2308-2097.52.3.2018.141842

Sonological methods for diagnosing liver steatosis and fibrosis in children

Yu.M. Stepanov, N.Yu. Zavhorodnia, O.Yu. Lukianenko, V.B. Yahmur, I.S. Konenko, O.P. Petishko

Abstract


Background. The purpose was to compare the possibilities of standard ultrasound, shear wave elastography with steatometry and transient elastography with CAP function for diagnosing liver steatosis and fibrosis. Materials and methods. The survey included 90 patients aged 5 to 17 years, with an average age of patients (12.08 ± 2.71) years. Determination of liver steatosis and its degree was carried out with FibroScan 520 Touch (Echosens, France) with CAP measurement. All children underwent an ultrasound examination of the liver parenchyma using B-method with simultaneous shear wave elastography and steatometry on Ultima PA (Radmir, Kharkiv). According to the CAP measurements and overweight/obesity parameters the patients were divided into 3 groups: 1st group consisted of 45 patients with liver steatosis and overweight and obesity (50.0 %), 2nd group — 35 patients with overweight and obesity without steatosis (38.9 %), 3rd group (control group) — 10 patients with normal weight without steatosis (11.1 %). Results. 75.0 % of patients experienced increased echogenicity of the liver. In children of the 1st group changes in liver parenchyma were observed 2.2 times more frequently than in the 2nd and 3rd groups. The liver stiffness in the examined patients varied from 2.3 to 8.8 kPa, and the CAP — from 108 to 349 dB/m. In the overwhelming majority (96.1 %) of patients, fibrosis was absent; the first and second degrees of fibrosis were found only in 3 patients (3.9 %) in the first group. According to steatometry of the liver, the average coefficient of ultrasound attenuation in children of the 1st group was significantly higher compared to the control group (p < 0.05). The shear wave elastography sensitivity in liver fibrosis detection versus transient elastography was 83.33 %, the specificity was 60.0 %, the positive predictive value was 15.15 %, the negative predictive value was 97.67 %. When comparing the methods of steatometry and CAP, the diagnosis of liver steatosis in children of the 1st group revealed coincidence in 15 of 26 cases, which corresponded to diagnostic efficiency of 57.7 %. Conclusions. Thus, the combination of ultrasound regimes for assessing structural changes in the liver with shear wave elastography and steatometry allows assessing the stage of fibrosis and the degree of steatosis in the context of multiparameter ultrasound examination in children with diffuse changes in the liver parenchyma.


Keywords


ultrasound; shear wave elastography with steatometry; transient elastography with CAP function; liver steatosis; liver fibrosis

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References


Vajro P, Lenta S, Socha P, et al. Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012 May;54(5):700-13. doi: 10.1097/MPG.0b013e318252a13f.

Di Martino M, Koryukova K, Bezzi M, Catalano C. Imaging Features of Non-Alcoholic Fatty Liver Disease in Children and Adolescents. Children (Basel). 2017 Aug 11;4(8). pii: E73. doi: 10.3390/children4080073.

Awai HI, Newton KP, Sirlin CB, Behling C, Schwimmer JB. Evidence and recommendations for imaging liver fat in children, based on systematic review. Clin Gastroenterol Hepatol. 2014 May;12(5):765-73. doi: 10.1016/j.cgh.2013.09.050. 

Isaksen VT, Larsen MA, Goll R, Florholmen JR, Paulssen EJ. Hepatic steatosis, detected by hepatorenal index in ultrasonography, as a predictor of insulin resistance in obese subjects. BMC Obes. 2016 Sep 20;3:39. doi: 10.1186/s40608-016-0118-0.

Liao YY, Yang KC, Lee MJ, Huang KC, Chen JD, Yeh CK. Multifeature analysis of an ultrasound quantitative diagnostic index for classifying nonalcoholic fatty liver disease. Sci Rep. 2016 Oct 13;6:35083. doi: 10.1038/srep35083.

Kanayama Y, Kamiyama N, Maruyama K, Sumino Y. Real-time ultrasound attenuation imaging of diffuse fatty liver disease. Ultrasound Med Biol. 2013 Apr;39(4):692-705. doi: 10.1016/j.ultrasmedbio.2012.10.021.

Goldschmidt I, Streckenbach C, Dingemann C, et al. Application and limitations of transient liver elastography in children. J Pediatr Gastroenterol Nutr. 2013 Jul;57(1):109-13. doi: 10.1097/MPG.0b013e31829206a0.

Sasso M, Beaugrand M, de Ledinghen V, et al. Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010 Nov;36(11):1825-35. doi: 10.1016/j.ultrasmedbio.2010.07.005.

de Lédinghen V, Vergniol J, Foucher J, Merrouche W, le Bail B. Non‐invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography. Liver Int. 2012 Jul;32(6):911-8. doi: 10.1111/j.1478-3231.2012.02820.x.

Shi KQ, Tang JZ, Zhu XL, et al. Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: A meta‐analysis of diagnostic accuracy. J Gastroenterol Hepatol. 2014 Jun;29(6):1149-58. doi: 10.1111/jgh.12519.

Desai NK, Harney S, Raza R, et al. Comparison of controlled attenuation parameter and liver biopsy to assess hepatic steatosis in pediatric patients. J Pediatr. 2016 Jun;173:160-164.e1. doi: 10.1016/j.jpeds.2016.03.021. 

Dynnyk OB, Mykhalchishin GP, Kobyliak NM, Bodnar PM. Liver Stiffness According to Data of Shear Wave Elastography in Patients with Diabetes Mellitus Type 2 and Nonalcoholic Fatty Liver Disease Depending on Activity of NAFLD. Gastroenterologia. 2014;(53):24-29. (in Ukrainian).

Tutar O1, Beşer ÖF, Adaletli I, et al. Shear wave elastography in the evaluation of liver fibrosis in children. J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):750-5. doi: 10.1097/MPG.0000000000000329.

World Health Organization. Growth reference 5-19 years: BMI-for-age (5-19 years). Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/.

Masaki K, Takaki S, Hyogo H, et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver disease. Hepatol Res. 2013 Nov;43(11):1182-9. doi: 10.1111/hepr.12094.

Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010 Dec;53(6):1013-21. doi: 10.1016/j.jhep.2010.05.035.

Mikolasevic I, Orlic L, Franjic N, Hauser G, Stimac D, Milic S. Transient elastography (FibroScan®) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand? World J Gastroenterol. 2016 Aug 28;22(32):7236-51. doi: 10.3748/wjg.v22.i32.7236.

Chan HL, Wong GL, Choi PC, et al. Alanine aminotransferase‐based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat. 2009 Jan;16(1):36-44. doi: 10.1111/j.1365-2893.2008.01037.x.

Tokuhara D, Cho Y, Shintaku H. Transient Elastography-Based Liver Stiffness Age-Dependently Increases in Children. PLoS One. 2016 Nov 18;11(11):e0166683. doi: 10.1371/journal.pone.0166683.

Yoneda M, Suzuki K, Kato S, et al. Nonalcoholic fatty liver disease: US based acoustic radiation force impulse elastography. Radiology. 2010 Aug;256(2):640-7. doi: 10.1148/radiol.10091662.

Marginean CO, Marginean C. Elastographic assessment of liver fibrosisin children: a prospective single center experience. Eur J Radiol. 2012 Aug;81(8):e870-4. doi: 10.1016/j.ejrad.2012.04.014.

Wong VW, Vergniol J, Wong GL, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liverdisease. Hepatology. 2010 Feb;51(2):454-62. doi: 10.1002/hep.23312.

Garcovich M, Veraldi S, Di Stasio E, et al. Liver stiffness in pediatric patients with fatty liver disease: diagnostic accuracy and reproducibility of shear-wave elastography. Radiology. 2017 Jun;283(3):820-827. doi: 10.1148/radiol.2016161002.

Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017 Feb;64(2):319-334. doi: 10.1097/MPG.0000000000001482.




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