Clinical value of ultrasound shear wave elastography in the diagnosis of biliary atresia in children

Abstract

Abstract: Objective To explore the clinical value of ultrasonic shear wave elastography (SWE) in the diagnosis of infantile biliary atresia (BA). Methods From January 2017 to July 2019, 72 suspected cases of cholestatic liver disease were treated in our hospital, including 42 males and 30 females, aged from 25 days to 160 days, with an average age of (82.6 ±16.8) days. 60 healthy patients were selected as control group. The measurement data were expressed as (±s), the t-test was used for comparative analysis, the counting data was expressed as absolute value, and the chi-square test was used for comparative analysis. The diagnostic indexes were obtained by drawing ROC curve. Results Among the 72 suspected cases of cholestatic liver disease, 38 cases of BA (BA group) were confirmed by operation, and the remaining 34 cases were included in non-BA group. There were 26 males and 12 females in BA group, with an average age of (84.3±19.8) days, while in non-BA group, there were 22 males and 12 females with an average age of (78.9±26.4) days. There was no significant difference in sex composition and age among BA group, non-BA group and control group. The average value of liver stiffness weasurement (LSM) in BA group was (14.6±6.2) kPa, the average value of LSM in non-BA group was (8.3±2.3) kPa, the average value of LSM in control group was (5.8±1.1) kPa,. There was significant difference in LSM among the three groups (P<0.05). There was no significant difference in the average value of LSM between male and female patients in the three groups (P>0. 05). The average value of LSM in BA group within 30 days was significantly lower than that in 90 days (P<0.05), but there was no significant difference in LSM between non-BA group and control group within 30 days and 90 days (P>0. 05). After drawing the ROC curve, the optimal critical value of LSM in the diagnosis of BA was 12.8 KPA, the sensitivity was 73.4% and the specificity was 88.7%, and the area under the Roc curve was 0.83. Conclusion SWE can accurately reflect the changes of LSM in infantile BA patients, and has important clinical value for the differential diagnosis of infantile BA patients.

Key words: Biliary atresia, Shear wave elastography, Liver stiffness measurement, Receiver operating characteristic curve

GENG Xing-lan, WANG Ke-jun, KANG You-liang. Clinical value of ultrasound shear wave elastography in the diagnosis of biliary atresia in children[J]. Chinese Hepatolgy, 2020, 25(8): 873-875.

References

[1] Hopkins PC, Yazigi N, Nylund CM. Incidence of biliary atresia and timing of hepatoportoenterostomy in the United States. J Pediatr, 2017, 187:253-257.
[2] Sanchez-Valle A, Kassira N, Varela VC, et al. Biliary atresia: epidemiology, genetics, clinical update, and public health perspective. Adv Pediatr, 2017, 64:285-305.
[3] Bijl EJ, Bharwani KD, Houwen RH, et al. The long-term outcome of the Kasai operation in patients with biliary atresia: a systematic review. Neth J Med, 2013, 71:170-173.
[4] Leschied JR, Dillman JR, Bilhartz J, et al. Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases. Pediatr Radiol, 2015, 45:366-375.
[5] Asai A, Miethke A, Bezerra JA. Pathogenesis of biliary atresia: defining biology to understand clinical phenotypes. Nat Rev Gastroenterol Hepatol, 2015, 12:342-352.
[6] Yokoyama S, Ishigami M, Honda T, et al. Spleen stiffness by 2-D shear wave elastography is the most accurate predictor of high-risk esophagogastric varices in children with biliary atresia. Hepatol Res, 2019, 49:1162-1168.
[7] Zhou LY, Jiang H, Shan QY, et al. Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a comparative study with grey-scale US. Eur Radiol, 2017, 27:3474-3484.
[8] Zhou L, Shan Q, Tian W, et al. Ultrasound for the diagnosis of biliary atresia: a meta-analysis. AJR Am J Roentgenol, 2016, 206:W73-82.
[9] Sasaki H, Tanaka H, Nio M. Current management of long-term survivors of biliary atresia: over 40 years of experience in a single center and review of the literature. Pediatr Surg Int, 2017, 33:1327-1333.
[10] Wong KKY, Wong CWY. A review of long-term outcome and quality of life of patients after Kasai operation surviving with native livers. Pediatr Surg Int, 2017, 33:1283-1287.
[11] Yoon HM, Suh CH, Kim JR, et al. Diagnostic performance of sonographic features in patients with biliary atresia: a systematic review and meta-analysis. J Ultrasound Med, 2017, 36:2027-2038.
[12] Suh CH, Choi YJ, Baek JH, et al. The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: a systematic review and meta-analysis. Eur Radiol, 2017, 27:222-230.
[13] Kim JR, Suh CH, Yoon HM, et al. The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: a systematic review and diagnostic meta-analysis. Eur Radiol, 2018, 28:1175-1186.
[14] Wang X, Qian L, Jia L, et al. Utility of shear wave elastography for differentiating biliary atresia from infantile hepatitis syndrome. J Ultrasound Mecl, 2016, 35:1475-1479.
[15] Duan X, Peng Y, Liu W, et al. Does supersonic shear wave elastography help differentiate biliary atresia from other causes of cholestatic hepatitis in infants less than 90 days old? Compared with grey-scale US. Biomed Res Int, 2019, 2019:9036362.