Abstract
Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD.
Highlights
Childhood obesity is a continuous emerging burden worldwide
The studies that assessed the role of elastography in pediatric nonalcoholic fatty liver disease (NAFLD) staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy
Similar findings were reported by Alkhouri et al on 67 children with histologically proven NAFLD according to the Kleiner’s system, who stated that TE is a useful non-invasive indicator of clinically significant liver fibrosis guiding the proper selection of patients that require liver biopsy [115]
Summary
According to the World Health Organization reports from 2018, pediatric overweight and obesity represent two major public health problems affecting over 40 million children aged under 5 years [1] Both conditions consist of excessive fat accumulation and carry a wide-spectrum of associated complications. The gold-standard in providing an accurate diagnosis and staging of NAFLD is undoubtedly liver biopsy, which allows a proper assessment of other hepatic conditions This procedure carries multiple risks in children and parents’ refusal is a major hindrance for this approach in young ages. Most of the studies sustain that elevated liver transaminases represent a common finding associated with liver disease in children with obesity [5] Taking into account their fluctuations over time and even their normal levels in children with NAFLD, or even NASH, their role as single parameter in diagnosing this hepatic condition is doubtable [13]. The aim of this review was to assess the role of elastography in pediatric NAFLD staging, as well as identifying its potential limitations and challenges in this age group
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