Shear Wave Elastography in Children

Abstract

Most recently the update on the 2013 published European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines and Recommendations on the clinical use of elastography have been published focusing on the assessment of diffuse liver disease (1, 2). The first part of the long version of these EFSUMB Guidelines deals with the basic principles of elastography including the reasons why ultrasound can be used to make elastograms. Transient elastography (TE) is explained as shear wave elastometry by measurement of the speed of a shear wave that has been generated using a surface impulse. Point shear wave elastography (pSWE) is explained as shear wave elastometry at a location by measurement of the speed of a shear wave generated using acoustic radiation force. Multidimensional shear-wave elastography (2D-SWE, 3D-SWE) is described as quantitative SWE imaging (and elastometry) by measuring the speed of shear waves generated using acoustic radiation force. Acoustic radiation force impulse (ARFI) imaging is discussed as well (1, 2). Guidance is provided on optimization of scanning technique, image display, image interpretation, reporting of data and some of the known image artefacts. The second and clinical part provides clinical information about the practical use of elastography equipment and interpretation of results in the assessment of different etiologies of diffuse liver disease including normal values and reliability indices (1-4). Comparative little is known about pediatric patients. Data regarding the pediatric population with biliary atresia suggest that liver (and spleen) elastography could be a valuable tool to predict outcomes before surgery, and might be used after the Kasai operation to monitor liver disease and portal hypertension [(5)]. Many other indications have been shown of value in daily practice but comparative studies are lacking. Here we present the current knowledge and our own data on the use of elastography in pediatric patients including the use of strain elastography (SE) and strain-rate imaging (quasi-static strain imaging). Future perspectives of this promising method are discussed as well. 1. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med 2017. 2. Dietrich CF, Bamber J, Berzigotti A, Bota S, Cantisani V, Castera L, Cosgrove D, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version). Ultraschall Med 2017. 3. Dong Y, Sirli R, Ferraioli G, Sporea I, Chiorean L, Cui X, Fan M, et al. Shear wave elastography of the liver - review on normal values. Z Gastroenterol 2017;55:153-166. 4. Dietrich CF, Dong Y. Shear wave elastography with a new reliability indicator. J Ultrason 2016;16:281-287. 5. Colecchia A, Di Biase AR, Scaioli E, Predieri B, Iughetti L, Reggiani ML, Montrone L, et al. Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Dig Liver Dis 2011;43:659-663.