Supersonic shearwave elastography in the assessment of liver fibrosis for postoperative patients with biliary atresia.

Shuling Chen,Xiaoyan Xie,Yanling Zheng,Quanyuan Shan,Zhihai Zhong,Bing Liao,Luyao Zhou,Baoxian Liu

doi:10.1038/srep31057

Abstract

To explore an effective noninvasive tool for monitoring liver fibrosis of children with biliary atresia (BA) is important but evidences are limited. This study is to investigate the predictive accuracy of supersonic shearwave elastography (SSWE) in liver fibrosis for postoperative patients with BA and to compare it with aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4). 24 patients with BA received SSWE and laboratory tests before scheduled for liver biopsy. Spearman rank coefficient and receiver operating characteristic (ROC) were used to analyze data. Metavir scores were F0 in 3, F1 in 2, F2 in 4, F3 in 7 and F4 in 8 patients. FIB-4 failed to correlate with fibrosis stage. The areas under the ROC curves of SSWE, APRI and their combination were 0.79, 0.65 and 0.78 for significant fibrosis, 0.81, 0.64 and 0.76 for advanced fibrosis, 0.82, 0.56 and 0.84 for cirrhosis. SSWE values at biopsy was correlated with platelet count (r = −0.426, P = 0.038), serum albumin (r = −0.670, P < 0.001), total bilirubin (r = 0.419, P = 0.041) and direct bilirubin levels (r = 0.518, P = 0.010) measured at 6 months after liver biopsy. Our results indicate that SSWE is a more promising tool to assess liver fibrosis than APRI and FIB-4 in children with BA.

Highlights

Changes or avoiding big vessels[16]
Our study revealed that SSWE examination had a promising diagnostic accuracy to predict liver fibrosis stage, which is better than APRI
There are a few studies on assessing the predictive power of Fibroscan, TE, ARFI in fibrosis stage for children with various liver diseases[7,8,9]

Summary

Introduction

Changes or avoiding big vessels[16]. Second, improved separation of fibrosis stages due to the use of shear waves with greater bandwidths has improved its discriminative power in staging fibrosis[17]. The aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI) and fibrosis-4 (FIB-4) score calculated from age, AST, alanine amino-transferase (ALT) and PLT, are both, inexpensive, available and non-invasive indices. They have been reported to be a surrogate marker of fibrosis and cirrhosis in adults with hepatitis C, hepatitis B, alcoholic hepatitis and nonalcoholic fatty liver[23,24,25]. This study aimed at evaluating the performance of SSWE to predict fibrosis stage in postoperative Chinese children with BA by comparing it with APRI and FIB-4, and to preliminarily investigate the correlation of SSWE with biochemical parameters of liver function at 6 months after liver biopsy

Objectives

Methods

Results

Conclusion