Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents.

Abstract

Purpose: Ultrasound elastography by acoustic radiation force impulse imaging (ARFI) is used in adults for non invasive measurement of liver stiffness, indicating liver diseases like fibrosis. To establish ARFI in children and adolescents we determined standard values of healthy liver tissue and analysed potentially influencing factors.

Materials and Methods: 132 patients between 0 and 17 years old were measured using ARFI. None of them had any liver disease or any other disease that could affect the liver secondarily. All patients had a normal ultrasound scan, a normal BMI and normal liver function tests. The mean value of all ARFI measurements was calculated and potentially influencing factors were analysed.

Results: The mean value of all ARFI elastography measurements was 1.16 m/sec (SD ± 0.14 m/sec). Neither age (p = 0.533) nor depth of measurement (p = 0.066) had no significant influence on ARFI values, whereas a significant effect of gender was found with lower ARFI values in females (p = 0.025), however, there was no significant interaction between age groups (before or after puberty) and gender (p = 0.276). There was an interlobar difference with lower values in the right liver lobe compared to the left (p = 0.036) and with a significantly lower variance (p < 0.001). Consistend values were measured by different examiners (p = 0.108), however, the inter examiner variance deviated significantly (p < 0.001).

Conclusion: ARFI elastography is a reliable method to measure liver stiffness in children and adolescents. In relation to studies which analyse liver diseases, the standard value of 1.16 m/sec (± 0.14 m/sec) allows a differentiation of healthy versus pathological liver tissue.

Zusammenfassung

Ziel: Ultraschall-Elastografie mit Acoustic Radiotion Force Impulse Imaging (ARFI) findet bei Erwachsenen Anwendung zur nicht invasiven Messung der Lebersteifigkeit, wodurch Pathologien wie Leberfibrose erkannt werden können. Um die ARFI-Methode bei Kindern und Jugendlichen zu etablieren, wurden von uns Normwerte für gesundes Lebergewebe erstellt und potenzielle Einflussfaktoren analysiert.

Material und Methoden: Es wurden 132 Patienten im Alter von 0 – 17 Jahren untersucht. Keiner der Patienten hatte eine Lebererkrankung oder andere Erkrankungen mit sekundärem Einfluss auf die Leber.  Alle Patienten wiesen einen normalen Ultraschall der Leber auf sowie einen normalen BMI und normale Leberlaborwerte. Der Mittelwert aller ARFI-Werte wurde errechnet und mögliche Einflussfaktoren wurden analysiert.

Ergebnisse: Von allen ARFI-Werten ergab sich ein Mittelwert von 1,16 m/s (± 0,14 m/s). Weder Alter (p = 0,533), noch Messtiefe (p = 0,066) zeigten einen signifikanten Einfluss. Dagegen hatten Mädchen niedrigere ARFI-Werte als Jungen (p = 0,025). Ein Interaktionseffekt zwischen Altersgruppen (vor/nach der Pubertät) und dem Geschlecht zeigte sich nicht (p = 0,276). Messungen im rechten Leberlappen ergaben niedrigere Messwerte (p = 0,036) und eine geringere Varianz (p < 0,001). Es zeigte sich kein Einfluss der verschiedenen Untersucher (p = 0,108), wobei sich die Varianz signifikant unterschied (p < 0,001).

Schlussfolgerung: Elastografie mittels ARFI ist eine zuverlässige Methode, um Lebersteifigkeit bei Kindern und Jugendlichen zu messen. Im Zusammenhang mit Studien über Leberpathologien ermöglicht ein Normwert von 1,16 m/s (± 0,14 m/s) eine korrekte Differenzierung von gesundem und pathologisch verändertem Lebergewebe.

Key words

acoustic radiation force impulse imaging elastography - liver stiffness - children - standard value - healthy subjects

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