CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 646-652
DOI: 10.1055/s-0044-1787668
Original Article

Evaluation of Hepatic Shear Wave Elastography to Assess Liver Fibrosis in Biliary Atresia Patients and Its Correlation with Liver Histology and Surgical Outcomes: A Prospective Observational Study

1   Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
1   Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ravi Prakash Kanojia
1   Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Anmol Bhatia
2   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Sadhna B. Lal
3   Division of Pediatric, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Akshay K. Saxena
2   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Kirti Gupta
4   Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Funding None.

Abstract

Introduction The native liver survival in biliary atresia (BA) depends on various factors, and one of the crucial factors is the rate of progression of liver fibrosis after portoenterostomy, but there is no reliable investigation to assess it. This study evaluated shear wave elastography (SWE) to detect liver fibrosis in BA patients and assess its utility during follow-up.

Materials and Methods This was an observational study; SWE was done preoperatively and postoperatively at 3 and 6 months. The SWE values were analyzed to determine their correlations with preoperative liver histology as well as with postoperative SWE variation between different postoperative outcomes.

Results Twenty-one patients were included in the study; the preoperative SWE values were strongly correlated with liver biopsy grading (p < 0.001). At the 3 months postoperatively, SWE was done for 18 children: 12 in group A (patent bilioenteric drainage on hepatobiliary iminodiacetic acid scan) and 6 (nonpatent) in group B; mean SWE value was 12.8 and 17.3 kPa, respectively (p < 0.001). Ten children from group A underwent SWE 6 months postoperatively, and the mean value was 13.23 kPa.

Conclusion The SWE values correlate with liver histology grading, suggesting a reliable alternative to biopsy. Additionally, the baseline SWE values and their trend during follow-up can provide information on the disease's progression.

Authors' Contributions

S.S. and M.F.A. conceptualized the study and contributed to writing—original draft preparation; S.S., R.P.K, and S.B.L. did the methodological analysis; S.S. and S.B.L. validated the study; A.B., A.K.S., and K.G. performed the formal analysis; S.S. and R.P. K. contributed to writing—review and editing, and supervised the study. All authors have read and agreed to the published version of the manuscript.




Publication History

Article published online:
06 June 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Pereira TN, Walsh MJ, Lewindon PJ, Ramm GA. Paediatric cholestatic liver disease: Diagnosis, assessment of disease progression and mechanisms of fibrogenesis. World J Gastrointest Pathophysiol 2010; 1 (02) 69-84
  • 2 Kasai M, Kimura S, Asakura Y, Suzuki H, Taira Y, Ohashi E. Surgical treatment of biliary atresia. J Pediatr Surg 1968; 3: 665-675
  • 3 Salzedas-Netto AA, Chinen E, de Oliveira DF. et al. Grade IV fibrosis interferes in biliary drainage after Kasai procedure. Transplant Proc 2014; 46 (06) 1781-1783
  • 4 Shteyer E, Ramm GA, Xu C, White FV, Shepherd RW. Outcome after portoenterostomy in biliary atresia: pivotal role of degree of liver fibrosis and intensity of stellate cell activation. J Pediatr Gastroenterol Nutr 2006; 42 (01) 93-99
  • 5 Solanki S, Kanojia RP, Gupta PK, Singhai P, Lal SB, Mahajan JK. A randomized control trial to evaluate the effect of local instillation of mitomycin-C at the porta after Kasai portoenterostomy in patients of biliary atresia. J Indian Assoc Pediatr Surg 2023; 28 (04) 307-313
  • 6 Lachaux A, Le Gall C, Chambon M. et al. Complications of percutaneous liver biopsy in infants and children. Eur J Pediatr 1995; 154 (08) 621-623
  • 7 Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ. Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol 2015; 21 (41) 11567-11583
  • 8 Heller MT, Tublin ME. The role of ultrasonography in the evaluation of diffuse liver disease. Radiol Clin North Am 2014; 52 (06) 1163-1175
  • 9 Jeong JY, Kim TY, Sohn JH. et al. Real time shear wave elastography in chronic liver diseases: accuracy for predicting liver fibrosis, in comparison with serum markers. World J Gastroenterol 2014; 20 (38) 13920-13929
  • 10 Solanki S, Bhatnagar V, Agarwala S. et al. Evaluation of serum levels of trace elements in children with biliary atresia and their correlation with liver histopathology. J Indian Assoc Pediatr Surg 2020; 25 (06) 352-356
  • 11 Jung C, Groth M, Petersen KU. et al. Hepatic shear wave elastography in children under free-breathing and breath-hold conditions. Eur Radiol 2017; 27 (12) 5337-5343
  • 12 Galina P, Alexopoulou E, Zellos A. et al. Performance of two–dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children. Pediatr Radiol 2019; 49 (01) 91-98
  • 13 Bedossa P, Poynard T. The METAVIR Cooperative Study Group. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24 (02) 289-293
  • 14 Dillman JR, Heider A, Bilhartz JL. et al. Ultrasound shear wave speed measurements correlate with liver fibrosis in children. Pediatr Radiol 2015; 45 (10) 1480-1488
  • 15 Özkan MB, Bilgici MC, Eren E. et al. Role of point shear wave elastography in the determination of the severity of fibrosis in pediatric liver diseases with pathologic correlations. J Ultrasound Med 2017; 36 (11) 2337-2344
  • 16 Hanquinet S, Rougemont AL, Courvoisier D. et al. Acoustic radiation force impulse (ARFI) elastography for the noninvasive diagnosis of liver fibrosis in children. Pediatr Radiol 2013; 43 (05) 545-551
  • 17 Shin NY, Kim MJ, Lee MJ. et al. Transient elastography and sonography for prediction of liver fibrosis in infants with biliary atresia. J Ultrasound Med 2014; 33 (05) 853-864
  • 18 Farmakis SG, Buchanan PM, Guzman MA, Hardy AK, Jain AK, Teckman JH. Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease. Pediatr Radiol 2019; 49 (13) 1742-1753
  • 19 Wagner ES, Abdelgawad HAH, Landry M, Asfour B, Slidell MB, Azzam R. Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: a meta-analysis. World J Gastroenterol 2022; 28 (32) 4726-4740
  • 20 Yoon H, Ihn K, Kim J. et al. Pre- and immediate post-Kasai portoenterostomy shear wave elastography for predicting hepatic fibrosis and native liver outcomes in patients with biliary atresia. Korean J Radiol 2023; 24 (05) 465-475
  • 21 Chen H, Zhou L, Liao B. et al. Two-dimensional shear wave elastography predicts liver fibrosis in jaundiced infants with suspected biliary atresia: a prospective study. Korean J Radiol 2021; 22 (06) 959-969
  • 22 Caruso M, Cuocolo R, Di Dato F. et al. Ultrasound, shear-wave elastography, and magnetic resonance imaging in native liver survivor patients with biliary atresia after Kasai portoenterostomy: correlation with medical outcome after treatment. Acta Radiol 2020; 61 (10) 1300-1308
  • 23 Srisuwan W, Laochareonsuk W, Wetwittayakhlang P, Kritsaneepaiboon S, Sangkhathat S. Correlation of transient elastography and biliary cirrhosis in longterm survivors of biliary atresia. Siriraj Med J. 2021; 73: 32-37
  • 24 Chongsrisawat V, Vejapipat P, Siripon N, Poovorawan Y. Transient elastography for predicting esophageal/gastric varices in children with biliary atresia. BMC Gastroenterol 2011; 11: 41
  • 25 Colecchia A, Di Biase AR, Scaioli E. et al. Non-invasive methods can predict oesophageal varices in patients with biliary atresia after a Kasai procedure. Dig Liver Dis 2011; 43 (08) 659-663
  • 26 Chen S, Liao B, Zhong Z. et al. Supersonic shearwave elastography in the assessment of liver fibrosis for postoperative patients with biliary atresia. Sci Rep 2016; 6: 31057
  • 27 Goldschmidt I, Streckenbach C, Dingemann C. et al. Application and limitations of transient liver elastography in children. J Pediatr Gastroenterol Nutr 2013; 57 (01) 109-113
  • 28 Engelmann G, Gebhardt C, Wenning D. et al. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr 2012; 171 (02) 353-360