Work

Diagnostic performance and reproducibility of shear wave elastography techniques for liver stiffness assessment in children with biliary atresia

Year: 2025

Type: article

Abstract: BACKGROUND: Biliary atresia casuses progressive liver fibrosis in infants. After Kasai portoenterostomy (KPE), non-invasive liver monitoring is essential. Shear wave elastography (SWE) offers a promising alternative to biopsy. OBJECTIVES: To evaluate the diagnostic performance, reproducibility, and inter-technique consistency of three shear wave elastography (SWE) modalities-point-SWE (p-SWE), two-dimensional SWE (2D-SWE), and supersonic shear imaging (supersonic-SWE)-in children with biliary atresia post-KPE. MATERIALS AND METHODS: This prospective study (March 2024-November 2024) recruited 76 children: 47 biliary atresia patients (mean age, 5.7 ± 3.3 years; 24 girls) post-KPE and 29 healthy controls (mean age, 6.9 ± 3.2 years; 12 girls). Liver stiffness values were obtained using three SWE techniques. Statistical methods included the Mann-Whitney U test, Friedman test, intraclass correlation coefficients (ICCs), Spearman correlation, and generalized liner model analysis. RESULTS: Biliary atresia group showed significantly higher liver stiffness values than controls across all techniques (supersonic-SWE: 8.20 vs. 5.20 kPa, p-SWE: 6.60 vs. 3.50 kPa, 2D-SWE: 4.90 vs. 2.90 kPa; all P< 0.001). Supersonic-SWE yielded higher liver stiffness values than p-SWE and 2D-SWE (P< 0.05). Strong correlations were observed. Reproducibility was good to excellent (ICCs: 0.74 to 0.90), with supersonic-SWE demonstrating the highest ICC. Anteroposterior diameter of the left lobe was an independent predictor significantly associated with liver stiffness values (P< 0.001). Supersonic-SWE required longer measurement time than other techniques (P< 0.001). CONCLUSION: SWE is a reliable tool for liver stiffness assessment in biliary atresia patients, however, inter-technique and inter-vendor discrepancies highlight the need for standardized protocol and techniques should not be used interchangeably.

Source: Pediatric Radiology

DOI: 10.1007/s00247-025-06333-z