Advances in Clinical and Experimental Medicine
2015, vol. 24, nr 3, May-June, p. 537–543
Publication type: review article
Ultrasound Elastography – Review of Techniques and Its Clinical Applications in Pediatrics – Part 1
1 Department of General and Pediatric Radiology, Department of Radiology, Independent Public Clinical Hospital No. 1, Wroclaw Medical University, Poland
2 Department of General and Pediatric Radiology, Independent Public Clinical Hospital No. 1, Wrocław, Poland
Sonoelastography is a novel technique that uses ultrasound waves to assess the elasticity of tissues noninvasively. It provides an ultrasound-based method to detect and display the relative stiffness of tissue. The main principle of sonoelastography is the measurement of tissue distortion in response to external compression. Changes in elasticity and tissue deformation elicited by compression are measured, processed and then shown in real time presentation with color-coded elastograms. One of the most important applications of sonoelastography is the evaluation of liver diseases, mainly liver fibrosis assessment and staging. Although in terms of definite diagnosis the liver biopsy still remains the golden standard, elastography seems to be a very inexpensive, repeatable and noninvasive method to evaluate most of liver conditions. The technique is also applicable in detection and differential diagnosis of focal lesions. It provides better imaging information and therefore more accurate evaluation of the lesions nature, e.g. in liver, lymphatic nodes or thyroid gland. Most of the applications mentioned above are well known and have been described in details in adults. Similarly, most of sonoelastographic studies are based on groups of adults. The purpose of this review article is to bring this technology closer to pediatric clinicians and to summarize some of its current clinical applications that are being pursued. In this part we focus on utility of elastography in liver assessment in pediatric patients.
sonoelastography, liver cirrhosis, cystic fibrosis, chronic hepatitis, NAFLD.
- Koenig K: Elastography. In: Contemporary Interventional Ultrasonography in Urology. Chapter 15, London: Springer-Verlag London Limited, 2009, 137–141.
- Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013, 34, 169–184.
- Treece G, Lindop J, Chen L, Housden J, Prager R, Gee A: Real-time quasi-static ultrasound elastography. Interface focus 2011, 1, 540–552.
- Pol S, Gennisson JL, Bavu E, Deffieux T, Fink M, Mallet V: Non-Invasive Staging of Liver Fibrosis with ShearWave™ Elastography Imaging. SonoWorld [Internet] 2011. Available from: http://www.sonoworld.com/ Client/Centers/WhitePaper.aspx?ContentId=58.
- Chiorean A, Duma MM, Dudea SM, Iancu A, Roman DDR, Sfrngeu S: Real-time ultrasound elastography of the breast: state of the art. Med Ultrasonography 2008, 10, 73–82.
- Carneiro-Pla D: Ultrasound elastography in the evaluation of thyroid nodules for thyroid cancer. Curr Opin Oncol 2013, 25, 1–5.
- Shiina T, Nitta N, Sjsum EU, Bamber JC: Real time tissue elasticity imaging using the combined autocorrelation method. J Med Ultrason 2002, 29, 119–128.
- Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY, Ahuja AT: Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur Radiol 2012, 22, 2397–2406.
- de Lédinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V: Liver stiffness measurement in children using FibroScan: feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr 2007, 45, 443–450.
- Hanquinet S, Rougemont AL, Courvoisier D, Rubbia-Brandt L, Mclin V, Tempia M: Acoustic radiation force impulse (ARFI) elastography for the noninvasive diagnosis of liver fibrosis in children. Ped Radiol 2013, 1–7.
- Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH: EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013, 34, 238–253.
- Piscaglia F, Marinelli S, Bota S, Serra C, Venerandi L, Leoni S: The role of ultrasound elastographic techniques in chronic liver disease: current status and future perspectives. Eur J Radiol 2013.
- Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK: Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol 2011, 54, 650–659.
- Nobili V, Monti L, Alisi A, Zupone CL, Pietrobattista A, Tomà P: Transient elastography for assessment of fibrosis in paediatric liver disease. Ped Radiol 2011, 41, 1232–1238.
- Bedossa P: Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology 1994, 20, 15–20.
- Monpoux F, Huguon E, Truchi R, Rubio A, Riolo V, Deville A: Transient elastography (Fibroscan) in HIV-1 vertically infected children. A cross-sectional study. Retrovirology 2009, 6 (Suppl 1), 13.
- Alkhouri N, Sedki E, Alisi A, Lopez R, Pinzani M, Feldstein AE: Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease. Liver Int 2013, 33, 79–85.
- Nobili V, Vizzutti F, Arena U, Abraldes JG, Marra F, Pietrobattista A: Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis. Hepatology 2008, 48, 442–448.
- Marginean CO, Marginean C: Elastographic assessment of liver fibrosis in children: A prospective single center experience. Eur J Radiol 2012, 81, 870–874.
- Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A: Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr 2013, 56, 72–76.
- Menten R, Leonard A, Clapuyt P, Vincke P, Nicolae AC, Lebecque P: Transient elastography in patients with cystic fibrosis. Ped Radiol 2010, 40, 1231–1235.
- Mueller-Abt PR, Frawley KJ, Greer RM, Lewindon PJ: Comparison of ultrasound and biopsy findings in children with cystic fibrosis related liver disease. J Cyst Fibros 2008, 7, 215–221.
- Behrens CB, Langholz JH, Eiler J, Jenewein R, Naehrlich L, Fuchs K: A pilot study of the characterization of hepatic tissue strain in children with cystic-fibrosis-associated liver disease (CFLD) by acoustic radiation force impulse imaging. Ped Radiol 2012, 1–6.
- Friedrich-Rust M, Schlueter N, Smaczny C, Eickmeier O, Rosewich M, Feifel K: Non-invasive measurement of liver and pancreas fibrosis in patients with cystic fibrosis. J Cyst Fibros 2013, 12, 431–439.
- Pinto J, Matos H, Nobre S, Cipriano MA, Marques M, Pereira JM: Prospective Comparison of ARFI, APRI and AST/ALT index For Fibrosis Assessment in a Liver Transplant Pediatric Population. J Pediatr Gastroenterol Nutr 2013.
- Tomita H, Hoshino K, Fuchimoto Y, Ebinuma H, Ohkuma K, Tanami Y: Acoustic radiation force impulse imaging for assessing graft fibrosis after pediatric living donor liver transplantation: A pilot study. Liver Transpl 2013, 19, 1202–1213.
- Honsawek S, Chayanupatkul M, Chongsrisawat V, Theamboonlers A, Praianantathavorn K, Udomsinprasert W: Serum adiponectin and transient elastography as non-invasive markers for postoperative biliary atresia. BMC Gastroenterol 2011, 11, 16.
- 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.
- Mehta SH, Buckle GC: Assessment of liver disease (noninvasive methods). Current Opinion in HIV and AIDS 2011, 6, 465–471.
- Hahn SM, Kim S, Park KI, Han SJ, Koh H: Clinical Benefit of Liver Stiffness Measurement at 3 Months after Kasai Hepatoportoenterostomy to Predict the Liver Related Events in Biliary Atresia. PloS One 2013, 8, 80652.
- Honsawek S, Vejchapipat P, Payungporn S, Theamboonlers A, Chongsrisawat V, Poovorawan Y: Soluble receptor for advanced glycation end products and liver stiffness in postoperative biliary atresia. Clin Biochem 2013, 46, 214–218.
- Honsawek S, Udomsinprasert W, Chirathaworn C, Anomasiri W, Vejchapipat P, Poovorawan Y: Correlation of connective tissue growth factor with liver stiffness measured by transient elastography in biliary atresia. Hepatology Research 2013, 43, 795–800.
- Honsawek S, Chongsrisawat V, Praianantathavorn K, Theamboonlers A, Poovorawan Y: Elevation of serum galectin-3 and liver stiffness measured by transient elastography in biliary atresia. Eur J Pediatr Surg 2011, 21, 250–254.
- Honsawek S, Chayanupatkul M, Chongsrisawat V, Vejchapipat P, Poovorawan Y: Increased osteopontin and liver stiffness measurement by transient elastography in biliary atresia. World J Gastroenterol 2010, 16, 5467.
- Shima H, Igarashi G, Wakisaka M, Hamano S, Nagae H, Koyama M: Noninvasive acoustic radiation force impulse (ARFI) elastography for assessing the severity of fibrosis in the post-operative patients with biliary atresia. Pediatr Surg Int 2012, 28, 869–872.
- Kummer S, Sagir A, Pandey S, Feldkötter M, Habbig S, Körber F: Liver fibrosis in recessive multicystic kidney diseases: transient elastography for early detection. Pediatr Nephrol 2011, 26, 725–731.
- Fontanilla T, Cañas T, Macia A, Alfageme M, Gutierrez Junquera C, Malalana A: Normal Values of Liver Shear Wave Velocity in Healthy Children Assessed by Acoustic Radiation Force Impulse Imaging Using a Convex Probe and a Linear Probe. Ultrasound Med Biol 2014, 40, 470–477.
- Lee MJ, Kim MJ, Han KH, Yoon CS: Age-related changes in liver, kidney, and spleen stiffness in healthy children measured with acoustic radiation force impulse imaging. Eur J Radiol 2013, 82, 290–294.
- Selmi B, Engelmann G, Teufel U, El Sakka S, Dadrich M, Schenk JP: Normal values of liver elasticity measured by real-time tissue elastography (RTE) in healthy infants and children. J Med Ultrason 2014, 41, 31–38.