Generic placeholder image

Current Medical Imaging

Author(s): Xiuru Gong, Tingting Zhu, Xiaolin Peng, Dongwei Xing and Minguang Zhang*

DOI: 10.2174/1573405618666220829152956

DownloadDownload PDF Flyer Cite As
Diagnostic Accuracy of Transient Elastography and Two-Dimensional Shear Wave Elastography for Staging Liver Fibrosis in Children or Adolescents: A Systematic Review and Meta-Analysis

Article ID: e290822208186 Pages: 15

  • * (Excluding Mailing and Handling)

Abstract

Background: Few studies comprehensively compared the performance of transient elastography (TE) and two-dimensional shear wave elastography(2D-SWE) to diagnose the stage of liver fibrosis in children and adolescents. We assessed the diagnostic performance of these non-invasive imaging techniques from published studies.

Methods: To evaluate the diagnostic performance of TE and 2D-SWE, we searched the PubMed, Embase, Web of Science, and Cochrane Library databases until November 13, 2021, for studies that diagnosed liver fibrosis in children and adolescents. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and area under the receiver operating characteristic curve were estimated using the bivariate model. We also performed a subgroup analysis of various research characteristics.

Results: Twenty-seven studies with 1956 patients were included in the analysis. The sensitivity and specificity of TE and 2D-SWE for detecting liver fibrosis in all stages were greater than 0.82. For the detection of significant fibrosis, advanced fibrosis and cirrhosis, the summary AUC was 0.90 (95% CI: 0.87-0.92), 0.95 (95% CI: 0.93-0.96) and 0.95 (95% CI: 0.93-0.97) for TE, and the summary AUC was 0.92 (95% CI: 0.89-0.94), 0.94 (95% CI: 0.92-0.96) and 0.96 (95% CI: 0.94-0.97) for 2D-SWE, respectively. Both imaging methods detected significant heterogeneity.

Conclusion: TE and 2D-SWE can provide accurate non-invasive staging of liver fibrosis in children or adolescents and are a promising technology, particularly for advanced liver fibrosis and cirrhosis, with a high potential to replace liver biopsy.

Keywords: Transient elastography (TE), two-dimensional shear wave elastography(2D-SWE), liver fibrosis, children, adolescents, meta-analysis.

Graphical Abstract

[1]
Morita K, Nishie A, Ushijima Y, et al. Noninvasive assessment of liver fibrosis by dual-layer spectral detector CT. Eur J Radiol 2021; 136: 109575.
[http://dx.doi.org/10.1016/j.ejrad.2021.109575] [PMID: 33548853]
[2]
Seitz T, Hellerbrand C. Role of fibroblast growth factor signalling in hepatic fibrosis. Liver Int 2021; 41(6): 1201-15.
[http://dx.doi.org/10.1111/liv.14863] [PMID: 33655624]
[3]
Alisi A, De Vito R, Monti L, Nobili V. Liver fibrosis in paediatric liver diseases. Best Pract Res Clin Gastroenterol 2011; 25(2): 259-68.
[http://dx.doi.org/10.1016/j.bpg.2011.02.008] [PMID: 21497743]
[4]
Ellis EL, Mann DA. Clinical evidence for the regression of liver fibrosis. J Hepatol 2012; 56(5): 1171-80.
[http://dx.doi.org/10.1016/j.jhep.2011.09.024] [PMID: 22245903]
[5]
Sharma S, Khalili K, Nguyen GC. Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol 2014; 20(45): 16820-30.
[http://dx.doi.org/10.3748/wjg.v20.i45.16820] [PMID: 25492996]
[6]
Friedrich RM, Poynard T, Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat Rev Gastroenterol Hepatol 2016; 13(7): 402-11.
[http://dx.doi.org/10.1038/nrgastro.2016.86] [PMID: 27273167]
[7]
Andersen SB, Ewertsen C, Carlsen JF, Henriksen BM, Nielsen MB. Ultrasound elastography is useful for evaluation of liver fibrosis in children: A systematic review. J Pediatr Gastroenterol Nutr 2016; 63(4): 389-99.
[http://dx.doi.org/10.1097/MPG.0000000000001171] [PMID: 26925609]
[8]
European Association for Study of Liver, & Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63(1): 237-64.
[http://dx.doi.org/10.1016/j.jhep.2015.04.006] [PMID: 25911335]
[9]
Park SH, Kim SY, Suh CH, et al. What we need to know when performing and interpreting US elastography. Clin Mol Hepatol 2016; 22(3): 406-14.
[http://dx.doi.org/10.3350/cmh.2016.0106] [PMID: 27729637]
[10]
Sandrin L, Tanter M, Gennisson JL, Catheline S, Fink M. Shear elasticity probe for soft tissues with 1-D transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control 2002; 49(4): 436-46.
[http://dx.doi.org/10.1109/58.996561] [PMID: 11989699]
[11]
Yoneda M, Yoneda M, Mawatari H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with Nonalcoholic Fatty Liver Disease (NAFLD). Dig Liver Dis 2008; 40(5): 371-8.
[http://dx.doi.org/10.1016/j.dld.2007.10.019] [PMID: 18083083]
[12]
Chon YE, Choi EH, Song KJ, et al. Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: A meta-analysis. PLoS One 2012; 7(9): e44930.
[http://dx.doi.org/10.1371/journal.pone.0044930] [PMID: 23049764]
[13]
Qi X, An M, Wu T, et al. Transient elastography for significant liver fibrosis and cirrhosis in chronic hepatitis B: A meta-analysis. Can J Gastroenterol Hepatol 2018; 2018: 3406789.
[http://dx.doi.org/10.1155/2018/3406789] [PMID: 29977884]
[14]
Hashemi SA, Alavian SM, Gholami FM. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Caspian J Intern Med 2016; 7(4): 242-52.
[PMID: 27999641]
[15]
Alkhouri N, Sedki E, Alisi A, et al. Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease. Liver Int 2013; 33(1): 79-85.
[http://dx.doi.org/10.1111/liv.12024] [PMID: 23146095]
[16]
Behairy BES, Sira MM, Zalata KR, Salama ESE, Abd-Allah MA. Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease: Does etiology matter? World J Gastroenterol 2016; 22(16): 4238-49.
[http://dx.doi.org/10.3748/wjg.v22.i16.4238] [PMID: 27122674]
[17]
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(1): 72-6.
[http://dx.doi.org/10.1097/MPG.0b013e31826f2760] [PMID: 22922372]
[18]
Kwon YD, Ko KO, Lim JW, Cheon EJ, Song YH, Yoon JM. Usefulness of transient elastography for non-invasive diagnosis of liver fibrosis in pediatric non-alcoholic steatohepatitis. J Korean Med Sci 2019; 34(23): e165.
[http://dx.doi.org/10.3346/jkms.2019.34.e165] [PMID: 31197983]
[19]
Gao Y, Zheng J, Liang P, et al. Liver fibrosis with two-dimensional us shear-wave elastography in participants with chronic hepatitis B: A prospective multicenter study. Radiology 2018; 289(2): 407-15.
[http://dx.doi.org/10.1148/radiol.2018172479] [PMID: 30040048]
[20]
Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: A pilot study. Hepatology 2012; 56(6): 2125-33.
[http://dx.doi.org/10.1002/hep.25936] [PMID: 22767302]
[21]
Bamber J, Cosgrove D, Dietrich C, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med 2013; 34(2): 169-84.
[http://dx.doi.org/10.1055/s-0033-1335205] [PMID: 23558397]
[22]
Zhang W, Zhu Y, Zhang C, Ran H. Diagnostic accuracy of 2-dimensional shear wave elastography for the staging of liver fibrosis: A meta-analysis. J Ultrasound Med 2019; 38(3): 733-40.
[http://dx.doi.org/10.1002/jum.14760] [PMID: 30171621]
[23]
Kim JR, Suh CH, Yoon HM, Lee JS, Cho YA, Jung AY. The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis. Eur Radiol 2018; 28(3): 1175-86.
[http://dx.doi.org/10.1007/s00330-017-5078-3] [PMID: 29018925]
[24]
Lee S, Choi YH, Cho YJ, et al. The usefulness of noninvasive liver stiffness assessment using shear-wave elastography for predicting liver fibrosis in children. BMC Med Imaging 2021; 21(1): 68.
[http://dx.doi.org/10.1186/s12880-021-00601-8] [PMID: 33845776]
[25]
Barr RG, Ferraioli G, Palmeri ML, et al. Elastography assessment of liver fibrosis: Society of radiologists in ultrasound consensus conference statement. Radiology 2015; 276(3): 845-61.
[http://dx.doi.org/10.1148/radiol.2015150619] [PMID: 26079489]
[26]
Parums DV. Editorial: Review articles, systematic reviews, meta-analysis, and the updated Preferred Reporting Items For Systematic Reviews And Meta-Analyses (PRISMA) 2020 guidelines. Med Sci Monit 2021; 27: e934475.
[http://dx.doi.org/10.12659/MSM.934475] [PMID: 34421116]
[27]
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155(8): 529-36.
[http://dx.doi.org/10.7326/0003-4819-155-8-201110180-00009] [PMID: 22007046]
[28]
Swets JA. Measuring the accuracy of diagnostic systems. Science 1988; 240(4857): 1285-93.
[http://dx.doi.org/10.1126/science.3287615] [PMID: 3287615]
[29]
Chyou PH. A simple and robust way of concluding meta-analysis results using reported P values, standardized effect sizes, or other statistics. Clin Med Res 2012; 10(4): 219-23.
[http://dx.doi.org/10.3121/cmr.2012.1068] [PMID: 22634543]
[30]
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. (2nd Ed.), Chichester, UK: John Wiley & Sons 2019.
[31]
Devillé WL, Buntinx F, Bouter LM, et al. Conducting systematic reviews of diagnostic studies: Didactic guidelines. BMC Med Res Methodol 2002; 2(1): 9.
[http://dx.doi.org/10.1186/1471-2288-2-9] [PMID: 12097142]
[32]
Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005; 58(9): 882-93.
[http://dx.doi.org/10.1016/j.jclinepi.2005.01.016] [PMID: 16085191]
[33]
Awad MEDAEA, Shiha GE, Sallam FA, Mohamed AEA, El Tawab A. Evaluation of liver stiffness measurement by fibroscan as compared to liver biopsy for assessment of hepatic fibrosis in children with chronic hepatitis C. J Egypt Soc Parasitol 2013; 43(3): 805-19.
[http://dx.doi.org/10.12816/0006437] [PMID: 24640880]
[34]
Costa P, Kogan LD, Rudolph B, et al. Detection of graft fibrosis by vibration‐controlled transient elastography in pediatric liver transplant recipients. Pediatr Transplant 2020; 24(6): e13731.
[http://dx.doi.org/10.1111/petr.13731] [PMID: 32427407]
[35]
Hong CR, Han SM, Staffa SJ, Carey AN, Lee CK, Modi BP. Noninvasive assessment of liver fibrosis in pediatric intestinal failure patients using liver stiffness measurement by vibration-controlled transient elastography. J Pediatr Surg 2019; 54(6): 1174-8.
[http://dx.doi.org/10.1016/j.jpedsurg.2019.02.038] [PMID: 30879747]
[36]
Hukkinen M, Kivisaari R, Lohi J, et al. Transient elastography and aspartate aminotransferase to platelet ratio predict liver injury in paediatric intestinal failure. Liver Int 2016; 36(3): 361-9.
[http://dx.doi.org/10.1111/liv.12887] [PMID: 26058319]
[37]
Jain V, Poddar U, Negi TS, et al. Utility and accuracy of transient elastography in determining liver fibrosis: A case-control study. Eur J Pediatr 2020; 179(4): 671-7.
[http://dx.doi.org/10.1007/s00431-019-03561-y] [PMID: 31960149]
[38]
Lee CK, Mitchell PD, Raza R, Harney S, Wiggins SM, Jonas MM. Validation of transient elastography cut points to assess advanced liver fibrosis in children and young adults: The Boston children’s hospital experience. J Pediatr 2018; 198: 84-9.e2.
[http://dx.doi.org/10.1016/j.jpeds.2018.02.062] [PMID: 29685617]
[39]
Lee CK, Nastasio S, Mitchell PD, et al. Transient elastography assessment of liver allograft fibrosis in pediatric transplant recipients. Pediatr Transplant 2020; 24(6): e13736.
[http://dx.doi.org/10.1111/petr.13736] [PMID: 32432836]
[40]
Lewindon PJ, Puertolas LMV, Ramm LE, et al. Accuracy of transient elastography data combined with APRI in detection and staging of liver disease in pediatric patients with cystic fibrosis. Clin Gastroenterol Hepatol 2019; 17(12): 2561-69.e5.
[http://dx.doi.org/10.1016/j.cgh.2019.03.015] [PMID: 30880274]
[41]
Nobili V, Vizzutti F, Arena U, et al. Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis. Hepatology 2008; 48(2): 442-8.
[http://dx.doi.org/10.1002/hep.22376] [PMID: 18563842]
[42]
Shen QL, Chen YJ, Wang ZM, et al. Assessment of liver fibrosis by Fibroscan as compared to liver biopsy in biliary atresia. World J Gastroenterol 2015; 21(22): 6931-6.
[http://dx.doi.org/10.3748/wjg.v21.i22.6931] [PMID: 26078570]
[43]
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(5): 853-64.
[http://dx.doi.org/10.7863/ultra.33.5.853] [PMID: 24764341]
[44]
Vinciguerra T, Brunati A, David E, et al. Transient elastography for non-invasive evaluation of post-transplant liver graft fibrosis in children. Pediatr Transplant 2018; 22(2): e13125.
[http://dx.doi.org/10.1111/petr.13125] [PMID: 29369488]
[45]
Voutilainen S, Kivisaari R, Lohi J, Jalanko H, Pakarinen MP. A prospective comparison of noninvasive methods in the assessment of liver fibrosis and esophageal varices in pediatric chronic liver diseases. J Clin Gastroenterol 2016; 50(8): 658-63.
[http://dx.doi.org/10.1097/MCG.0000000000000532] [PMID: 27105175]
[46]
Xu Z, Zhao J, Liu J, et al. Assessment of liver fibrosis by transient elastography in young children with chronic hepatitis B virus infection. Hepatol Int 2021; 15(3): 602-10.
[http://dx.doi.org/10.1007/s12072-021-10194-7] [PMID: 34240319]
[47]
Akyuz M, Gurcan KN, Esendagli G, Dalgic B, Ozhan Oktar S. The evaluation of the use of 2D shear-wave ultrasound elastography in differentiation of clinically insignificant and significant liver fibrosis in pediatric age group. Abdom Radiol 2021; 46(5): 1941-6.
[http://dx.doi.org/10.1007/s00261-020-02844-5] [PMID: 33231728]
[48]
Alhashmi GH, Gupta A, Trout AT, Dillman JR. Two-dimensional ultrasound shear wave elastography for identifying and staging liver fibrosis in pediatric patients with known or suspected liver disease: A clinical effectiveness study. Pediatr Radiol 2020; 50(9): 1255-62.
[http://dx.doi.org/10.1007/s00247-020-04720-2] [PMID: 32588095]
[49]
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(6): 959-69.
[http://dx.doi.org/10.3348/kjr.2020.0885] [PMID: 33569934]
[50]
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(1): 31057.
[http://dx.doi.org/10.1038/srep31057] [PMID: 27511435]
[51]
Dardanelli EP, Orozco ME, Lostra J, et al. Bidimensional shear-wave elastography for assessing liver fibrosis in children: A proposal of reference values that correlate with the histopathological Knodell–Ishak score. Pediatr Radiol 2020; 50(6): 817-26.
[http://dx.doi.org/10.1007/s00247-020-04632-1] [PMID: 32072246]
[52]
Dhyani M, Gee MS, Misdraji J, Israel EJ, Shah U, Samir AE. Feasibility study for assessing liver fibrosis in paediatric and adolescent patients using real-time shear wave elastography. J Med Imaging Radiat Oncol 2015; 59(6): 687-94.
[http://dx.doi.org/10.1111/1754-9485.12388] [PMID: 26503488]
[53]
Franchi AS, Corno L, Gonzales E, et al. Feasibility and diagnostic accuracy of supersonic shear-wave elastography for the assessment of liver stiffness and liver fibrosis in children: A pilot study of 96 patients. Radiology 2016; 278(2): 554-62.
[http://dx.doi.org/10.1148/radiol.2015142815] [PMID: 26305193]
[54]
Galal SM, Soror SM, Hussien O, Moustafa EF, Hassany SM. Noninvasive assessment of liver fibrosis in children with chronic hepatitis C: Shear wave elastography and APRI versus liver biopsy. Arab J Gastroenterol 2020; 21(4): 253-9.
[http://dx.doi.org/10.1016/j.ajg.2020.08.002] [PMID: 33041193]
[55]
Galina P, Alexopoulou E, Mentessidou A, et al. Diagnostic accuracy of two-dimensional shear wave elastography in detecting hepatic fibrosis in children with autoimmune hepatitis, biliary atresia and other chronic liver diseases. Pediatr Radiol 2021; 51(8): 1358-68.
[http://dx.doi.org/10.1007/s00247-020-04959-9] [PMID: 33755748]
[56]
Garcovich M, Veraldi S, Di Stasio E, et al. Liver stiffness in pediatric patients with fatty liver disease: Diagnostic accuracy and reproducibility of shear-wave elastography. Radiology 2017; 283(3): 820-7.
[http://dx.doi.org/10.1148/radiol.2016161002] [PMID: 27982761]
[57]
Tanwar S, Rhodes F, Srivastava A, Trembling PM, Rosenberg WM. Inflammation and fibrosis in chronic liver diseases including non-alcoholic fatty liver disease and hepatitis C. World J Gastroenterol 2020; 26(2): 109-33.
[http://dx.doi.org/10.3748/wjg.v26.i2.109] [PMID: 31969775]
[58]
Sohrabpour AA, Mohamadnejad M, Malekzadeh R. Review article: The reversibility of cirrhosis. Aliment Pharmacol Ther 2012; 36(9): 824-32.
[http://dx.doi.org/10.1111/apt.12044] [PMID: 22966946]
[59]
Hwang JY, Yoon HM, Kim JR, et al. Diagnostic performance of transient elastography for liver fibrosis in children: A systematic review and meta-analysis. AJR Am J Roentgenol 2018; 211(5)W257-66,
[http://dx.doi.org/10.2214/AJR.18.19535] [PMID: 30106615]
[60]
Mărginean CO Meliţ LE, Ghiga DV Săsăran MO. The assessment of liver fibrosis in children with obesity on two methods: Transient and two dimensional shear wave elastography. Sci Rep 2019; 9(1): 19800.
[http://dx.doi.org/10.1038/s41598-019-56358-2] [PMID: 31875010]