Sylviane Hanquinet1, Delphine S Courvoisier2, Anne-Laure Rougemont3, Barbara E Wildhaber4, Laura Merlini5, Valérie A McLin6, Mehrak Anooshiravani5. 1. Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland. sylviane.hanquinet-ginter@hcuge.ch. 2. Division of Quality of Care, University Hospital of Geneva, Geneva, Switzerland. 3. Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland. 4. Department of Pediatric Surgery, Children's University Hospital of Geneva, Geneva, Switzerland. 5. Department of Pediatric Radiology, Children's University Hospital of Geneva, 6 rue Willy Donzé, Ch 1211, Genève 14, Switzerland. 6. Department of Pediatric Gastroenterology, Children's University Hospital of Geneva, Geneva, Switzerland.
Abstract
BACKGROUND: Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation. OBJECTIVE: To assess liver fibrosis by acoustic radiation force impulse elastography (ARFI) in children who had Kasai operation, with the goal of identifying an ARFI value cut-off for children requiring liver transplantation. MATERIALS AND METHODS: Of the 32 post-Kasai children included, 19 were transplanted or listed for transplantation (group A), while 13 were not on the list during their follow-up (group B). We recorded biopsies, blood samples and ARFI values over time, including at Kasai operation and at transplantation. We estimated an association between groups and continuous variables using generalized estimating equations, and we compared categorical variables using the Fisher exact test. RESULTS: Portal hypertension signs were similar in both groups, whereas ARFI values were higher in group A (mean±standard deviation=3.3±1.2 m/s) than in group B (2.0±0.7 m/s; P=.0003). Eighteen of 19 (94.7%) children in group A and 6/13 (46.2%) children in group B presented with two consecutive ARFI values ≥2 m/s (sensitivity=7%, specificity=53.8%; P=0.003). CONCLUSION: We found that children who were transplanted had two consecutive ARFI values ≥2 m/s during follow-up. ARFI for evaluation of post-Kasai liver fibrosis may assist the long-term assessment of biliary atresia and may even guide treatment decisions.
BACKGROUND:Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation. OBJECTIVE: To assess liver fibrosis by acoustic radiation force impulse elastography (ARFI) in children who had Kasai operation, with the goal of identifying an ARFI value cut-off for children requiring liver transplantation. MATERIALS AND METHODS: Of the 32 post-Kasai children included, 19 were transplanted or listed for transplantation (group A), while 13 were not on the list during their follow-up (group B). We recorded biopsies, blood samples and ARFI values over time, including at Kasai operation and at transplantation. We estimated an association between groups and continuous variables using generalized estimating equations, and we compared categorical variables using the Fisher exact test. RESULTS: Portal hypertension signs were similar in both groups, whereas ARFI values were higher in group A (mean±standard deviation=3.3±1.2 m/s) than in group B (2.0±0.7 m/s; P=.0003). Eighteen of 19 (94.7%) children in group A and 6/13 (46.2%) children in group B presented with two consecutive ARFI values ≥2 m/s (sensitivity=7%, specificity=53.8%; P=0.003). CONCLUSION: We found that children who were transplanted had two consecutive ARFI values ≥2 m/s during follow-up. ARFI for evaluation of post-Kasai liver fibrosis may assist the long-term assessment of biliary atresia and may even guide treatment decisions.
Authors: Richard G Barr; Giovanna Ferraioli; Mark L Palmeri; Zachary D Goodman; Guadalupe Garcia-Tsao; Jonathan Rubin; Brian Garra; Robert P Myers; Stephanie R Wilson; Deborah Rubens; Deborah Levine Journal: Radiology Date: 2015-06-16 Impact factor: 11.105
Authors: Mireen Friedrich-Rust; Katrin Wunder; Susanne Kriener; Fariba Sotoudeh; Swantje Richter; Joerg Bojunga; Eva Herrmann; Thierry Poynard; Christoph F Dietrich; Johannes Vermehren; Stefan Zeuzem; Christoph Sarrazin Journal: Radiology Date: 2009-08 Impact factor: 11.105