Performance of two--dimensional ultrasound shear wave elastography: reference values of normal liver stiffness in children
Two-dimensional (2-D) shear wave elastography is a new sonographic elastography method for noninvasive measurement of liver stiffness.
The aim of this study was to establish reference values of normal liver stiffness on 2-D shear wave elastography in children.
Materials and methods
Two-dimensional shear wave elastography values were measured in 202 children with no liver disease from the neonatal period to puberty, who were divided into 4 age groups: newborns and infants, preschoolers, elementary school children and adolescents. We investigated the effects of age, depth of elastography measurement, transducer, number of measurements per child, liver size and Doppler parameters of hepatic blood flow on liver elasticity values.
The mean normal liver elasticity value in the study population was: 4.29±0.59 kilopascals (kPa). In neonates and infants, mean liver elasticity value was 4.63 (± 0.6) kPa, in preschoolers and elementary school children, 4.05 (± 0.57) kPa and 4.15 (± 0.52) kPa, respectively, and in adolescents, 4.39 (± 0.55) kPa. Values in neonates and infants as well as adolescents were significantly higher than in preschoolers and elementary school children (Kruskal-Wallis, P<0.001; Mann-Whitney U tests, P<0.05). There was no significant association between liver elasticity values and size of the right lobe or Doppler parameters of hepatic blood flow. Different depths and the number of elastography measurements had no effect on liver elasticity values.
Two-dimensional shear wave elastography is achievable in a wide range of age in children. We established the reference values of normal liver stiffness on 2-D shear wave elastography in children.
KeywordsAdolescents Children Elastography Liver stiffness Two-dimensional shear wave imaging Ultrasound
Compliance with ethical standards
Conflicts of interest
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Tutar O, Beser OF, Adaletli I et al (2014) Shear wave elastography in the evaluation of liver fibrosis in children. J Pediatr Gastroenterol Nutr 58:750–755Google Scholar
- 7.Eiler J, Kleinholdermann U, Albers D et al (2012) Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med 8:474–479Google Scholar
- 10.Nobili V, Monti L, Alisi A et al (2011) Transient elastography for assessment of fibrosis in paediatric liver disease. Pediatr Radiol 41:1232–1238Google Scholar
- 12.Tokuhara D, Cho Y, Shintaku H (2016) Transient Elastography-based liver stiffness age-dependently increases in children. PLoS One 11:e0166683Google Scholar
- 17.Lee MJ, Kim MJ, Han KH, Yoon CS (2013) Age-related changes in liver, kidney and spleen stiffness in healthy children measured with acoustic radiation force impulse imaging. Eur J Radiol 82:290–294Google Scholar
- 18.Shin HJ, Kim MJ, Kim HY et al (2016) Optimal acquisition number for hepatic shear wave velocity measurements in children. PLoS One 11:e0168758Google Scholar
- 19.Konus OL, Ozdemir A, Akkaya A et al (1998) Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography. AJR Am J Roentgenol 171:1693–1698Google Scholar
- 20.de Bruyn R (2005) Pediatric ultrasound how, why and when. Elsevier/Churchill LivingstoneGoogle Scholar
- 21.Mueller S, Sandrin L (2010) Liver stiffness: a novel parameter for the diagnosis of liver disease. Hepat Med 2:49–67Google Scholar
- 23.Lee SM, Lee JM, Kang HJ et al (2017) Liver fibrosis staging with a new 2D-shear wave elastography using comb-push technique: applicability, reproducibility, and diagnostic performance. PLoS One 12:e0177264Google Scholar
- 25.GE Healthcare LOGIQ E9 Shear Wave Elastography Whitepaper recommendations. Available at: http://www3.gehealthcare.com