Technical performance of shear wave elastography for measuring liver stiffness in pediatric and adolescent patients: a systematic review and meta-analysis
To assess the technical performance (proportion of technical failure and unreliable measurements) of shear wave elastography (SWE) for assessing liver stiffness in pediatric and adolescent patients.
We searched Ovid-MEDLINE and EMBASE databases for eligible studies and selected original articles investigating transient elastography (TE), point shear wave elastography (pSWE), or two-dimensional SWE (2D-SWE) for measuring liver stiffness in pediatric and adolescent patients. A quantitative synthesis of studies reporting technical failures and/or unreliable measurements of TE, pSWE, or 2D-SWE is presented. Meta-analytic pooling was conducted using the random effects model. Meta-regression analysis was conducted to explore potential causes of heterogeneity.
Forty of 69 studies (58%) provided technical performance information. Technical failure data were reported in 3 TE, 6 pSWE, and 8 2D-SWE studies. Unreliable measurement data were provided in 21 TE, 4 pSWE, and 1 2D-SWE study. The pooled proportion of unreliable measurements of TE was 12.1%. Meta-regression analysis showed that the study population size and readers’ blinding to pathologic results affected the study’s heterogeneity. The pooled proportions of technical failure during pSWE and 2D-SWE were 4.1% and 2.2%, respectively, demonstrating no significant difference between the techniques.
We reviewed the technical performance of SWE, especially the rate of unreliable measurements from TE studies and rates of technical failure from pSWE and 2D-SWE studies. Considering the importance of technical performance for clinical validation of SWE, numbers of and reasons for technical failure and unreliable measurements should be reported in future studies. Further efforts are necessary to standardize SWE reliability criteria.
• Most TE studies reported rate of unreliable measurements, whereas pSWE and 2D-SWE studies were likely to report rates of technical failure.
• The pooled proportion of unreliable measurements of TE was 12.1%.
• The pooled proportions of technical failure during pSWE and 2D-SWE were 4.1% and 2.2%, respectively, demonstrating no significant difference between the techniques.
KeywordsElasticity imaging techniques Liver Meta-analysis Pediatrics Ultrasonography
Two-dimensional shear wave elastography
Acoustic radiation force impulse
Point shear wave elastography
Shear wave elastography
This study was supported by a grant (2016-719) from the Asan Medical Center, Seoul, Korea.
Compliance with ethical standards
The scientific guarantor of this publication is Jin Seong Lee.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
An expert (Chong Hyun Suh), who has 5 years of experience with more than 30 papers in a systematic review and meta-analysis, assisted in statistics for our study.
Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.
Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.
• A systemic review and meta-analysis performed at one institution
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