Pediatric Radiology

, Volume 46, Issue 7, pp 1011–1016 | Cite as

Acoustic radiation force impulse sonography in assessing children with biliary atresia for liver transplantation

  • Sylviane HanquinetEmail author
  • Delphine S. Courvoisier
  • Anne-Laure Rougemont
  • Barbara E. Wildhaber
  • Laura Merlini
  • Valérie A. McLin
  • Mehrak Anooshiravani
Original Article



Children with biliary atresia are prone to developing progressive hepatic fibrosis and biliary cirrhosis following the Kasai operation. The only treatment is liver transplantation.


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.


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).


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.


Acoustic radiation force impulse elastography (ARFI) Biliary atresia Children Cholestasis Kasai operation Liver stiffness Liver transplantation Shear wave elastography Ultrasound 



We tank Isabelle Bosquet, pediatric radiology nurse at Children’s Hospital Geneva, Switzerland, for data management.

Compliance with ethical standards

Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sylviane Hanquinet
    • 1
    Email author
  • Delphine S. Courvoisier
    • 2
  • Anne-Laure Rougemont
    • 3
  • Barbara E. Wildhaber
    • 4
  • Laura Merlini
    • 1
  • Valérie A. McLin
    • 5
  • Mehrak Anooshiravani
    • 1
  1. 1.Department of Pediatric RadiologyChildren’s University Hospital of GenevaGenève 14Switzerland
  2. 2.Division of Quality of CareUniversity Hospital of GenevaGenevaSwitzerland
  3. 3.Division of Clinical PathologyUniversity Hospital of GenevaGenevaSwitzerland
  4. 4.Department of Pediatric SurgeryChildren’s University Hospital of GenevaGenevaSwitzerland
  5. 5.Department of Pediatric GastroenterologyChildren’s University Hospital of GenevaGenevaSwitzerland

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