Acoustic radiation force impulse (ARFI) is a non-invasive alternative to a liver biopsy for the evaluation of liver fibrosis (LF).
Purpose
To investigate the potential usefulness of acoustic radiation force impulse ARFI for detecting LF in overweight and obese children
Material and Methods
A cross-sectional study was conducted in 148 schoolchildren. A diagnosis of non-alcoholic fatty liver disease (NAFLD) and LF was based on ultrasound (US) and ARFI shear wave velocity (SWV).
Results
The laboratory parameters were normal in all the children. NAFLD was observed in 50 children (33.8%). The median SWV was 1.18 ± 0.28 m/s. Differences between ARFI categories and hepatic steatosis grades were observed (χ2 = 43.38, P = 0.0005). No fibrosis or insignificant fibrosis (SWV ≤ 1.60 m/s) was detected in 137 children (92.5%), and significant fibrosis (SWV > 1.60 m/s) in 11 children (7.5%), nine of whom had normal US or mild steatosis.
Conclusion
The present study is the first to evaluate the utility of the ARFI technique for detecting LF in overweight and obese children. The results of the study suggest that children with normal laboratory parameters such as normal liver ultrasound or mild steatosis may present with significant LF.
OgdenCLCarrollMDCurtinLRet al.Prevalence of overweight and obesity in the United States, 1999-2004. JAMA2006; 295: 1549–1555.
3.
PalmeriMLWangMHRouzeNCet al.Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol2011; 55: 666–672.
4.
AwaiHINewtonKPSirlinCBet al.Evidence and recommendations for imaging liver fat in children, based on systematic review. Clin Gastroenterol Hepatol2014; 12: 765–773.
BarshopNJSirlinCBSchwimmerJBet al.Review article: epidemiology, pathogenesis and potential treatments of paediatric non-alcoholic fatty liver disease. Aliment Pharmacol Ther2008; 28: 13–24.
9.
WidhalmKGhodsE. Nonalcoholic fatty liver disease: a challenge for pediatricians. Int J Obes (Lond)2010; 34: 1451–1467.
10.
SarvazyanAPRudenkoOVSwansonSDet al.Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol1998; 24: 1419–1435.
11.
ZhaiLPalmeriMLBouchardRRet al.An integrated indenter-ARFI imaging system for tissue stiffness quantification. Ultrason Imaging2008; 30: 95–111.
12.
Guzmán-ArocaFReusMBerná-SernaJDet al.Reproducibility of shear wave velocity measurements by acoustic radiation force impulse imaging of the liver: a study in healthy volunteers. J Ultrasound Med2011; 30: 975–979.
13.
Fierbinteanu BraticeviciCSporeaIPanaitescuEet al.Value of acoustic radiation force impulse imaging elastography for non-invasive evaluation of patients with nonalcoholic fatty liver disease. Ultrasound Med Biol2013; 39: 1942–1950.
14.
ToshimaTShirabeKTakeishiKet al.New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver. J Gastroenterol2011; 46: 705–711.
15.
KarlasTPfrepperCWiegandJet al.Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of fibrosis: examination standards and evaluation of interlobe differences in the healthy subjects and chronic liver disease. Scand J Gastroenterol2011; 46: 1458–1467.
16.
Friedrich-RustMNierhoffJLupsorMet al.Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat2012; 19: e212–e219.
17.
NierhoffJChávez OrtizAAHerrmannEet al.The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a metaanalysis. Eur Radiol2013; 23: 3040–3053.
18.
LiCZhangCLiJHuoHet al.Diagnostic accuracy of real-time shear wave elastography for staging of liver fibrosis: a meta-analysis. Med Sci Monit2016; 22: 1349–1359.
19.
NoruegasMJMatosHGonçalvesIet al.Acoustic radiation force impulse imaging in the assessment of liver fibrosis in children. Pediatr Radiol2012; 42: 201–214.
20.
HanquinetSRougemontALCourvoisierDet al.Acoustic radiation force impulse (ARFI) elastography for the noninvasive diagnosis of liver fibrosis in children. Pediatr Radiol2013; 43: 545–551.
21.
Picó AliagaSDMuro VelillaDGarcía-MartíGet al.Acoustic radiation force impulse imaging elastography is efficacious in detecting hepatic fibrosis in children. Radiologia2015; 57: 314–320.
22.
DillmanJRHeiderABilhartzJLet al.Ultrasound shear wave speed measurements correlate with liver fibrosis in children. Pediatr Radiol2015; 45: 1480–1488.
23.
KimSHLeeJMKimJHet al.Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images–initial experience. Radiology2005; 234: 793–803.
24.
El-KoofyNEl-KaraksyHEl-AkelWet al.Ultrasonography as a non-invasive tool for detection of nonalcoholic fatty liver disease in overweight/obese Egyptian children. Eur J Radiol2012; 81: 3120–3123.
25.
StraussSGavishEGottliebPKatsnelsonL. Interobserver and intraobserver variability in the sonographic assessment of fatty liver. Am J Roentgenol2007; 189: W320–323.
26.
HernaezRLazoMBonekampSet al.Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis. Hepatology2011; 54: 1082–1090.
27.
CengizMSentürkSCetinBet al.Sonographic assessment of fatty liver: intraobserver and interobserver variability. Int J Clin Exp Med2014; 7: 5453–5460.
28.
HanquinetSCourvoisierDKanavakiAet al.Acoustic radiation force impulse imaging-normal values of liver stiffness in healthy children. Pediatr Radiol2013; 43: 539–544.
29.
MatosHTrindadeANoruegasMJ. Acoustic radiation force impulse imaging in paediatric patients: normal liver values. J Pediatr Gastroenterol Nutr2014; 59: 684–688.
30.
FontanillaTCañasTMaciaAet al.Normal values of liver shear wave velocity in healthy children assessed by acoustic radiation force impulse imaging using a convex probe and a linear probe. Ultrasound Med Biol2014; 40: 470–477.
31.
SonCYKimSUHanWKet al.Normal liver elasticity values using acoustic radiation force impulse imaging: a prospective study in healthy living liver and kidney donors. J Gastroenterol Hepatol2012; 27: 130–136.
32.
PopescuASporeaISirliRet al.The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med Ultrason2011; 13: 33–37.
33.
HorsterSMandelPZachovalRet al.Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without Valsalva manoeuvre. Clin Hemorheol Microcirc2010; 46: 159–168.
34.
EilerJKleinholdermannUAlbersDet al.Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med2012; 33: 474–479.
35.
RoulotDCzernichowSLe ClésiauHet al.Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol2008; 48: 606–613.
36.
SirliRSporeaITudoraAet al.Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness?J Gastrointestin Liver Dis2009; 18: 57–60.
37.
CañasTMaciáAMuñoz-CodoceoRAet al.Hepatic and splenic acoustic radiation force impulse shear wave velocity elastography in children with liver disease associated with cystic fibrosis. Biomed Res Int2015; 2015: 517369–517369.
38.
PiscagliaFSalvatoreVDi DonatoRet al.Accuracy of VirtualTouch Acoustic Radiation Force Impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med2011; 32: 167–175.
39.
KarlasTPfrepperCWiegandJet al.Acoustic radiation force impulse imaging (ARFI) for non-invasive detection of liver fibrosis: examination standards and evaluation of interlobe differences in healthy subjects and chronic liver disease. Scand J Gastroenterol2011; 46: 1458–1467.
40.
ToshimaTShirabeKTakeishiKet al.New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver. J Gastroenterol2011; 46: 705–711.
41.
Guzmán-ArocaFFrutos-BernalMDBasALuján-MompeánJAet al.Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging. Eur Radiol2012; 22: 2525–2532.
42.
RatziuVCharlotteFHeurtierAet al.Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology2005; 7: 1898–1906.
43.
VajroPLentaSSochaPet al.Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr2012; 54: 700–713.
