Gastroenterologìa (Sep 2018)
Sonological methods for diagnosing liver steatosis and fibrosis in children
Abstract
Background. The purpose was to compare the possibilities of standard ultrasound, shear wave elastography with steatometry and transient elastography with CAP function for diagnosing liver steatosis and fibrosis. Materials and methods. The survey included 90 patients aged 5 to 17 years, with an average age of patients (12.08 ± 2.71) years. Determination of liver steatosis and its degree was carried out with FibroScan 520 Touch (Echosens, France) with CAP measurement. All children underwent an ultrasound examination of the liver parenchyma using B-method with simultaneous shear wave elastography and steatometry on Ultima PA (Radmir, Kharkiv). According to the CAP measurements and overweight/obesity parameters the patients were divided into 3 groups: 1st group consisted of 45 patients with liver steatosis and overweight and obesity (50.0 %), 2nd group — 35 patients with overweight and obesity without steatosis (38.9 %), 3rd group (control group) — 10 patients with normal weight without steatosis (11.1 %). Results. 75.0 % of patients experienced increased echogenicity of the liver. In children of the 1st group changes in liver parenchyma were observed 2.2 times more frequently than in the 2nd and 3rd groups. The liver stiffness in the examined patients varied from 2.3 to 8.8 kPa, and the CAP — from 108 to 349 dB/m. In the overwhelming majority (96.1 %) of patients, fibrosis was absent; the first and second degrees of fibrosis were found only in 3 patients (3.9 %) in the first group. According to steatometry of the liver, the average coefficient of ultrasound attenuation in children of the 1st group was significantly higher compared to the control group (p < 0.05). The shear wave elastography sensitivity in liver fibrosis detection versus transient elastography was 83.33 %, the specificity was 60.0 %, the positive predictive value was 15.15 %, the negative predictive value was 97.67 %. When comparing the methods of steatometry and CAP, the diagnosis of liver steatosis in children of the 1st group revealed coincidence in 15 of 26 cases, which corresponded to diagnostic efficiency of 57.7 %. Conclusions. Thus, the combination of ultrasound regimes for assessing structural changes in the liver with shear wave elastography and steatometry allows assessing the stage of fibrosis and the degree of steatosis in the context of multiparameter ultrasound examination in children with diffuse changes in the liver parenchyma.
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