Ultraschall Med 2012; 33(5): 474-479
DOI: 10.1055/s-0032-1313145
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents.

Normwert für Ultraschall-Elastografie mittels Acoustic Radiation Force Impulse Imaging (ARFI) in gesundem Lebergewebe bei Kindern und Jugendlichen
J. Eiler
1   Pediatric Radiology, UKGM Giessen
,
U. Kleinholdermann
2   General Psychology, JLU Giessen
,
D. Albers
3   Pediatrics, UKGM Marburg
,
J. Dahms
1   Pediatric Radiology, UKGM Giessen
,
F. Hermann
1   Pediatric Radiology, UKGM Giessen
,
C. Behrens
1   Pediatric Radiology, UKGM Giessen
,
M. Luedemann
4   Pediatric Cardiology, UKGM Giessen
,
V. Klingmueller
3   Pediatrics, UKGM Marburg
,
G. F. P. Alzen
1   Pediatric Radiology, UKGM Giessen
› Author Affiliations
Further Information

Publication History

14 May 2012

13 July 2012

Publication Date:
15 October 2012 (online)

Abstract

Purpose: Ultrasound elastography by acoustic radiation force impulse imaging (ARFI) is used in adults for non invasive measurement of liver stiffness, indicating liver diseases like fibrosis. To establish ARFI in children and adolescents we determined standard values of healthy liver tissue and analysed potentially influencing factors.

Materials and Methods: 132 patients between 0 and 17 years old were measured using ARFI. None of them had any liver disease or any other disease that could affect the liver secondarily. All patients had a normal ultrasound scan, a normal BMI and normal liver function tests. The mean value of all ARFI measurements was calculated and potentially influencing factors were analysed.

Results: The mean value of all ARFI elastography measurements was 1.16 m/sec (SD ± 0.14 m/sec). Neither age (p = 0.533) nor depth of measurement (p = 0.066) had no significant influence on ARFI values, whereas a significant effect of gender was found with lower ARFI values in females (p = 0.025), however, there was no significant interaction between age groups (before or after puberty) and gender (p = 0.276). There was an interlobar difference with lower values in the right liver lobe compared to the left (p = 0.036) and with a significantly lower variance (p < 0.001). Consistend values were measured by different examiners (p = 0.108), however, the inter examiner variance deviated significantly (p < 0.001).

Conclusion: ARFI elastography is a reliable method to measure liver stiffness in children and adolescents. In relation to studies which analyse liver diseases, the standard value of 1.16 m/sec (± 0.14 m/sec) allows a differentiation of healthy versus pathological liver tissue.

Zusammenfassung

Ziel: Ultraschall-Elastografie mit Acoustic Radiotion Force Impulse Imaging (ARFI) findet bei Erwachsenen Anwendung zur nicht invasiven Messung der Lebersteifigkeit, wodurch Pathologien wie Leberfibrose erkannt werden können. Um die ARFI-Methode bei Kindern und Jugendlichen zu etablieren, wurden von uns Normwerte für gesundes Lebergewebe erstellt und potenzielle Einflussfaktoren analysiert.

Material und Methoden: Es wurden 132 Patienten im Alter von 0 – 17 Jahren untersucht. Keiner der Patienten hatte eine Lebererkrankung oder andere Erkrankungen mit sekundärem Einfluss auf die Leber.  Alle Patienten wiesen einen normalen Ultraschall der Leber auf sowie einen normalen BMI und normale Leberlaborwerte. Der Mittelwert aller ARFI-Werte wurde errechnet und mögliche Einflussfaktoren wurden analysiert.

Ergebnisse: Von allen ARFI-Werten ergab sich ein Mittelwert von 1,16 m/s (± 0,14 m/s). Weder Alter (p = 0,533), noch Messtiefe (p = 0,066) zeigten einen signifikanten Einfluss. Dagegen hatten Mädchen niedrigere ARFI-Werte als Jungen (p = 0,025). Ein Interaktionseffekt zwischen Altersgruppen (vor/nach der Pubertät) und dem Geschlecht zeigte sich nicht (p = 0,276). Messungen im rechten Leberlappen ergaben niedrigere Messwerte (p = 0,036) und eine geringere Varianz (p < 0,001). Es zeigte sich kein Einfluss der verschiedenen Untersucher (p = 0,108), wobei sich die Varianz signifikant unterschied (p < 0,001).

Schlussfolgerung: Elastografie mittels ARFI ist eine zuverlässige Methode, um Lebersteifigkeit bei Kindern und Jugendlichen zu messen. Im Zusammenhang mit Studien über Leberpathologien ermöglicht ein Normwert von 1,16 m/s (± 0,14 m/s) eine korrekte Differenzierung von gesundem und pathologisch verändertem Lebergewebe.

 
  • References

  • 1 Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001; 344: 495-500
  • 2 Colloredo G, Guido M, Sonzogni A et al. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003; 39: 239-244
  • 3 Regev A, Berho M, Jeffers LJ et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97: 2614-2618
  • 4 Friedrich-Rust M, Zeuzem S. Transient elastography (FibroScan) for the non-invasive assessment of liver fibrosis: current status and perspectives. Z Gastroenterol 2007; 45: 387-394
  • 5 Friedrich-Rust M, Wunder K, Kriener S et al. Liver fibrosis in viral hepatitis: noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009; 252: 595-604
  • 6 Sporea I, Sirli RL, Deleanu A et al. Acoustic radiation force impulse elastography as compared to transient elastography and liver biopsy in patients with chronic hepatopathies. Ultraschall in Med 2011; 32: S46-S52
  • 7 Rizzo L, Calvaruso V, Cacopardo B et al. Comparison of transient elastography and acoustic radiation force impulse for non-invasive staging of liver fibrosis in patients with chronic hepatitis C. Am J Gastroenterol 2011; 106: 2112-2120
  • 8 Roulot D, Czernichow S, Le Clésiau H et al. Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol 2008; 48: 606-613
  • 9 Şirli R, Sporea I, Tudora A et al. Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness?. J Gastrointestin Liver Dis 2009; 18: 57-60
  • 10 Wong GLH, Wong VWS, Chim AML et al. Factors associated with unreliable liver stiffness measurement and its failure with transient elastography in the Chinese population. J Gastroenterol Hepatol 2011; 26: 300-305
  • 11 Engelmann G, Gebhardt C, Wenning D et al. Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr 2012; 171: 353-360
  • 12 Karlas T, Pfrepper C, Wiegand J et 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 Gastroenterol 2011; 46: 1458-1467
  • 13 Rifai K, Cornberg J, Mederacke I et al. Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Dig Liver Dis 2011; 43: 491-497
  • 14 Toshima T, Shirabe K, Takeishi K et 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 Gastroenterol 2011; 46: 705-711
  • 15 Goertz RS, Zopf Y, Jugl V et al. Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis. Ultraschall in Med 2010; 31: 151-155
  • 16 Takahashi H, Ono N, Eguchi Y et al. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study. Liver Int 2010; 30: 538-545
  • 17 Grgurevic I, Cikara I, Horvat J et al. Noninvasive assessment of liver fibrosis with acoustic radiation force impulse imaging: increased liver and splenic stiffness in patients with liver fibrosis and cirrhosis. Ultraschall in Med 2011; 32: 160-166
  • 18 Ebinuma H, Saito H, Komuta M et al. Evaluation of liver fibrosis by transient elastography using acoustic radiation force impulse: comparison with Fibroscan®. J Gastroenterol 2011; 46: 1238-1248
  • 19 Fierbinteanu-Braticevici C, Andronescu D, Usvat R et al. Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis. World J Gastroenterol 2009; 15: 5525-5532
  • 20 Kim JE, Lee JY, Kim YJ et al. Acoustic radiation force impulse elastography for chronic liver disease: comparison with ultrasound-based scores of experienced radiologists, Child-Pugh scores and liver function tests. Ultrasound Med Biol 2010; 36: 1637-1643
  • 21 Son CY, Kim SU, Han WK et al. Normal liver elasticity values using acoustic radiation force impulse (ARFI) imaging: a prospective study in healthy living liver and kidney donors. J Gastroenterol Hepatol 2012; 27: 130-136
  • 22 Popescu A, Sporea I, Şirli R et al. The mean values of liver stiffness assessed by Acoustic Radiation Force Impulse elastography in normal subjects. Med Ultrason 2011; 13: 33-37
  • 23 Horster S, Mandel P, Zachoval R et al. Comparing acoustic radiation force impulse imaging to transient elastography to assess liver stiffness in healthy volunteers with and without valsalva manoeuvre. Clin Hemorheol Microcirc 2010; 46: 159-168
  • 24 Noruegas M, Matos H, Gonçalves I et al. Acoustic radiation force impulse-imaging in the assessment of liver fibrosis in children. Pediatr Radiol 2012; 42: 201-204
  • 25 Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303
  • 26 Guzmán-Aroca F, Reus M, Berná-Serna JD et al. Reproducibility of shear wave velocity measurements by acoustic radiation force impulse imaging of the liver: a study in healthy volunteers. J Ultrasound Med 2011; 30: 975-979
  • 27 Gallotti A, D’Onofrio M, Mucelli R. Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen. Radiol Med 2010; 115: 889-897
  • 28 D’Onofrio M, Gallotti A, Mucelli RP. Tissue quantification with acoustic radiation force impulse imaging: Measurement repeatability and normal values in the healthy liver. Am J Roentgenol 2010; 195: 132-136
  • 29 Corpechot C, El Naggar A, Poupon R. Gender and liver: is the liver stiffness weaker in weaker sex?. Hepatology 2006; 44: 513-514
  • 30 Kaminuma C, Tsushima Y, Matsumoto N et al. Reliable measurement procedure of virtual touch tissue quantification with acoustic radiation force impulse imaging. J Ultrasound Med 2011; 30: 745-751