The role of sonoelastography in evaluation of the pediatric age group patients with hepatic fibrosis

PURPOSE: The aim of this study was to evaluate potential role of ultrasound elastography in the assessment of hepatic fibrosis of pediatric patients.MATHERIALS AND METHODS: Twenty four pediatric(0-18 y) patients with hepatic fibrosis were included in this study. Eight of the patients were female and sixteen were male. All patients were evaluated with B-mode and sonoelastography using Hitachi EUB 7500 digital ultrasound equipment. All images were recorded digitally. The biopsy procedure was performed to all patients in a week after or before sonoelastography. Elastographic scores of liver parenchyma were categorized to four main groups. Elastographic scores were determined as non-fibrotic (score 1), mild fibrosis (score 2), modarete fibrosis (score 3) and severe fibrosis (score 4). All sonoelastographic images were assessed by two blinded radiologists and were scored in consensus. Strain index values were calculated for 16 patients. The elastographic scores and mean strain index values of the liver parenchyma were correlated with their pathological diagnosis.RESULTS: In histopathological examination, cases were classified by using `Modified ISHAK Classification?. Eight of the patients were diagnosed as non fibrotic (F0), 5 of them diagnosed as mild fibrosis (F1) , 9 of them diagnosed as modarete fibrosis (F2) and 2 of them diagnosed as severe fibrosis (F3). In116elastographic examination mean elastography scores were 1,75 ± 0,707 for 8 non-fibrotic patients. Mean elastography scores of 16 patient with fibrosis were 2,94 ± 0,772. Sonoelastography was statistically significant (p<0,05) for the presence of hepatic fibrosis. The mean values of strain index were 0.69 ± 0.56 in non-fibrotic patients and 1.76 ± 0.56 in fibrotic patients. Elastography has %100 sensitivity and %83.3 specifity to distunguish the presence of hepatic fibrosis if the cutoff values of strain index were selected as 1.03.In our study, due to the small number of patients, patients with moderate and severe fibrosis were evaluated in the same group. Elastography scores were statistically significant to differentiate mild and moderate-severe fibrosis. In multiple comparisons strain index values were statistically significant for the evaluation of hepatic fibrosis.CONCLUSION: Our findings support that real time elastography is a non-invasive methot that has the potential to improve the diagnostic value of gray scale sonography for the diagnosis and staging of hepatic fibrosis.