elastography | Acta Medica Marisiensis

The Elastographic Aspect of Liver in Pediatric Patients with Hepatopathies and Malignities Versus Healthy Children

Mărginean Oana¹, Baghiu Maria Despina¹, Brînzaniuc Klara², Mărginean Claudiu³, Chinceșan Mihaela¹, Pitea Ana Maria¹

1 Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Liver injury in context of chronical diseases, including malignacies, obesity, viral hepatitis, drug-related hepatotoxicity is an important concern for practicing pediatricians. The usual (biochemical) parameters for liver assessment prove to be now insufficient. Nowadays there is a high interest for finding non-invasive methods of hepatic evaluation, as an alternative to liver biopsy. Elastography fills a gap, provi-ding information on the degree of hepatic fibrosis.
Objective: Real-time elastographic assessment of liver tissue in correlation with biochemical parameters in children with hepatopathies and malignancies versus healthy children.
Material and method: Between September 15, 2010 and March 15, 2011 we conducted a prospective study in the Ist Pediatric Clinic Tîrgu Mureș, Romania, including a group of children with various malignancies under/after chemotherapy, a group of children with liver diseases (drug-related hepatotoxicity, obesity, hepatitis) and a control group composed of children with normal biochemical parameters. We assessed the liver tissue elasticity, expressed as SWV (shear wave velocity) on elastography, biochemical parameters, then statistical correlations were performed.
Results: Comparing SWV-values between the three groups, higher speeds were found in groups with liver damage after chemotherapy and those with hepatopathies (p=0.04). Aspartate transaminase (AST, IU) and alanine transaminase (ALT, IU) levels were different in a statistically significant manner between the three groups (p=0.0006 and 0.0002 respectively). In the after-chemiotherapy group significant correlations were obtained between elasticity and AST (p=0.0001).
Conclusions: In children with liver damage, SWV (which is correlated with the degree of liver fibrosis) increase in parallel with transaminases.

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children.
Methods: Eighty-six children, aged 3–18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureș between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it’s own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test.
Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings.
Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver.