Comparison of Transient Elastography, ShearWave Elastography, Magnetic Resonance Elastography and FibroTest as routine diagnostic markers for assessing liver fibrosis in children with Cystic Fibrosis - 27/03/22
, Muriel Girard d, e, Stéphanie Franchi-Abella f, Laureline Berteloot a, Martina Benoit-Cherifi a, Françoise Imbert-Bismut g, h, Isabelle Sermet-Gaudelus i, j, Dominique Debray d, hBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | Liver stiffness clearly identifies patients with cystic fibrosis related liver disease and may predict major liver events. |
• | Transient Elastography and Shearwave Elastography demonstrated higher diagnostic performance and reliability than Magnetic Resonance Elastography for assessing liver fibrosis in Cystic Fibrosis. |
• | The optimal cut-off values for predicting Cystic Fibrosis related liver disease on Transient Elastography, Shearwave Elastography and MR Elastography are 8.7, 7.8, and 4.15 kPa, respectively. |
Abstract |
Background and Objective |
Reliable markers are needed for early diagnosis and follow-up of liver disease in Cystic Fibrosis (CF).
The objective was to evaluate the diagnostic performance of Transient Elastography (TE), Real-Time ShearWave Ultrasound Elastography (SWE), Magnetic Resonance Elastography (MRE) and the FibroTest as markers of Cystic Fibrosis Liver Disease (CFLD).
Methods |
A monocentric prospective cross-modality comparison study was proposed to all children (6 to 18 years of age) attending the CF center. Based on liver ultrasound findings, participants were classified into 3 groups: multinodular liver or portal hypertension (Nodular US/PH, advanced CFLD), heterogeneous increased echogenicity (Heterogeneous US, CFLD) or neither (Normal/Homogeneous US, no CFLD). The 4 tests were performed on the same day. The primary outcome was the FibroTest value and liver stiffness measurements (LSM).
Results |
55 participants (mean age 12.6 ± 3.3 years; 25 girls) were included between 2015 and 2018: 23 in group Nodular US/PH, 8 in group Heterogeneous US and 24 in group Normal/Homogeneous US (including 4 with steatosis). LSM on TE, SWE and MRE were higher in participants with CFLD (groups Nodular US/PH and Heterogeneous US) compared to others (group Normal/Homogeneous US) (p<0.01), while FibroTest values did not differ (p = 0.09). The optimal cut-off values for predicting CFLD on TE, SWE and MRE were 8.7 (AUC=0.83, Se=0.71, Sp=0.96), 7.8 (AUC=0.85, Se=0.73, Sp=0.96) and 4.15 kPa (AUC=0.68, Se=0.73, Sp=0.64), respectively. LSM predicted the occurrence of major liver-related events at 3 years. TE and SWE were highly correlated (Spearman's ρ=0.9) and concordant in identifying advanced CFLD (Cohen's κ=0.84) while MRE was moderately correlated and concordant with TE (ρ=0.41; κ=36) and SWE (ρ=0.5; κ=0.50).
Conclusion |
This study demonstrated excellent diagnostic performance of TE, SWE and MRE for the diagnosis of CFLD.
Le texte complet de cet article est disponible en PDF.Keywords : Cystic fibrosis liver disease, Liver stiffness, Elastography, Children
Abbreviations : AUC, APRI, CF, CFLD, GPR, GRE, LSM, MRE, PDFF, SE-EPI, SWE, TE, US
Plan
Vol 46 - N° 3
Article 101855- mars 2022 Retour au numéro
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