New imagistic method for assessment of liver structure in children

Abstract

Introduction: Newly, acoustic radiation force impulse (ARFI) elastography has been introduced as a noninvasive technique for evaluating liver fibrosis. Matherial and methods: The present study was carried out at the Ist Pediatric Clinic Tg.-Mures, Romania, between 2010 September and 2011, April; it was a prospective study including a control group composed of 38 children with normal clinical and paraclinical findings related to the liver function and a lot of 96 children with different causes of hepatopathies. In group of patients with liver damage there were 28 overweight and obese children (considered overweight whether their weight was between the 85th and 95thpercentilefor age and sex, and obese whether their weight exceeds 95th percentile, respectively), all of them with modifications to the standard abdominal ultrasound (high echogenicity, granular liver aspect, posterior attenuation suggestive for steatosis); there were 48 patients with various malignancies under or after chemotherapy, with tumor infiltration of the liver or hepatotoxicity related to cytostatic treatment and a number of 20 patients with various etiology of hepatopathy (viral hepatitis, acute toxic hepatitis, drug hepatotoxicity).Alanine transaminase(ALT, IU) was 19,56±8,67 SD in the control group, and 37,42±31,16 in the group of children with liver diseases, while aspartate transaminase (AST, IU) was 24,88±8.67 SD in the control group, and 39,92±20,12 in the group of children with liver inury. As far as it concerns aspartate transaminase(AST, IU), in the control group it were, also, smaller levels than inthe groupofchildrenwithhepatopathies, the difference between AST mean for the two groups was, as for ALT, statistically extremely significant, with p<0.0001 We searched for correlations between global SVW and other determined parameters (AST and ALT) in each group, but we obtained no statisticaly significant correlations between the assesed parameters, except that between SWV and AST, only for the group of children with liver injury (r = 0,54 and p = 0,01),statistically significant. Conclusions: In normal conditions (children with free liver tissue), SVW was higher for the segment VIII compared to I, statistically significant, meaning that caudate lobe is “softer”, difference that does not exist in the group of liver diseases. SWV values in group of children with hepatopathies were found to increase particularly in the segment I (caudate lobe), which shows that it is first affected by any liver injury.