Bidimensional shear wave spleen elastography for diagnosis and grading of esophageal varices in children with portal hypertension.

IF 2.3 3区 医学 Q2 PEDIATRICS
Cecilia Mackintosh, Julio Sebastian Kaplan, Alejandra Yanet Prati, Silvina Denise Ruvinsky, Macarena Roel, Adriana Bottero, Esteban Pablo Dardanelli
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引用次数: 0

Abstract

Background: Portal hypertension in children can result from a wide range of liver diseases, both cirrhotic and non-cirrhotic. Non-invasive diagnosis of esophageal varices, a potentially life-threatening complication, is of utmost importance in these patients.

Objective: To assess the agreement between spleen stiffness by bidimensional shear wave elastography (2D SWE) and endoscopic findings (presence and grading of esophageal varices) in pediatric patients with portal hypertension.

Materials and methods: Single-center retrospective observational study between February 2021 and August 2024. Data from pediatric patients (< 18 years old) who underwent esophagogastroduodenoscopy within a month of a grayscale ultrasound including spleen elastography were collected. Patients were divided into three groups: varices-free, low-risk varices, and high-risk varices (enlarged tortuous varices with red color sign, or large size varices). The area under the receiver operating characteristic curve (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were estimated.

Results: We included 163 patients (86 males, 77 females; median age: 9 years (interquartile range (IQR) 6-13 years)). The sample included 80 varices-free (49%), 38 low-risk varices (23%), and 45 high-risk varices (28%) cases. The median spleen elastography was 20 kPa (2.58 m/s), 34 kPa (3.36 m/s), and 40 kPa (3.65 m/s) in the varices-free, low-risk, and high-risk varices groups, respectively. When a cut-off value of 28.5 kPa (3.08 m/s) was used to detect varices of any grade, the sensitivity was 93% (95% confidence interval: 85-97), the specificity was 94% (86-98), PPV 94% (86-98), and NPV 93% (85-97). An AUROC of 0.93 (0.90-0.98) was obtained. When comparing the high versus low-risk varices groups, using a cut-off point of 35.35 kPa (3.43 m/s), we obtained an AUROC of 0.66, with a sensitivity of 71%, specificity of 61%, PPV 68%, and NPV of 64%.

Conclusion: Spleen stiffness by bidimensional shear wave elastography showed excellent diagnostic performance for detecting esophageal varices in children with portal hypertension and a moderate performance for distinguishing patients with low-risk varices from those with high-risk varices.

二维剪切波脾弹性成像对门脉高压患儿食管静脉曲张的诊断和分级。
背景:儿童门脉高压可由多种肝脏疾病引起,包括肝硬化和非肝硬化。食管静脉曲张是一种潜在的危及生命的并发症,对这些患者的无创诊断至关重要。目的:评估小儿门静脉高压患者的二维剪切波弹性成像(2D SWE)和内镜检查结果(食管静脉曲张的存在和分级)之间的一致性。材料和方法:2021年2月至2024年8月的单中心回顾性观察研究。结果:我们纳入163例患者(男性86例,女性77例;中位年龄:9岁(四分位数范围(IQR) 6-13岁))。样本包括80例无静脉曲张(49%),38例低风险静脉曲张(23%)和45例高风险静脉曲张(28%)。无静脉曲张组、低危组和高危组脾弹性图中值分别为20 kPa (2.58 m/s)、34 kPa (3.36 m/s)和40 kPa (3.65 m/s)。当截断值28.5 kPa (3.08 m/s)用于检测任何级别的静脉曲张时,灵敏度为93%(95%置信区间:85-97),特异性为94% (86-98),PPV为94% (86-98),NPV为93%(85-97)。AUROC为0.93(0.90 ~ 0.98)。当比较高风险静脉曲张组和低风险静脉曲张组时,使用35.35 kPa (3.43 m/s)的截断点,我们得到AUROC为0.66,敏感性为71%,特异性为61%,PPV为68%,NPV为64%。结论:脾僵硬度二维剪切波弹性成像对门脉高压患儿食管静脉曲张的诊断效果较好,对低风险静脉曲张和高风险静脉曲张的鉴别效果中等。
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来源期刊
Pediatric Radiology
Pediatric Radiology 医学-核医学
CiteScore
4.40
自引率
17.40%
发文量
300
审稿时长
3-6 weeks
期刊介绍: Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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