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.
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.