Effect of breath control on hepatic shear wave elasticity and dispersion in pediatric patients.

Purpose: This study aimed to evaluate the effect of breath control on the reliability of two-dimensional shear wave elastography (2D-SWE) and shear wave dispersion (SWD) measurements in pediatric patients.

Methods: This study included a retrospective cohort of 163 children and a prospective cohort of 27 children (aged 8-17 years). All participants underwent 2D-SWE and SWD under both free-breathing and breath-hold conditions between September 2021 and February 2023. The prospective cohort also underwent magnetic resonance elastography (MRE). Liver stiffness and dispersion values were compared between respiratory conditions. Inter- and intra-rater agreements were assessed, and correlations with MRE were analyzed in the prospective cohort.

Results: Liver stiffness and dispersion values were significantly higher during free-breathing compared to breath-hold (mean differences: 0.22 kPa and 0.39 m/s/kHz, respectively; both P<0.01). Breath-hold improved inter-rater agreement for 2D-SWE (intraclass correlation coefficient [ICC], 0.94 vs. 0.83; P=0.005) and SWD (ICC, 0.85 vs. 0.70; P=0.048). Intra-rater agreement for 2D-SWE (ICC, 0.88 vs. 0.88; P>0.99) and SWD (ICC, 0.70 vs. 0.74; P=0.396) remained moderate to good and did not differ significantly between conditions. The correlation between 2D-SWE and MRE was stronger under breath-hold than free-breathing (r=0.73 vs. r=0.56), although this difference was not statistically significant (P=0.299).

Conclusion: Breath-holding increases the reliability of pediatric 2D-SWE and SWD by improving inter-rater agreement and correlation with MRE. However, free-breathing also demonstrates comparable reproducibility with minimal bias, supporting its clinical feasibility for use in uncooperative pediatric patients.