Value of shear wave elastography for the evaluation of hepatics fibrosis in infants with biliary atresia before Kasai portoenterostomy

Objective To investigate the application value of shear wave elastography(SWE) in assessing the degree of hepatics fibrosis in children with biliary atresia before Kasai portoenterostomy. Methods From January 2017 to January 2018, 49 cases of children in Hunan Children′s Hospital with highly suspected biliary atresia in clinical were collected. The stiffness of the lower segment of right anterior lobe of the liver in all cases was assessed using SWE in 3 days before Kasai portoenterostomy. Pathological results of liver tissue specimens from the lower edge of the right liver during the surgery was taken as the gold standard. The correlation between the liver stiffness and the hepatics fibrosis was analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curves were created to assess the area under curve (AUC), the best cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the liver stiffness in diagnosing hepatocirrhosis. Results All of the 49 cases were confirmed by surgery and pathology. According to the stages of hepatics fibrosis, 5 cases were in stage S2, 23 cases in stage S3, 21 cases in stage S4, and no cases of stage S0 and S1. Spearman correlation analysis showed that the correlation coefficient between the liver stiffness and the stages of hepatics fibrosis was 0.779(P<0.001). The area under the curve of the liver stiffness in diagnosing cirrhosis was 0.914. When the cutoff value was 14.45 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85.7%, 89.3%, 85.7%, 89.3%, 87.8%, respectively. Conclusions The liver stiffness measured by SWE is positively correlated with the stages of hepatic fibrosis, and the performance of SWE in the diagnosis of cirrhosis is remarkable. SWE can be used to evaluate the stages of hepatics fibrosis in children with biliary atresia before Kasai portoenterostomy. Key words: Ultrasonography; Biliary atresia; Infant; Hepatic fibrosis; Shear wave elastography