Transient elastography (FibroScan) is a novel, noninvasive, rapid bedside method to assess liver fibrosis by measuring liver stiffness in adult patients. The usefulness of FibroScan in children with chronic liver diseases is unknown. The aim of this prospective study was to evaluate the feasibility of liver stiffness measurement and to compare FibroScan, Fibrotest, and aspartate transaminase to platelets ratio index (APRI) with liver biopsy for the diagnosis of cirrhosis in children with chronic liver diseases.
PATIENTS AND METHODS
Between February 2004 and October 2005, 116 consecutive children with chronic liver diseases were prospectively included. All except 1 child (58 boys, mean age 10.7 years) could have noninvasive tests for fibrosis: FibroScan, Fibrotest, and APRI, and, when necessary, a liver biopsy (n = 33).
FibroScan, Fibrotest, and APRI were correlated with clinical or biological parameters of chronic liver diseases, but the FibroScan marker correlated most with all parameters. By histology, the METAVIR fibrosis category score was F1 in 7 cases, F2 in 8 cases, F3 in 6 cases, and F4 in 12 cases. FibroScan, Fibrotest, and APRI were significantly correlated with the METAVIR fibrosis score. For the diagnosis of cirrhosis, the area under the receiver operating characteristic curve was 0.88, 0.73, and 0.73 for FibroScan, Fibrotest, and APRI, respectively.
These results indicate that liver stiffness measurement is feasible in children and is related to liver fibrosis. A specific probe dedicated to children and slender patients has thus been developed and is currently under evaluation. The FibroScan equipped with this specific probe could become a useful tool for the management of chronic liver diseases in children.
7 Figures and Tables
FIG. 1. Time-motion mode image and elastogram displayed on the screen of FibroScan during liver stiffness measurement.
TABLE 1. Characteristics of
FIG. 2. Example of elastogram with 2 black bands in an A pattern. A, Slow wave; B, fast wave.
TABLE 2. Spearman correlations of FibroScan, Fibrotest, and APRI values vs biological and clinical parameters
FIG. 3. Box plots of FibroScan (A), Fibrotest (B), and APRI (C) valu quartiles, respectively. Length of box thus represents the IQR within represents the median. Error bars show minimum and maximum
TABLE 3. Median values of noninvasive tests for different stages of fibrosis as defined by METAVIR score in the 33 children with biopsy
FIG. 4. ROC curves for FibroScan, Fibrotest, and APRI, for diagnosis of cirrhosis (METAVIR F1-2-3 vs F4).
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