Accuracy and reproducibility of transient elastography for the diagnosis of fibrosis in pediatric nonalcoholic steatohepatitis

• Published in: Hepatology (Baltimore, Md.) Vol. 48; no. 2; pp. 442 - 448
• Main Authors: Nobili, Valerio, Vizzutti, Francesco, Arena, Umberto, Abraldes, Juan G., Marra, Fabio, Pietrobattista, Andrea, Fruhwirth, Rodolfo, Marcellini, Matilde, Pinzani, Massimo
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2008; Wiley
• Subjects: Adolescent; Biological and medical sciences; Child; Cohort Studies; Disease Progression; Elasticity Imaging Techniques - adverse effects; Elasticity Imaging Techniques - methods; Elasticity Imaging Techniques - standards; Fatty Liver - complications; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Likelihood Functions; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Observer Variation; Reproducibility of Results; ROC Curve; Human; Pediatrics; Accuracy; Transient elastography; Reproducibility; Fibrosis; Gastroenterology; Medical imagery; Diagnosis; Child
• ISSN: 0270-9139; 1527-3350; 1527-3350
• DOI: 10.1002/hep.22376

Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in chronic liver disease patients. In this study, we assessed the value of TE for the prediction of fibrosis stage in a cohort of pediatric patients with nonalcoholic steatohepatitis. Furthermore, TE interobserver agreement was evaluated. TE was performed in 52 consecutive biopsy‐proven nonalcoholic steatohepatitis patients (32 males, 20 females, age 13.6 ± 2.44 years). The area under the receiver operating characteristic curves for the prediction of “any” (≥1), significant (≥2), or advanced fibrosis (≥3) were 0.977, 0.992, and 1, respectively. Calculation of multilevel likelihood ratios showed that TE values <5, <7, and <9 kPa, suggest the presence of “any” fibrosis, significant fibrosis, and advanced fibrosis, respectively. TE values between 5 and 7 kPa predict a fibrosis stage of 1, but with some degree of uncertainty. TE values between 7 and 9 kPa predict fibrosis stages 1 or 2, but cannot discriminate between these two stages. TE values of at least 9 kPa are associated with the presence of advanced fibrosis. The intraclass correlation coefficient for absolute agreement was 0.961. Conclusion: TE is an accurate and reproducible methodology to identify pediatric subjects without fibrosis or significant fibrosis, or with advanced fibrosis. In patients in which likelihood ratios are not optimal to provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. (HEPATOLOGY 2008.)