Normal Liver Stiffness Values in Children – A Comparison of Three Different Elastography Methods

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Objectives:Noninvasive tests for the evaluation of liver fibrosis are particularly helpful in children to avoid general anesthesia and potential complications of invasive tests. We aimed to establish reference values for two different elastography methods in a head-to-head-comparison for children and adolescents 4-17 years, using transient elastography as common reference in a subset.Methods:243 healthy participants aged 4-17 years were examined by a single observer with a full liver B-mode scan prior to elastography, following a minimum of 3 hours fasting. Liver stiffness measurements (LSM) using two-dimensional shear wave elastography (2D-SWE, GE Logiq E9) and point shear wave elastography (pSWE, Samsung RS80A with Prestige) were performed in all participants, and compared to transient elastography (TE, Fibroscan) in a subset (n = 87). Interobserver agreement was evaluated in 50 children aged 4-17 years.Results:Valid measurements were obtained in 242/243 (99.6%) subjects for 2D-SWE, 238/243 (97.9%) for pSWE, and in 83/87 (95.4%) for TE. Median liver stiffness overall was 3.3 (IQR 2.7–4.3), 4.1 (IQR 3.6–4.7), and 4.1 kPa (IQR 3.5–4.6) for 2D-SWE, pSWE and TE, respectively. Intraclass correlation coefficients (ICC) between observers were 0.84 and 0.83 for 2D-SWE and pSWE, respectively. LSM values were significantly lower for 2D-SWE compared to pSWE and TE, and increased with advancing age. Higher LSM values in males were observed in adolescents.Conclusions:All methods showed excellent feasibility. 2D-SWE showed significantly lower LSM values than pSWE and TE, and lower failure rate compared to TE. Our results further indicate an age and sex effect on LSM values.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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