Value of transient elastography in noninvasive assessment in children's hepatic fibrosis

Aim. Transient elastography (FibroScan) is a novel, noninvasive, rapid bedside method to assess liver fibrosis by measuring liver stiffness. This study aimed to determine the feasibility and reliability of liver stiffness measurement in children with liver diseases. Patients and methods. Liver stiffness measurements were carried out on 72 children, from 4 to 18 years of age, with potential hepatic fibrosis disease. The clinical, biological, ultrasonographic, and endoscopic parameters were noted to identify children with portal hypertension syndrome. The APRI (ASAT-to-platelet ratio index) test was calculated according to the standard formula. An APRI test score higher than 1.5 indicates significant hepatic fibrosis. META-VIR scoring from 14 liver biopsies was compared to the liver stiffness using the Kappa statistic. Results. Twenty-eight patients had viral hepatitis, 20 cystic fibrosis, 16 chronic liver cholestasis, 5 autoimmune hepatitis, and 3 patients had liver fibrosis with uncertain etiology. FibroScan measurements were available in all children. There was good agreement between FibroScan and pathological studies (weighted kappa = 0.814). Only 9 children had portal hypertension syndrome with an average measurement of liver stiffness significantly higher than children without portal hypertension (26.5 kPa vs 6.4 kPa; p < 0.01). The APRI test for 6 out of 9 patients scored higher than 1.5. Conclusion. These results indicate that liver stiffness measurement is feasible in children and seems to be related to liver fibrosis. Larger prospective studies are needed to validate this FibroScan method. (C) 2009 Published by Elsevier Masson SAS.