Eda ALBAYRAK, Ergün SÖNMEZGÖZ, Meral Gizem AKBAŞ, Osman DEMİR

Çocuk ve Erişkin Yaş Gruplarında Karaciğer Elastisitesinin Karaciğer Boyutu, Yaş, Cinsiyet ve Beden Kitle İndeksi ile İlişkisinin 2-D Shear Wave Elastografi ile Değerlendirilmesi

Amaç: Bu çalışma çocuklarda ve erişkinlerde normal karaciğer elastisite değerinin (liver stiffness value, LSV) shear wave elastografi (SWE) ile değerlendirilmesini ve LSV ile yaş, cinsiyet, beden kitle indeksi (BKİ) ve karaciğer boyutu arasındaki ilişkinin ortaya koyulmasını amaçlamaktadır. Gereç ve Yöntemler: Bu çalışmaya yaşları 4 ve 50 yıl arasında olan, 92 kadın ve 81 erkek olmak üzere toplam 173 sağlıklı gönüllü dahil edilmiştir. LSV ölçümleri supin pozisyonda, normal nefes alma esnasında sağ interkostal aralıktan, akustik pencerenin en iyi olduğu aralıktan yapıldı. Beş güvenli ölçümün ortalaması ortalama LSV değeri olarak kabul edildi. Ortalama LSV ile yaş, cinsiyet, karaciğer boyutu ve BKİ arasındaki ilişki değerlendirildi. Bulgular: LSV ile yaş arasında (p<0,001; r=0,609), LSV ile BKİ arasında (p<0.001; r=0,512) ve LSV ile karaciğer boyutu arasında (p<0,001; r=0,485) pozitif yönlü orta dereceli bir ilişki saptanmıştır. Ancak multivariate lineer regresyon analizi karaciğer boyutunun ve cinsiyetin LSV üzerine etkisinin anlamlı olmadığını (sırasıyla p=0,091 ve p=0,759), yaş ve BKİ’nin etkisinin ise anlamlı olduğunu ortaya çıkarmıştır (sırasıyla p<0,001 ve p=0,019). Sonuç: 2-D SWE hem çocuklarda hem de erişkinlerde LSV’nin değerlendirilmesinde etkili bir görüntüleme yöntemidir. LSV yaş ve BKİ arttıkça artış göstermekte, bununla birlikte, cinsiyet ve karaciğer boyutundan etkilenmemektedir. Mevcut çalışmada elde edilen normal LSV çeşitli karaciğer hastalıklarının 2-D SWE ile değerlendirilmesinde referans değerler olarak kullanılabilir.

Anahtar Kelimeler:

Karaciğer;, elastografi, ultrasonografi

The Relationship of Liver Stiffness with Liver Size, Age, Gender, and Body Mass Index in Child and Adult Age Groups by 2-D Shear Wave Elastography

Aim: The study aimed to evaluate the normal liver stiffness value (LSV) with shear wave elastography (SWE) in children and adults, and reveal the relationship between LSV and age, gender, body mass index (BMI), and liver size. Material and Methods: A total of 173 healthy volunteers, 92 female and 81 male, aged between 4 and 50 years were included in this study. LSV measurements were performed in the supine position during normal breathing and from the right intercostal space where the acoustic window is best. The mean of the five valid measurements was accepted as the mean LSV. The relationship between the mean LSV and age, gender, liver size, and BMI was evaluated. Results: There was a moderate positive correlation between LSV and age (p<0.001, r=0.609), LSV and BMI (p<0.001, r=0.512), and LSV and liver size (p<0.001, r=0.485). However, the multivariate linear regression analysis revealed that the effects of liver size and gender on LSV were not significant (p=0.091, and p=0.759, respectively), while the effects of age and BMI were significant (p<0.001, and p=0.019, respectively). Conclusion: 2-D SWE is an effective imaging method to evaluate LSV both in children and adults. LSV increases with increasing age and BMI, however, it is not affected by gender and liver size. The normal LSV obtained in the present study can be used as reference values in the evaluation of various liver diseases with 2-D SWE.

Keywords:

: liver, shear wave elastography, ultrasonography,

PDF

___

Ferraioli G. Review of liver elastography guidelines. J Ultrasound Med. 2019;38(1):9-14.
Barr RG. Ultrasound of diffuse liver disease including elastography. Radiol Clin North Am. 2019;57(3):549-62.
Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Helge O, et al. Liver stiffness by 2-D shear wave elastography in a healthy cohort. Ultrasound Med Biol. 2018;44(2):332-41.
Felicani C, De Molo C, Stefanescu H, Conti F, Mazzotta E, Gabus V, et al. Point quantification elastography in the evaluation of liver elasticity in healthy volunteers: a reliability study based on operator expertise. J Ultrasound. 2018;21(2):89-98.
Barr RG. Liver elastography still in its infancy. Radiology. 2018;288(1):107-8.
Ryu H, Ahn SJ, Yoon JH, Lee JM. Reproducibility of liver stiffness measurements made with two different 2-dimensional shear wave elastography systems using the comb-push technique. Ultrasonography. 2019;38(3):246-54.
Ryu H, Ahn SJ, Yoon JH, Lee JM. Inter-platform reproducibility of liver stiffness measured with two different point shear wave elastography techniques and 2-dimensional shear wave elastography using the comb-push technique. Ultrasonography. 2019;38(4):345-54.
Alrashed AI, Alfuraih AM. Reproducibility of shear wave elastography among operators, machines, and probes in an elasticity phantom. Ultrasonography. 2021;40(1):158-66.
Wu JF, Song SH, Lee CS, Chen HL, Ni YH, Hsu HY, et al. Clinical predictors of liver fibrosis in patients with chronic hepatitis B virus infection from children to adults. J Infect Dis. 2018;217(9):1408-16.
Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(5):1264-81.e4.
Yang H, Sun Y, Tang Y, Lu Y, Hu B, Ying T. Shear-wave elastography of the liver in a healthy pediatric population. J Clin Ultrasound. 2020;48(3):139-44.
Lewindon PJ, Balouch F, Pereira TN, Puertolas-Lopez MV, Noble C, Wixey JA, et al. Transient liver elastography in unsedated control children: Impact of age and intercurrent illness. J Paediatr Child Health. 2016;52(6): 637-42.
Tokuhara D, Cho Y, Shintaku H. Transient elastography-based liver stiffness age-dependently increases in children. PLoS One. 2016;11(11):e0166683.
Mulabecirovic A, Mjelle AB, Gilja OH, Vesterhus M, Havre FR. Liver elasticity in healthy individuals by two novel shear-wave elastography systems-Comparison by age, gender, BMI, and number of measurements. PLoS One. 2018;13(9):e0203486.
Dong Y, Sirli R, Ferraioli G, Sporea I, Chiorean L, Cui X, et al. Shear wave elastography of the liver - review on normal values. Z Gastroenterol. 2017;55(2):153-66.
Grgurevic I, Puljiz Z, Brnic D, Bokun T, Heinzl R, Lukic A, et al. Liver, and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis. Eur Radiol. 2015;25(11):3214-21.
Borner N, Schwerk WB, Braun B. Leber. In: Braun B, Gunther R, Schwerk WB, editors. Ultraschalldiagnostik: Lehrbuch und Atlas. Landsberg: Ecomed; 1987. p.1-18. German.
Eiler J, Kleinholdermann U, Albers D, Dahms J, Hermann F, Behrens C, et al. Standard value of ultrasound elastography using acoustic radiation force impulse imaging (ARFI) in healthy liver tissue of children and adolescents. Ultraschall Med. 2012;33(5):474-9.
Sun PX, Tong YY, Shi J, Zhang H, Liu SJ, Du J. Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology. World J Clin Cases. 2019;7(21):3463-73.
Bazerbachi F, Haffar S, Wang Z, Cabezas J, Arias-Loste MT, Crespo J, et al. Range of normal liver stiffness and factors associated with increased stiffness measurements in apparently healthy individuals. Clin Gastroenterol Hepatol. 2019;17(1):54-64.e1.
Roulot D, Costes JL, Buyck JF, Warzocha U, Gambier N, Czernichow S, et al. Transient elastography as a screening tool for liver fibrosis and cirrhosis in a community-based population aged over 45 years. Gut. 2011;60(7):977-84.
Colombo S, Belloli L, Zaccanelli M, Badia E, Jamoletti C, Buonocore M, et al. Normal liver stiffness and its determinants in healthy blood donors. Dig Liver Dis. 2011;43(3):231-6.
Madhok R, Tapasvi C, Prasad U, Gupta AK, Aggarwal A. Acoustic radiation force impulse imaging of the liver: measurement of the normal mean values of the shearing wave velocity in a healthy liver. J Clin Diagn Res. 2013;7(1):39-42.
Kim DW, Suh CH, Kim KW, Pyo J, Park C, Jung SC. Technical performance of two-dimensional shear wave elastography for measuring liver stiffness: a systematic review and meta-analysis. Korean J Radiol. 2019;20(6):880-93.