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SAĞLIKLI ÇOCUKLARDA KARACİĞER ELASTİKİYETİNİN pSWE VE 2D-SWE TEKNİKLERİ İLE DEĞERLENDİRİLMESİ

Amaç Share wave elastografi (SWE), karaciğer sertliğini non-invaziv olarak değerlendirebilen yeni bir ultrasonografi tekniğidir. Yetişkinlerde SWE'nin etkinliği çok sayıda çalışmayla gösterilmiştir, ancak pediatrik gruplarda çok az SWE çalışması vardır. Karaciğer sertliği değerleri (KSD), cihaza ve kullanılan SWE yöntemine göre değişiklik gösterdiğinden, standart referans değerleri henüz oluşturulmamıştır. Bu çalışmanın amacı, iki farklı SWE yöntemine göre, sağlıklı çocuklarda normal karaciğerin referans sertlik değerlerini belirlemekti. Gereç ve Yöntem Karaciğer sertliği değerleri, 8-18 yaş arası 107 sağlıklı çocukta, iki farklı SWE yöntemi olan point SWE (pSWE) ve 2-dimentional SWE (2D-SWE) ile ölçüldü. pSWE (EPQ) ve 2D-SWE (EQI) ölçümleri aynı cihaz (Philips Epiq Elite) ile, tek seansta ve en az 4 saat aç kaldıktan sonra alındı. Cinsiyet, yaş, vücut kitle indeksi (VKİ), bazı biyokimyasal belirteçler ((açlık kan şekeri, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), albümin, trombosit, INR gibi)) ve karaciğer boyutunun, KSD’ye etkisi araştırıldı. Bulgular Ortalama KSD, pSWE ile 4,04±0,84kPa ((%95 güven aralığı (CI):3,67-4,42)) ve 2D-SWE ile 4,41±0,71kPa (%95 CI:4,09-4,72) bulundu. Üst sınır KSD'ler sırasıyla 4,42kPa ve 4,72kPa idi. 2D-SWE'de ölçülen KSD'ler, pSWE'den daha yüksekti ((sırasıyla medyan; min-maks, 4,34kPa; 2,82-6kPa ve 3,86kPa; 2,55– 5,78, (r=0,59, p<0,001)). KSD ile yaş arasında düşük düzeyde anlamlı pozitif korelasyon saptandı (r=0,267; p=0,006). Fakat karaciğer büyüklüğü, cinsiyet, VKİ ve biyokimyasal belirteçler ile KDS arasında anlamlı ilişki saptanmadı. Sonuç 8-18 yaş arası sağlıklı çocuklarda ortalama karaciğer sertliği referans değerleri, Philips Epiq Elite ultrason cihazı ile yapılan ölçümlerde, pSWE yöntemi ile 4,04±0,84kPa ve 2D-SWE yöntemi ile 4,41±0,71kPa olarak bulundu. Bu referans değerleri, kronik karaciğer hastalıklarında karaciğer parankiminin değerlendirilmesinde SWE yönteminin daha etkin kullanılmasına yardımcı olacaktır.

Anahtar Kelimeler:

Çocuk, karaciğer sertliği, ultrason, shear wave elastografi, iki boyutlu-shear wave elastografi.

EVALUATION OF LIVER ELASTICITY USING pSWE AND 2D-SWE TECHNIQUES IN HEALTHY CHILDREN

Objective Shear wave elastography (SWE) is a new ultrasonography technique that can non-invasively evaluate liver stiffness. The efficacy of SWE in adults has been demonstrated by numerous studies, but there are few SWE studies of pediatric groups. Since the liver stiffness values (LSV) vary according to the device and the SWE method used, standard reference values have not been established as yet. The aim of this study was to establish the reference values of normal liver stiffness in healthy children according to the two SWE methods. Materials and Method Liver stiffness values were measured using the two different SWE methods of point SWE (pSWE) and 2-dimensional SWE (2D-SWE) in 107 healthy children aged 8-18 years with no liver disease. The pSWE (EPQ) and 2D-SWE (EQI) measurements were taken in one session on the same device (Philips Epiq Elite) and after at least 4 hours of fasting. The effects on liver elasticity values were investigated of gender, age, body mass index (BMI), some biochemical markers (such as fasting blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, platelet, INR) and liver size. Results The mean LSV was 4.04±0.84kPa ((95% confidence interval (CI):3.67-4.42)) on pSWE and 4.41±0.71kPa (95% CI:4.09-4.72) on 2D-SWE. The upper limit LSVs were found to be 4.42kPa and 4.72kPa, respectively. The LSVs measured on 2D-SWE were found to be higher than on pSWE ((median; min-max, 4.34kPa; 2.82-6kPa and 3.86kPa; 2.55–5.78, respectively, (r=0.59, p<0.001)). A low-level significant positive correlation was determined between LSV and age (r=0.267; p=0.006). No significant association was determined between LSV and hepatic size, gender, BMI and biochemical markers. Conclusion In healthy children aged 8-18 years, the mean liver stiffness reference values obtained on the Philips Epiq Elite ultrasound device were 4.04±0.84kPa using the pSWE method and 4.41±0.71kPa using the 2D-SWE method.These reference values will help the SWE method to be used more effectively in the evaluation of liver parenchyma in chronic liver diseases.

Keywords:

Children, liver stiffness, ultrasound, shear wave elastography, two-dimensional shear wave imaging,

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