Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis  

作　　者：Ellen S Wagner Hussien Ahmed H Abdelgawad Meghan Landry Belal Asfour Mark B Slidell Ruba Azzam 

机构地区：[1]Pediatric Gastroenterology,Hepatology,and Nutrition,The University of Chicago Medicine,Comer Children’s Hospital,Chicago,IL 60637,United States [2]Department of Medicine,Zagazig University,Zagazig 44511,Egypt,Egypt [3]Department of Pediatrics,The University of Chicago Medicine,Comer Children’s Hospital,Chicago,IL 60637,United States [4]Graduate School of Professional Education-Biomedical Informatics,University of Chicago,Chicago,IL 60637,United States [5]Department of Surgery,The University of Chicago Medicine,Comer Children’s Hospital,Chicago,IL 60637,United States

出　　处：《World Journal of Gastroenterology》2022年第32期4725-4739,共15页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Timely differentiation of biliary atresia(BA)from other infantile cholestatic diseases can impact patient outcomes.Additionally,non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized.Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness.The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.AIM To assess the utility of elastography in:(1)BA diagnosis,and(2)post-Kasai fibrosis surveillance.METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up.Twenty studies met criteria for meta-analysis:Eleven for diagnosis and nine for follow-up post-Kasai.Estimated diagnostic odds ratio(DOR),sensitivity,and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA,with overall DOR 24.61,sensitivity 83%,and specificity 79%.Post-Kasai,mean liver stiffness was significantly higher in BA patients with varices than in patients without,with DOR 16.36,sensitivity 85%,and specificity 76%.Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03,sensitivity 96%,and specificity 89%.Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68,sensitivity 85%,and specificity 81%.CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai.This paper’s limitations include inter-study method heterogeneity and small sample sizes.Future,standardized,multi-center studies are recommended.

关 键 词：Biliary atresia CHOLESTASIS Hepatic portoenterostomy FIBROSIS Esophageal and gastric varices Elasticity imaging techniques 

分 类 号：R726.5[医药卫生—儿科]