الفهرس 
The Diagnostic accuracy and reproducibility of shear-wave elastography in assessment of pediatric hepatic cholestasis
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Abstract
Objective: To investigate Shear Wave Elastography’s accuracy in
assessing pediatric cholestasis and differentiating biliary atresia from
other causes.
Study Method: the study enrolled 59 pediatric patients with cholestatic
liver disease and 21 matched control starting from December 2020 till
May 2022 at the radiology department in collaboration with the
hepatology department at Cairo University children’s hospital (Abu El
Reesh). History taking and examination were done as well as full lab
investigations. Both conventional liver US and SWE were performed in
all cases, liver biopsy was done in indicated cases. Follow-up SWE was
done in 20 post-Kasai cases. Receiver Operator characteristic (ROC)
analysis was used to determine the diagnostic discrimination of SWE in
predicting the type of atresia, and the state post-Kasai procedure was
performed.
Results:
Ten patients (34.48%) were diagnosed with cholestasis with normal/ low
GGT. Five patients (17.24%) were diagnosed with hepatitis, and two
patients had syndromes (10.34%). At the same time, other causes were
found in 11 patients (37.93%) as Criger-Najar, choledochal cyst, bile
acid synthetic defect, Dubin Jonson, and idiopathic causes
Major bile duct obstruction with fibrosis/cirrhosis was the most results
found in biliary atresia patients (100%), most of them with mild fibrosis
(40%), followed by moderate (36.67%), then marked fibrosis (13.33 %)
and secondary cirrhosis (10%).
ROC curve analysis shows that the best cut-off value for SWE = 1.97
with a sensitivity of 75.0 % and specificity of 83.5%, area under the
curve of 0.819 (95% CI=0.699–0.937) for predicting the type of atresia (biliary/non-biliary) with positive and negative predictive values were
82.8% and 74.1%, respectively.
Mean shear wave elastography was significantly higher among the
biliary atresia group (median 2.86) than in non-biliary atresia (median
1.81) and control groups (median 1.64) (P<0.001).
The best cut-off value of SWE for predicting outcome in pediatric
patients post-Kasai procedure was 3.55, with a sensitivity of 66.7 %,
specificity of 64.7%, area under the curve 0.510 (95% CI = 0.184 –
0.836), positive and predictive values were 25% and 91.7%
respectively, with accuracy 65%.
Conclusion: SWE measurements can differentiate between BA and nonBA cholestatic cases however they weren’t significantly accurate in
differentiating between successful and failed Kasai operations.