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Points to be considered when applying FibroScan S probe in children with biliary atresia.

Kim S, Kang Y, Lee MJ, Kim MJ, Han SJ, Koh H - J. Pediatr. Gastroenterol. Nutr. (2014)

Bottom Line: Patients were assigned to 2 groups according to thoracic perimeter (≤ 45 cm vs > 45 cm).In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index was analyzed.In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51).

View Article: PubMed Central - PubMed

Affiliation: *Department of Pediatrics †Department of Radiology and Research Institute of Radiological Science ‡Department of Pediatric Surgery, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, South Korea.

ABSTRACT

Objectives: With the introduction of smaller probes (S1, S2), the use of transient elastography has been expanded to children. Accordingly, we aimed to address points of consideration in probe choice and interpretation of measured liver stiffness by applying and comparing FibroScan S and M probes in biliary atresia.

Methods: Using S1, S2, and M probes, 3 liver stiffness measurements, success rates, and interquartile ranges were obtained from 100 patients. Patients were assigned to 2 groups according to thoracic perimeter (≤ 45 cm vs > 45 cm). In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index was analyzed.

Results: In the small-thorax group, the success rate was highest with the S1 probe and the intraclass correlation coefficient (ICC) was highest for S1 versus S2 (0.98), compared with that for S1 versus M (0.69) and S2 versus M (0.77). In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51). In the small-thorax group, correlations between aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement were stronger for S1 (0.65) and S2 (0.64) than for M (0.49). In the large-thorax group, all probes showed good correlation, S1 (0.68), S2 (0.62), and M (0.62).

Conclusions: We recommend that the S1 probe is more appropriate for use in small children, especially those with a thorax perimeter of < 45 cm. If no S probe is available, the M probe may be acceptable in children whose thorax perimeter is > 45 cm.

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Related in: MedlinePlus

Bland-Altman plot of the difference in LSM by 2 different probes versus the mean of LSM. The solid lines indicate mean difference, and dotted lines represent 2 standard deviations between 2 probes. A, S1 and S2, 5.2 ± 16.8 kPa; (B) S1 and M, 8.3 ± 22.3 kPa; and (C) S2 and M, 3.0 ± 11.8 kPa. Outliers are noted in patients with high mean LSM. LSM = liver stiffness measurement.
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Figure 2: Bland-Altman plot of the difference in LSM by 2 different probes versus the mean of LSM. The solid lines indicate mean difference, and dotted lines represent 2 standard deviations between 2 probes. A, S1 and S2, 5.2 ± 16.8 kPa; (B) S1 and M, 8.3 ± 22.3 kPa; and (C) S2 and M, 3.0 ± 11.8 kPa. Outliers are noted in patients with high mean LSM. LSM = liver stiffness measurement.

Mentions: ICC was used to evaluate the correlation of LSM among the various probes (Table 2). In the small thoracic perimeter group, the ICC of S1 versus S2 was highest (0.98). In the large thoracic perimeter group, the ICC of S2 versus M was highest (0.88). Regardless of thoracic perimeter, the ICC of LSM obtained using every probe showed more than moderate correlation (ICC >0.50). On the Bland-Altman plot, most points were within 2 standard deviations, thus demonstrating fair consonance between results with the 2 probes; however, some outliers were noted in patients with large mean LSM (Fig. 2). On a simple scatterplot, S probe seems to show large LSM compared with the M probe (Fig. 3). According to the linear mixed model, LSMs (mean ± SD) of the S1, S2, and M probes were 20.6 ± 17.9, 15.4 ± 12.8, and 12.3 ± 9.8 kPa, respectively; significant differences were observed among probes: S1 versus S2 (P < 0.001), S1 versus M (P < 0.001), and S2 versus M (P = 0.003). Figure 4 shows distributions of LSM values according to the probe with box-and-whisker plots.


Points to be considered when applying FibroScan S probe in children with biliary atresia.

Kim S, Kang Y, Lee MJ, Kim MJ, Han SJ, Koh H - J. Pediatr. Gastroenterol. Nutr. (2014)

Bland-Altman plot of the difference in LSM by 2 different probes versus the mean of LSM. The solid lines indicate mean difference, and dotted lines represent 2 standard deviations between 2 probes. A, S1 and S2, 5.2 ± 16.8 kPa; (B) S1 and M, 8.3 ± 22.3 kPa; and (C) S2 and M, 3.0 ± 11.8 kPa. Outliers are noted in patients with high mean LSM. LSM = liver stiffness measurement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4222704&req=5

Figure 2: Bland-Altman plot of the difference in LSM by 2 different probes versus the mean of LSM. The solid lines indicate mean difference, and dotted lines represent 2 standard deviations between 2 probes. A, S1 and S2, 5.2 ± 16.8 kPa; (B) S1 and M, 8.3 ± 22.3 kPa; and (C) S2 and M, 3.0 ± 11.8 kPa. Outliers are noted in patients with high mean LSM. LSM = liver stiffness measurement.
Mentions: ICC was used to evaluate the correlation of LSM among the various probes (Table 2). In the small thoracic perimeter group, the ICC of S1 versus S2 was highest (0.98). In the large thoracic perimeter group, the ICC of S2 versus M was highest (0.88). Regardless of thoracic perimeter, the ICC of LSM obtained using every probe showed more than moderate correlation (ICC >0.50). On the Bland-Altman plot, most points were within 2 standard deviations, thus demonstrating fair consonance between results with the 2 probes; however, some outliers were noted in patients with large mean LSM (Fig. 2). On a simple scatterplot, S probe seems to show large LSM compared with the M probe (Fig. 3). According to the linear mixed model, LSMs (mean ± SD) of the S1, S2, and M probes were 20.6 ± 17.9, 15.4 ± 12.8, and 12.3 ± 9.8 kPa, respectively; significant differences were observed among probes: S1 versus S2 (P < 0.001), S1 versus M (P < 0.001), and S2 versus M (P = 0.003). Figure 4 shows distributions of LSM values according to the probe with box-and-whisker plots.

Bottom Line: Patients were assigned to 2 groups according to thoracic perimeter (≤ 45 cm vs > 45 cm).In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index was analyzed.In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51).

View Article: PubMed Central - PubMed

Affiliation: *Department of Pediatrics †Department of Radiology and Research Institute of Radiological Science ‡Department of Pediatric Surgery, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, South Korea.

ABSTRACT

Objectives: With the introduction of smaller probes (S1, S2), the use of transient elastography has been expanded to children. Accordingly, we aimed to address points of consideration in probe choice and interpretation of measured liver stiffness by applying and comparing FibroScan S and M probes in biliary atresia.

Methods: Using S1, S2, and M probes, 3 liver stiffness measurements, success rates, and interquartile ranges were obtained from 100 patients. Patients were assigned to 2 groups according to thoracic perimeter (≤ 45 cm vs > 45 cm). In both groups, obtained values were compared and the relation between liver stiffness measurement and aspartate aminotransferase-to-platelet ratio index was analyzed.

Results: In the small-thorax group, the success rate was highest with the S1 probe and the intraclass correlation coefficient (ICC) was highest for S1 versus S2 (0.98), compared with that for S1 versus M (0.69) and S2 versus M (0.77). In the large-thorax group, ICC was the highest for S2 versus M (0.88), compared with that for S1 versus S2 (0.69) and S1 versus M (0.51). In the small-thorax group, correlations between aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement were stronger for S1 (0.65) and S2 (0.64) than for M (0.49). In the large-thorax group, all probes showed good correlation, S1 (0.68), S2 (0.62), and M (0.62).

Conclusions: We recommend that the S1 probe is more appropriate for use in small children, especially those with a thorax perimeter of < 45 cm. If no S probe is available, the M probe may be acceptable in children whose thorax perimeter is > 45 cm.

Show MeSH
Related in: MedlinePlus