Performance Characteristics, Intra- and Inter-operator Agreement of Transient Elastography in Pediatric Nonalcoholic Fatty Liver Disease
Performance Characteristics, Intra- and Inter-operator Agreement of Transient Elastography in Pediatric Nonalcoholic Fatty Liver Disease
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DOI：
10.1097/mpg.0000000000002991
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发表时间：
2021-03-01
影响因子：
2.9
通讯作者：
Selvakumar, Praveen Kumar Conjeevaram
中科院分区：
文献类型：
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作者：
Mandelia, Chetan;Kabbany, Mohammad Nasser;Selvakumar, Praveen Kumar Conjeevaram
背景和目的：瞬时弹性成像（TE）是评估肝脂肪变性和肝纤维化的一种有价值的工具，分别使用肝刚度测量（LSM）和控制衰减参数（CAP）。尽管TE（使用纤维扫描装置）广泛用于成人，但在评估儿童非酒精性脂肪性肝病（NAFLD）中的性能特征和可重复性知之甚少。方法：前瞻性招募NAFLD患儿。在同一次访问中，连续进行了三次纤维扫描检查，两次由一位专家操作人员进行，一次由不同的新手操作人员进行。使用一致性相关系数（CCC）计算操作者内部和操作者之间的一致性。失败定义为无法获得10个有效测量值，如果LSM四分位间距/中位数大于30%，则认为检查不可靠。结果：招募了51名儿童（34名男孩，中位年龄15岁）。专家和新手操作员的失败率分别为10%（5/51）和12%(6/51)，而获得不可靠读数的患者分别为2%（1/46）和4%（2/45）。与测量可靠的患者相比，测量失败/不可靠的患者明显更肥胖（BMI中位数46.2 vs 33.1 kg/m(2), P = 0.002）。对于LSM和CAP值（CCC分别为0.85和0.73），运营商内部的一致性几乎是完美的。操作者之间的一致性对于LSM是显著的，对于CAP值是中等的（CCC分别= 0.76和0.58）。LSM的操作者之间的一致性并没有随着时间的推移而发生显著变化，但与BMI和cap呈负相关。结论：我们的研究表明，使用TE评估NAFLD儿童肝纤维化和脂肪变性是高度可靠的，失败率低，高度可重复性，操作者内部和操作者之间的可重复性高。
Background and Aims: Transient elastography (TE) is a valuable tool in assessment of hepatic steatosis and fibrosis using liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), respectively. Although widely used in adults, little is known about performance characteristics and reproducibility of TE (using Fibroscan device) in evaluation of pediatric nonalcoholic fatty liver disease (NAFLD).Methods: We prospectively recruited children with NAFLD. Three consecutive Fibroscan examinations were performed during the same visit-twice by a single expert operator and once by a different novice operator. Intra and inter-operator agreement was calculated using concordance correlation coefficient (CCC). Failure was defined as inability to obtain 10 valid measurements and examination was considered unreliable if LSM interquartile range/median was greater 30%.Results: Fifty-one children (34 boys; median age 15 years) were recruited. Failure rates for expert and novice operator were 10% (5/51) and 12% (6/51) while unreliable readings were obtained in 2% (1/46) and 4% (2/45) of patients, respectively. Patients with failed/unreliable measurements were significantly more obese (median BMI 46.2 vs 33.1 kg/m(2), P = 0.002) compared with those with reliable measurements. The intra-operator agreement was almost perfect for LSM and substantial for CAP values (CCC = 0.85 and 0.73, respectively). Inter-operator agreement was substantial for LSM and moderate for CAP values (CCC = 0.76 and 0.58, respectively). The inter-operator agreement in LSM did not vary significantly over time but showed an inverse correlation with BMI and CAP.Conclusion: Our study demonstrated that use of TE in assessment of hepatic fibrosis and steatosis in children with NAFLD is highly reliable with low failure rate and highly reproducible with high intra- and inter-operator reproducibility.