Shear wave elastography helps differentiate biliary atresia from other neonatal/infantile liver diseases

Biliary atresia is a rapidly progressive liver disease necessitating prompt diagnosis and surgical intervention, so it must be promptly distinguished from other neonatal/infantile liver diseases. To determine whether US shear wave elastography (SWE) can differentiate biliary atresia from other neonatal/infantile liver diseases based on liver hardness. Eleven children younger than 1 year who had suspected liver disease underwent anatomically and temporally-related hepatic shear wave elastography and clinically indicated percutaneous core needle biopsy. Shear wave elastography was performed immediately prior to liver biopsy at the targeted biopsy site using an Acuson S3000 US system/9L4 transducer (Siemens Medical Solutions USA, Malvern, PA). Shear wave elastography was performed using Virtual Touch Quantification (VTQ) and Virtual Touch IQ (VTIQ) modes, and six shear wave speed measurements were acquired from each subject for each mode. Children were placed in two groups based on histology, biliary atresia (n = 6) vs. non-biliary atresia (other neonatal/infantile liver diseases) (n = 5), and mean shear wave speed measurements were compared using the unpaired student's t-test (two-tailed). A P-value < 0.05 was considered significant. Using the VTQ mode, mean liver shear wave speed was 2.08 +/- 0.17 m/s for the biliary atresia group and 1.28 +/- 0.13 m/s for the non-biliary atresia group (P < 0.0001). Using the VTIQ mode, mean liver shear wave speed was 3.14 +/- 0.73 m/s for the biliary atresia group and 1.61 +/- 0.23 m/s for the non-biliary atresia group (P = 0.003). Ishak liver fibrosis scores ranged from 3 to 6 for the biliary atresia group and from 0 to 1 for the non-biliary atresia group. Liver shear wave speed is abnormally increased in neonates and infants with biliary atresia.