Usefulness of Transient Elastography for Non-Invasive Diagnosis of Liver Fibrosis in Pediatric Non-Alcoholic Steatohepatitis

Background: Transient elastography (FibroScan (R)) is a non-invasive and rapid method for assessing liver fibrosis. While the feasibility and usefulness of FibroScan (R) have been proven in adults, few studies have focused on pediatric populations. We aimed to determine the feasibility and usefulness of FibroScan (R) in Korean children. Methods: FibroScan (R) examinations were performed in 106 children (age, 5-15 years) who visited the Konyang University Hospital between June and September 2018. Liver steatosis was measured in terms of the controlled attenuation parameter (CAP), while hepatic fibrosis was evaluated in terms of the liver stiffness measurement (LSM). Children were stratified into obese and non-obese controls, according to body mass index (>= or < 95th percentile, respectively). Results: The obese group was characterized by significantly higher levels of aspartate aminotransferase (AST, 57.00 +/- 48.47 vs. 26.40 +/- 11.80 IU/L; P < 0.001) and alanine aminotransferase (ALT, 91.27 +/- 97.67 vs. 16.28 +/- 9.78 IU/L; P < 0.001), frequency of hypertension and abdominal obesity (abdominal circumference > 95% percentile) (P < 0.001), CAP (244.4-340.98 dB/m), and LSM (3.85-7.77 kPa) (P < 0.001). On FibroScan (R), 30 of 59 obese children had fibrosis (LSM > 5.5 kPa), whereas the remaining 29 did not (LSM < 5.5 kPa). Obese children with fibrosis had higher levels of AST (73.57 +/- 56.00 vs. 39.86 +/- 31.93 IU/L; P = 0.009), ALT (132.47 +/- 113.88 vs. 48.66 +/- 51.29 IU/L; P = 0.001), and gamma-glutamyl transferase (106.67 +/- 69.31 vs. 28.80 +/- 24.26 IU/L; P = 0.042) compared to obese children without fibrosis. LSM had high and significant correlation (P < 0.05) with AST, ALT, homeostasis model assessment for insulin resistance, and AST-to-platelet ratio index. Conclusion: FibroScan (R) is clinically feasible and facilitates non-invasive, rapid, reproducible, and reliable detection of hepatic steatosis and liver fibrosis in the Korean pediatric population.