The degree of spleen stiffness measured on acoustic radiation force impulse elastography predicts the severity of portal hypertension in patients with biliary atresia after portoenterostomy

J Pediatr Surg. 2015 Apr;50(4):559-64. doi: 10.1016/j.jpedsurg.2014.12.026. Epub 2015 Jan 14.


Background/purpose: Acoustic radiation focus impulse (ARFI) elastography is a new method for assessing the degree of tissue stiffness. We herein evaluated the degree of spleen stiffness (SS) using ARFI elastography in patients with biliary atresia (BA) after Kasai portoenterostomy (KPE).

Methods: We retrospectively collected the liver stiffness (LS) and SS values on ARFI elastography from 43 patients undergoing KPE between September 2010 and November 2013. We analyzed the correlations between these values and variables related to the severity of liver dysfunction and portal hypertension (PHT). The data were expressed as the standard deviation score (z-score) relative to the previously reported normal values for the patient's age.

Results: The SS value was significantly associated with the spleen diameter and development of collateral vessels, in comparison to the LS value. Interestingly, there was a significant correlation between SS value and the portal vein (PV) diameter. Thirty patients (69.8%) consequently underwent LT; these patients showed higher SS values and smaller PV diameters than the patients monitored without LT.

Conclusions: The degree of SS measured on ARFI elastography can be used to predict the severity of PHT in BA patients after KPE.

Keywords: Acoustic radiation force impulse; Biliary atresia; Pediatric liver transplantation; Portal vein; Spleen stiffness.

Publication types

  • Evaluation Study

MeSH terms

  • Biliary Atresia / surgery*
  • Child, Preschool
  • Elasticity Imaging Techniques / methods*
  • Female
  • Humans
  • Hypertension, Portal / diagnostic imaging
  • Hypertension, Portal / etiology*
  • Infant
  • Male
  • Portoenterostomy, Hepatic*
  • Postoperative Complications* / diagnostic imaging
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index*
  • Spleen / diagnostic imaging*
  • Treatment Outcome