DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20150986

Virtual touch tissue quantification of liver in thalassemia

Shivaraja A, Pavan Hegde, Mario J. Bukelo, Sanjaykumar P, Ram Shenoy Basti

Abstract


Background: Objective of current study was to study the liver stiffness measurements in thalassemia patients by virtual touch tissue quantification technique.
Methods: Study was case control study. Study was conducted in Pediatrics department in a tertiary care teaching hospital, between Febrauary 2015 to June 2015. 32 thalassemia patients attending outpatient department or admitted for blood transfusion were included in the study. 32 nonthalassemic patients with normal liver function tests were selected by convenience as controls to detect normal liver stiffness value. Assessment of liver stiffness was done using Acoustic radiation force impulse elastography from Philips iu22 machine using low frequency C5-2probe. 10 measurements were taken from right lobe segment-5 of liver about 1 to 2 cm from skin surface, from the right intercostal window, with patient lying in supine position, with right arm abducted. Liver stiffness measurements were taken by the same person (radiologist) to minimize inter-observer variabilities. Serum ferritin was measured by particle induced immunoturbidimetric method in the biochemistry laboratory. Primary outcome was mean value of liver stiffness measurement in thalassemia patient and to know the effect of sex, age, serum ferritin and annual blood cell requirement on the Liver stiffness value.
Results: Mean value of liver stiffness value in thalassemia patients was 1.48 m/s and non-thalassemia patients were 1.15 m/s. Difference between Liver stiffness measurement between thalassemia cases and controls were significant with p value <0.001. Cut off value of 1.24 differentiates between the two groups with sensitivity of 93.8 % and specificity of 94%. Liver stiffness value is highly correlated with serum ferritin level (r=0.517, p<0.002). There were no statistically significant difference in Liver stiffness measurement between cases and controls with respect to age, sex, annual blood cell requirement.
Conclusions: Liver stiffness value is higher in patients with thalassmia and differs significantly from non thalassmic children.


Keywords


ARFI, Liver stiffness, Serum ferritin, Thalassemia

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References


Fraquelli M, Cassinerio E, Roghi A, Rigamonti C, Casazza G, Colombo M, et al. Transient elastography in the assessment of liver fibrosis in adult thalassemia patients. Am J Hematol. 2010;85(8):564-8.

Soliman A, Yassin M, AlYafei F, Al-Naimi L, Almarri N, Sabt A, et al. Longitudinal study on liver functions in patients with thalassemia major before and after deferasirox (dfx) therapy. Mediterr J Hematol Infect Dis. 2014;6(1):2014025.

EASL-ALEH Clinical Practice Guidelines. Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63:237-64.

Li C. Liver disease in transfusion dependent thalassaemia major. Arch Dis Childhood. 2002;86(5):344-7.

Mauss S, Berg T, Rockstroh J, Sarrazin C, Wedemeyer H, Kamps B. Hepatology, a clinical textbook. In: Mauss S, Berg T, Rockstroh J, Sarrazin C, Wedemeyer H, Kamps B, eds. A Book. 5th ed. Germany: Flying Publishers; 2014.

Hashemizadeh H, Noori R, Kolagari S. Assessment hepatomegaly and liver enzymes in 100 patients with beta thalassemia major in Mashhad, Iran. Iran J Pediatr Hemato Oncol. 2012;2(4):171-7.

Vichinsky E, Butensky E, Fung E, Hudes M, Theil E, Ferrell L, et al. Comparison of organ dysfunction in transfused patients with SCD or β thalassemia. Am J Hematol. 2005;80(1):70-4.

Jung K, Kim S. Clinical applications of transient elastography. Clin Molecul Hepatol. 2012;18(2):163.

Tomita H, Hoshino K, Fuchimoto Y, Ebinuma H, Ohkuma K, Tanami Y, et al. Acoustic radiation

Shiva Raja A et al. Int J Contemp Pediatr. 2015 Nov;2(4):415-418

International Journal of Contemporary Pediatrics | October-December 2015 | Vol 2 | Issue 4 Page 418

force impulse imaging for assessing graft fibrosis after pediatric living donor liver transplantation: a pilot study. Liver Transpl. 2013;19(11):1202-13.

de Lacdinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, et al. Liver stiffness measurement in children using FibroScan: feasibility study and comparison with fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr. 2007;45(4):443-50.

Onofrio M. Acoustic radiation force impulse of the liver. World J Gastroenterol. 2013;19(30):4841.

Rifai K, Cornberg J, Mederacke I, Bahr M, Wedemeyer H, Malinski P, et al. Clinical feasibility of liver elastography by acoustic radiation force impulse imaging (ARFI). Digest Liver Dis. 2011;43(6):491-7.

Cui X. Liver elastography, comments on EFSUMB elastography guidelines 2013. World J Gastroenterol. 2013;19(38):6329.

Goertz R, Sturm J, Pfeifer L, Wildner D, Wachter D, Neurath M, et al. ARFI cut off values and significance of standard deviation for liver fibrosis

staging in patients with chronic liver disease. Ann Hepatol. 2013;12(6):935-41.

Sporea I, Bota S, Saftoiu A, Sirli R, Tascau O, Popescu A, et al. Romanian national guidelines and practical recommendations on liver elastography. Med Ultrasonography. 2014;16(2):123-38.

Hanquinet S, Courvoisier D, Kanavaki A, Dhouib A, Anooshiravani M. Acoustic radiation force impulse imaging - normal values of liver stiffness in healthy children. Pediatr Radiol. 2012;43(5):539-44.

Matos H, Trindade A, Noruegas M. Acoustic radiation force impulse imaging in paediatric patients. J Pediatr Gastroenterol Nutr. 2014;59(6):684-8.

Yap W, Kirke R, Yoshida E, Own D, Harris A. noninvasive assessment of liver fibrosis using ARFI with pathological correlation, a prospective study. Ann Hepatol. 2013;4:440-7.

Sporea I. Liver elastography: an update. Med Ultrasonography. 2013;15(4):304-14.