Dynamic elastography provides a noninvasive and reliable method of detecting liver fibrosis in pediatric patients with cystic fibrosis (CF), according to findings published in Disease Markers.

Investigators compared the efficacy of dynamic shear-wave elastography with current liver fibrosis assessments in 41 pediatric patients aged 2 to 21 years treated for CF at the Department of Paediatrics of the Medical University of Silesia in Katowice, Poland. They subdivided the patients into those who met the Debray criteria for cystic fibrosis-associated liver disease (CFLD) (n=16) and those who did not (n=25).

Patients with CFLD reported malnutrition more frequently than those without diagnosed CFLD. Malnutrition significantly correlated with abnormal elastography results as evidenced by a link between insufficient body mass and elastography results, which indicated more advanced liver disease.

Read more about CF patient education

Shear-wave elastography measures liver stiffness by how fast the waves travel through the liver tissues, thus, indirectly measuring the degree of fibrotic tissue caused by CF-related liver damage. Elastography results of F3 and F4 reflect advanced changes within the liver tissue, while results ranging from F0 to F1 indicate normal elastography.

Approximately 75% of patients with CFLD and 25% without diagnosed CFLD exhibited abnormal elastography results. The CFLD cohort demonstrated statistically significant higher average elastography values compared with those without CFLD (7.73 kPa vs 3.62 kPa).

Elastography changes marked the progression of liver fibrosis correlated with other liver fibrosis assessments, including the aminotransferase-to-platelet ratio index (APRI) and the Fibrotest. Average APRI results proved statistically higher in the CFLD group (0.37 vs 0.14). Abnormal Fibrotest results occurred in 50% of patients with CFLD and 8% of those without CFLD.

All patients demonstrating abnormal elastography results of F3-4 also demonstrated abnormal APRI and Fibrotest results, while most patients with elastography results of F2 exhibited normal APRI (85.7%) and Fibrotest (64.3%) results.

“Diagnostic markers which would allow for early detection of changes in the liver in the course of [CF], and simultaneously facilitate the assessment of already ongoing changes, seems important,” the authors said. “Studies in adults have shown that [transient elastography] is a useful tool for monitoring disease progression.”


Wiecek S, Fabrowicz P, Wos H, et al. Assessment of liver fibrosis with the use of elastography in paediatric patients with diagnosed cystic fibrosis. Dis Markers. 2022;2022:e4798136. doi:10.1155/2022/4798136