Budd‐Chiari syndrome in children: Radiological intervention and role of shear wave elastography in monitoring response

Abstract

AbstractObjectivesRadiological intervention (RI) is the preferred treatment in children with Budd‐Chiari syndrome (BCS). We studied the comparative long‐term outcome of BCS children, with and without RI and utility of liver and splenic stiffness measurement (LSM, SSM) by 2‐dimensional shear wave elastography (2D‐SWE) in assessing response.MethodsSixty children (40 boys, median age 10.5 [6.5–15.25] years) with BCS (29 newly diagnosed, 31 follow‐up) were evaluated. LSM and SSM by 2D‐SWE and vascular patency were monitored pre‐ and postprocedure (≥ 6 months postprocedure) in those undergoing RI. Medical therapy without anticoagulation and monitoring was done in subjects without RI. The RI and no‐RI groups were compared.ResultsAscites (54,90%), hepatomegaly (56,93%) and prominent abdominal‐veins (42,70%), were the commonest features. The majority (46,78%) had isolated hepatic vein block. 44 (73%) cases underwent RI, while 16 (27%) were managed conservatively. Both groups were similar at baseline. Post‐RI subjects showed significant improvement in clinical findings, liver functions and portal hypertension. LSM [33 (32–34.5) to 19.2 (18–20.67) kPa] and SSM [54.5 (52.3–57.6) to 28.9 (27.6–30.25) kPa] showed a significant decline from baseline value over a follow‐up of 12 (6–13) months. Gradual reduction occurred in the LSM and SSM over 1–5 years, with near‐normal LSM [10.2 (9.2–11.5) kPa] and SSM [22.3 (20.5–24.3) kPa] values in patients (n‐16) with > 5 years follow‐up. Patients without RI showed worsening in LSM and SSM. Hepatopulmonary syndrome and hepatocellular carcinoma developed in 4 (8%) and 1 (1.7%) cases respectively.ConclusionRI leads to clinical recovery and reduction with near normalization of LSM and SSM over long‐term follow‐up in children with BCS. 2D‐SWE is a promising tool to monitor outcomes.