Purpose or Case Report: Pediatric chronic liver disease (CLD) poses a significant clinical challenge, necessitating precise diagnostic tools for comprehensive evaluation. Microvascular perfusion abnormalities play a pivotal role in disease progression. Contrast-enhanced ultrasound (CEUS) detects the flow in the micro-vessels, however, objective means are needed for better understanding. In this study we evaluate a novel quantitative method utilizing CEUS for assessing microvascular perfusion in pediatric patients with CLD.
Methods & Materials: We conducted a prospective study involving pediatric patients diagnosed with CLD. Liver CEUS images were acquired from a cohort of seven pediatric patients, including (3 females and 4 males). CEUS images from four normal controls were used for comparison. All images were employed for quantitative analysis. We used an image processing technique based on Interactive Data Language, known as delta projection. This method was utilized to systematically track and measure microvascular perfusion dynamics within the liver. Various perfusion parameters were quantified, among which the perfusion index (PI) and peak enhancement (PE) held significance.
Results: In 3 patients with primary sclerosing cholangitis, we observed comparable perfusion parameters. They exhibited PI values of 3.3, 3.2, and 3.5, respectively. The corresponding PE values were 53.5, 52.8, and 49.8 for each patient.

In a patient with biliary atresia, the initial PI was 5.8, with a corresponding PE of 83.5. Six months later, we noted a significant decrease in flow, with the PI dropping to 1.7 and the PE decreasing to 45.4. These perfusion values were comparable to another patient with biliary atresia (PI of 1.3 and a PE of 40).

One patient with autoimmune hepatitis had a PI of 2.9 and a PE of 47.9. and another with chronic hepatitis, the PI was at 18.77, and the PE was 99.6.

In normal patients, liver perfusion exhibited consistency across the 4 individuals and surpassed the values observed in patients with CLD. PI ranged from 19.6 to 24.2, while the PE ranged from 112.4 to 126.2.
Conclusions: This quantitative method effectively revealed distinct patterns of microvascular perfusion across liver diseases compared to normal liver. Its capability to detect changes occurring with the progression of the disease represents a significant advancement in the assessment of pediatric CLD. The precision and non-invasive nature of this method make it a promising tool for early diagnosis and monitoring of disease progression.