Ultrasound elastography is a useful non-invasive tool for the diagnosis of liver fibrosis in adults (1). It plays a similar role in children, with some differences in the confounding factors and in the etiological spectrum of the liver disease; however, guidelines and recommendations have not been published. Preliminary data using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) techniques, have shown that they are all feasible and accurate for the evaluation of liver fibrosis due to several etiologies in children (2). Assessment of liver stiffness is the most used application in children. However, there are other applications of ultrasound elastography such as for the evaluation of the spleen, pancreas, kidney, gastrointestinal tract, and thyroid (3).
Specific considerations relating to pediatric investigations include: (a) feasibility in children, related also to the differences in anatomy, anthropometrics, metabolic profile and psychology of each age group, the lack of cooperation to stop breathing, et cetera; (b) the type of probe that should be used; (c) some differences in etiology and pathology in children; (d) cut-off values and (e) definition of preventable fibrosis in liver diseases (2).