# Reference values for shear wave elastography, shear wave dispersion and attenuation imaging in healthy paediatric livers

## TL;DR

This study establishes reference values for ultrasound-based liver measurements in healthy children and finds that age and sex affect these values.

## Contribution

The paper provides age-specific reference values for shear wave elastography, dispersion, and attenuation imaging in healthy pediatric livers.

## Key findings

- ATI and SWD values decrease significantly with increasing age.
- SWD is significantly lower in females and correlates negatively with BMI z-score.
- SWE shows only a weak correlation with measurement depth but not with fasting duration.

## Abstract

The rising prevalence of paediatric liver disease, including metabolic dysfunction- associated steatotic liver disease, highlights the need for reliable, non-invasive diagnostic tools. Advanced ultrasound techniques such as shear wave elastography (SWE), shear wave dispersion (SWD), and attenuation imaging (ATI) offer promising alternatives to biopsy or magnetic resonance imaging, but normative paediatric values remain limited.

This study aimed to establish age-specific reference values for SWE, SWD, and ATI in healthy children and to assess potential influencing factors such as age, sex, body mass index (BMI), and fasting duration.

In this retrospective study, 264 children (135 female, median age 11.5 years) without known liver disease were selected from a cohort of 734. Each child underwent liver ultrasound using a standardized protocol with five ATI and ten SWE/SWD measurements. Only high-quality data were included. Statistical analyses examined correlations between imaging parameters and patient characteristics.

The median ATI was 0.54 dB/cm/MHz [interquartile range (IQR):0.50–0.58], SWE was 1.24 m/s (IQR:1.14–1.33) and SWD was 11.70 (m/s)/kHz (IQR:10.84–12.13). ATI and SWD values showed significant negative correlations with age (P < 0.001 and P = 0.0048, respectively). SWD also correlated negatively with BMI z-score (P < 0.001) and was significantly lower in females (P = 0.001). SWE showed only a weak positive correlation with measurement depth (P = 0.0261). Fasting duration had no significant impact on any measurement.

This study provides reference values for SWE, SWD, and ATI in children. Age and sex influence SWD and ATI values, underscoring the importance of age-specific interpretation in paediatric liver ultrasound.

The online version contains supplementary material available at 10.1007/s00247-025-06434-9.