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A 3D Quantification Technique for Liver Fat Fraction Distribution Analysis Using Dixon Magnetic Resonance Imaging
Published on: October 20, 2023
Evidence and recommendations for imaging liver fat in children, based on systematic review
Hannah I Awai1, Kimberly P Newton2, Claude B Sirlin3
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California; Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California.
Insights
Current imaging methods like ultrasonography are not reliable for diagnosing pediatric fatty liver disease. Magnetic resonance imaging (MRI) shows promise but requires more research for accurate assessment of liver fat in children.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Hepatology
Background:
- Pediatric fatty liver disease poses risks for cirrhosis, diabetes, and cardiovascular issues.
- Liver biopsy is the standard but invasive; noninvasive methods are needed for children.
- A systematic review evaluated imaging techniques for assessing pediatric liver fat.
Purpose of the Study:
- To systematically review studies on imaging liver fat in children.
- To assess the diagnostic accuracy of noninvasive imaging modalities for pediatric hepatic steatosis.
Main Methods:
- Systematic literature search of PubMed (1982-2012) using "imaging liver fat."
- Included English-language studies of children (0-18 years) measuring hepatic steatosis with imaging and a quantitative reference.
- Analyzed 9 studies (610 children) evaluating ultrasonography and magnetic resonance imaging (MRI).
Main Results:
- Ultrasonography showed limited diagnostic value (47-62% PPV) with inconsistent correlation to reference standards.
- MRI-based liver fat measurements varied by methodology; correlation with histology was observed but lacked diagnostic accuracy assessment due to sample size.
- No consistent relationship between ultrasound steatosis scores and reference measurements was found.
Conclusions:
- Current evidence does not support ultrasonography for diagnosing or grading pediatric fatty liver.
- Magnetic resonance imaging (MRI) is a potential tool, but insufficient data exists for evidence-based recommendations on its use in children.
- Further research is needed to establish reliable noninvasive imaging methods for pediatric hepatic steatosis.
Background & Aims:
Fatty liver is a common problem in children and increases their risk for cirrhosis, diabetes, and cardiovascular disease. Liver biopsy is the clinical standard for diagnosing and grading fatty liver. However, noninvasive imaging modalities are needed to assess liver fat in children. We performed a systematic review of studies that evaluated imaging liver fat in children.
Methods:
We searched PubMed for original research articles in peer-reviewed journals from January 1, 1982, through December 31, 2012, using the key words "imaging liver fat." Studies included those in English, and those performed in children from birth to 18 years of age. To be eligible for inclusion, studies were required to measure hepatic steatosis via an imaging modality and a quantitative comparator as the reference standard.
Results:
We analyzed 9 studies comprising 610 children; 4 studies assessed ultrasonography and 5 studies assessed magnetic resonance imaging (MRI). Ultrasonography was used in the diagnosis of fatty liver with positive predictive values of 47% to 62%. There was not a consistent relationship between ultrasound steatosis score and the reference measurement of hepatic steatosis. Liver fat as measurements by MRI or by spectroscopy varied with the methodologies used. Liver fat measurements by MRI correlated with results from histologic analyses, but sample size did not allow for an assessment of diagnostic accuracy.
Conclusions:
Available evidence does not support the use of ultrasonography for the diagnosis or grading of fatty liver in children. Although MRI is a promising approach, the data are insufficient to make evidence-based recommendations regarding its use in children for the assessment of hepatic steatosis.
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