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Liver acoustic radiation force impulse (ARFI) in childhood obesity: comparison and correlation with biochemical
Rajeev Kamble1, Kushaljit S Sodhi1, Babu R Thapa2
1Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Acoustic Radiation Force Impulse (ARFI) elastography effectively correlates with AST/ALT ratios in obese children. This noninvasive method aids in detecting nonalcoholic fatty liver disease (NAFLD) and related liver changes in pediatric patients.
Area of Science:
- Pediatric gastroenterology and hepatology.
- Medical imaging and diagnostic techniques.
- Biochemical markers of liver health.
Background:
- Obesity in children is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD).
- Early detection of hepatic changes in obese children is crucial for timely intervention.
- Noninvasive diagnostic tools are preferred over liver biopsy in pediatric populations.
Purpose of the Study:
- To compare the diagnostic efficiency of ARFI elastography with biochemical markers for hepatic changes in overweight and obese children.
- To assess the correlation between ARFI elastography measurements and liver enzyme levels (AST, ALT) and triglycerides.
- To evaluate ARFI elastography as a noninvasive tool for NAFLD detection in children.
Main Methods:
- A prospective study involving 54 overweight/obese children and 50 normal controls (aged 5-18 years).
- Grayscale ultrasonography for fatty liver diagnosis.
- ARFI elastography for liver stiffness measurement.
- Biochemical evaluation of AST, ALT, and triglyceride levels.
Main Results:
- Elevated AST/ALT ratios (>0.8) were observed in 4 obese children, all showing abnormal ARFI elastography readings.
- One obese child with elevated ARFI values did not have an elevated AST/ALT ratio.
- The mean ARFI value in obese children (1.13 m/s) was higher than in controls (1.02 m/s).
- Fatty liver changes were present in 94.4% of obese children, with Grade II changes in 40.7%.
Conclusions:
- ARFI elastography demonstrates an excellent correlation with AST/ALT ratios in obese children.
- ARFI elastography serves as a valuable noninvasive tool for detecting NAFLD and associated hepatic changes in pediatric patients.
- This technique is particularly useful given the challenges of liver biopsy in children.
Purpose:
To compare and correlate the diagnostic efficiency of acoustic radiation force impulse (ARFI) elastography with biochemical markers for assessing hepatic changes in overweight and obese children.
Methods:
This prospective study was approved by the institutional ethics committee. It included 54 overweight and obese children and 50 normal children (as a control group) in the age range 5-18 years. For all children, we performed grayscale ultrasonography to diagnose fatty liver, ARFI elastography to measure liver stiffness, and biochemical evaluation for aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum triglyceride (TG) levels.
Results:
Of the 54 obese children, AST was elevated in 13 (24.1%) and ALT was elevated in 16 (29.6%); however, only 4 (25%) of these 16 obese children with abnormal aminotransferase levels had an AST/ALT ratio >0.8. Furthermore, all children with abnormal aminotransferase levels with AST/ALT ratio >0.8 also had abnormal readings of ARFI elastography. The TG was elevated (>150 mg/dL) in 2 out of 54 (3.7%) obese children. None of the normal children showed abnormal levels of aminotransferase and TG. Three out of 54 (5.6%) obese children did not show fatty liver changes, while 29 (53.7%) showed grade-I fatty liver changes, and 22 (40.7%) showed grade-II fatty liver changes. The mean (SD) ARFI value was 1.13 m/s (SD 0.199) for obese children and 1.02 m/s (SD 0.11) for children in the control group. Of the 54 obese children, 49 (90.7%) showed ARFI values of <1.19 m/s (normal), 4 (7.4%) had ARFI values from >1.19 to <1.75 m/s, and 1 (1.9%) had an ARFI value >1.75 m/s. Four children with an increased ARFI value also had an AST/ALT ratio >0.8. However, one obese child with a raised ARFI value did not have an elevated AST/ALT ratio, and none of his aminotransferase levels were abnormal. All normal children had ARFI values <1.19 m/s.
Conclusion:
ARFI elastography shows excellent correlation with AST/ALT ratios in obese children and may be used as a noninvasive tool to detect nonalcoholic fatty liver disease (NAFLD) and associated hepatic changes, especially in pediatric patients, for whom liver biopsy is not always feasible.
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