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Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study
Mesut Bulakci1, Celal Caner Ercan2, Edanur Karapinar2
1Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey. mesutbulakci@yahoo.com.
Insights
Ultrasound attenuation imaging (ATI) shows promise for diagnosing pediatric fatty liver disease. This noninvasive method accurately detects and stages hepatic steatosis, offering a safe alternative to more invasive procedures.
Area of Science:
- Radiology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Pediatric obesity is driving an increase in fatty liver disease, a leading cause of chronic childhood liver issues.
- Current diagnostic methods for hepatic steatosis lack noninvasiveness, accessibility, and safety.
- There is a critical need for reliable, non-sedation imaging techniques for pediatric fatty liver disease diagnosis and monitoring.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ultrasound attenuation imaging (ATI) for detecting and staging fatty liver in children.
- To compare ATI findings against magnetic resonance imaging (MRI)-proton density fat fraction, used as the gold standard.
- To assess the reliability and reproducibility of ATI in a pediatric cohort.
Main Methods:
- 140 children underwent both ATI and MRI (1.5-T) for fatty liver assessment.
- Fatty liver was categorized by MRI-proton density fat fraction: mild (S1, ≥5%), moderate (S2, ≥10%), and severe (S3, ≥20%).
- Two blinded radiology residents performed ATI independently, with MRI data serving as the reference standard.
Main Results:
- A strong correlation (r=0.88) was observed between ATI attenuation coefficient and MRI-proton density fat fraction.
- ATI demonstrated high diagnostic performance: AUCs of 0.944 (S>0), 0.976 (S>1), and 0.970 (S>2).
- Excellent inter-observer agreement (ICC=0.90) and test-retest reproducibility (ICC=0.91) were achieved.
Conclusions:
- Ultrasound attenuation imaging is a highly accurate and reproducible noninvasive tool for quantifying pediatric fatty liver disease.
- ATI offers a safe and accessible imaging solution for the diagnosis and management of hepatic steatosis in children.
- This technique holds significant potential for routine clinical use in pediatric liver disease evaluation.
Background:
Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease.
Objective:
In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference.
Materials And Methods:
A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data.
Results:
While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84-0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test-retest reproducibility were calculated as 0.90 and 0.91, respectively.
Conclusion:
Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.
