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Noninvasive assessment of paediatric hepatic steatosis by using attenuation imaging
Sook Min Hwang1, Ky Young Cho2
1Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, 07441, Korea.
Insights
Attenuation imaging (ATI) is a promising ultrasound technique for detecting pediatric hepatic steatosis. This noninvasive method shows high accuracy and correlates well with obesity and liver disease indicators.
Area of Science:
- Pediatric radiology
- Hepatology
- Medical imaging
Background:
- Pediatric hepatic steatosis, often linked to obesity, requires accurate noninvasive diagnostic tools.
- Current noninvasive methods for diagnosing fatty liver disease in children have limitations.
Purpose of the Study:
- To assess the diagnostic performance of attenuation imaging (ATI) using ultrasound (US) for detecting hepatic steatosis in children.
- To compare ATI's effectiveness against established nonalcoholic fatty liver disease (NAFLD) predictors.
Main Methods:
- Ninety-four children were categorized into normal weight and overweight/obese (OW/OB) groups based on BMI.
- Ultrasound (US) was used to assess hepatic steatosis grade and ATI values by two radiologists.
- Anthropometric, biochemical parameters, and NAFLD scores (FSI, HSI) were collected and analyzed.
Main Results:
- ATI values were significantly higher in the OW/OB group and positively correlated with BMI, ALT, uric acid, and NAFLD scores.
- Receiver operating characteristic analysis indicated a very good ability of ATI to predict hepatic steatosis.
- ATI demonstrated superior diagnostic performance compared to other noninvasive NAFLD predictors.
Conclusions:
- Attenuation imaging (ATI) serves as an objective, noninvasive ultrasound-based tool for quantifying hepatic steatosis in pediatric patients.
- ATI shows significant potential as a surrogate screening test for hepatic steatosis, particularly in obese children.
- The quantitative nature of ATI aids in monitoring disease progression and guiding treatment decisions in pediatric hepatic steatosis.
Objectives:
To evaluate the diagnostic performance of attenuation imaging (ATI) with an ultrasound scanner (US) in the detection of paediatric hepatic steatosis.
Methods:
Ninety-four prospectively enrolled children were classified into normal weight and overweight/obese (OW/OB) groups according to body mass index (BMI). US findings, including hepatic steatosis grade and ATI value, were examined by two radiologists. Anthropometric and biochemical parameters were obtained, and nonalcoholic fatty liver disease (NAFLD) scores, including the Framingham steatosis index (FSI) and hepatic steatosis index (HSI), were calculated.
Results:
After screening, 49 OW/OB and 40 normal weight children aged 10-18 years old (55 males and 34 females) participated in this study. The ATI value was significantly higher in the OW/OB group than in the normal weight group and showed a significant positive correlation with BMI, serum alanine transferase (ALT), uric acid, and NAFLD scores (p < 0.05). In the multiple linear regression adjusted for age, sex, BMI, ALT, uric acid, and HSI, ATI showed a significant positive association with BMI and ALT (p < 0.05). The receiver operating characteristic analysis showed a very good ability of ATI to predict hepatic steatosis. The intraclass correlation coefficient (ICC) of interobserver variability was 0.92, and the ICCs of intraobserver variability were 0.96 and 0.93 (p < 0.05). According to the two-level Bayesian latent class model analysis, the diagnostic performance of ATI showed the best performance for predicting hepatic steatosis among other known noninvasive NAFLD predictors.
Conclusions:
This study suggests that ATI is an objective and possible surrogate screening test for detecting hepatic steatosis in paediatric patients with obesity.
Clinical Relevance Statement:
Using ATI as a quantitative tool in hepatic steatosis allows clinicians to estimate the extent of the condition and track changes over time. This is helpful for monitoring disease progression and guiding treatment decisions, especially in paediatric practice.
Key Points:
• Attenuation imaging is a noninvasive US-based method for the quantification of hepatic steatosis. • Attenuation imaging values were significantly higher in the OW/OB and steatosis groups than in the normal weight and no steatosis groups, respectively, with a meaningful correlation with known clinical indicators of nonalcoholic fatty liver disease. • Attenuation imaging performs better than other noninvasive predictive models used to diagnose hepatic steatosis.
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