Multidimensional Reliability Assessment of the Hepato-Renal Index for Pediatric Metabolic Dysfunction-Associated
Xiaowu Yuan1, Jian Dong1, XuHong Qin2
1Department of Ultrasound, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Uygur Autonomous Region, China.
Insights
Hepatorenal index (HRI) measurements show high reliability and reproducibility across different ultrasound devices and operators. This consistency supports the use of HRI for the early diagnosis of metabolic-associated fatty liver disease (MAFLD).
Area of Science:
- Medical Imaging
- Diagnostic Ultrasound
- Hepatology
Background:
- Metabolic-associated fatty liver disease (MAFLD) is a growing global health concern.
- Accurate and reliable non-invasive diagnostic tools are crucial for early detection and management.
- Hepatorenal index (HRI) is an emerging ultrasound-based metric for assessing liver conditions.
Purpose of the Study:
- To quantitatively evaluate the agreement and reproducibility of hepatorenal index (HRI) measurements.
- To assess the reliability of HRI across different ultrasound planes, devices, and operators.
- To determine the suitability of HRI for early MAFLD diagnosis.
Main Methods:
- 307 children underwent ultrasonography by an experienced sonographer.
- Intraclass correlation coefficient (ICC) assessed reproducibility for longitudinal (HRIL) and transverse (HRIT) planes, devices, and intra-operator measurements.
- Inter-operator reproducibility and systematic bias were evaluated using Bland-Altman analysis in a subset of 40 children.
Main Results:
- HRI measurements demonstrated high reliability with no significant difference between HRIL and HRIT (ICC = 0.84).
- Excellent agreement was observed across different ultrasound systems (ICC = 0.95).
- High intra-operator (ICC = 0.92) and inter-operator (ICC = 0.80) reproducibility was confirmed, along with consistency in measurement frequency.
Conclusions:
- Hepatorenal index (HRI) exhibits robust stability and reproducibility.
- The findings support HRI as a reliable ultrasound parameter for clinical application.
- HRI has the potential to aid in the early diagnosis of MAFLD.
Objective:
To quantitatively evaluate the agreement of the HRI measurements.
Materials And Methods:
In 2024, 307 children underwent ultrasonography by an experienced sonographer (> 5 years). ICC assessed reproducibility between longitudinal (HRIL) / transverse (HRIT) planes, devices, and intra-operator measurements. Inter-operator reproducibility was determined by a junior sonographer in 40 children; systematic bias was quantified by Bland-Altman analysis.
Results:
HRI measurements demonstrated high reliability: among 307 subjects, HRIL (1.39 ± 0.55) and HRIT (1.36 ± 0.67) showed no significant difference (t = 1.29, p = 0.20; ICC = 0.84, 95% CI 0.80-0.87); in 70 subjects using different ultrasound systems, HRI (1.68 ± 0.64, 1.69 ± 0.64, 1.71 ± 0.74) exhibited no inter-device variation (H = 0.31, p = 0.86; ICC = 0.95, 95% CI 0.93-0.97). Intra-operator reproducibility was consistent for Operator 1 (baseline: 1.54 ± 0.65 vs. 2-week: 1.54 ± 0.56; t = -0.01, p = 0.99; ICC = 0.92, 95% CI 0.84-0.96) and Operator 2 (1.27 ± 0.50 vs. 1.30 ± 0.50; t = -0.62, p = 0.53; ICC = 0.86, 95% CI 0.75-0.92). Inter-operator analyses agreed between Operator 2 baseline (1.27 ± 0.50) and Operator 1 baseline (1.31 ± 0.61; t = 0.72, p = 0.48; ICC = 0.80, 95% CI 0.65-0.89), and Operator 2 2-week (1.30 ± 0.50) and Operator 1 baseline (t = 0.30, p = 0.77; ICC = 0.86, 95% CI 0.75-0.92). Measurement frequency assessments revealed consistency for Operator 1 baseline (first-three: 1.55 ± 0.58 vs. five: 1.54 ± 0.65; t = -0.18, p = 0.86; ICC = 0.91, 95% CI 0.83-0.95), Operator 2 baseline (1.19 ± 0.54 vs. 1.27 ± 0.50; t = 1.74, p = 0.09; ICC = 0.84, 95% CI 0.71-0.91), and Operator 2 2-week (1.31 ± 0.60 vs. 1.30 ± 0.50; t = -0.27, p = 0.79; ICC = 0.87, 95% CI 0.77-0.93).
Conclusion:
HRI demonstrates high stability and reproducibility across platforms, supporting MAFLD early diagnosis.
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