Longitudinal performance of vibration controlled transient elastography in pediatric metabolic dysfunction associated
Naima Diop-West1, Nicholas Denson1, Ana Catalina Arce-Clachar1,2
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Serial noninvasive liver assessments in children with metabolic dysfunction-associated steatotic liver disease show variability. While changes in controlled attenuation parameter and liver stiffness measurements may indicate disease progression, they are less reliable for detecting short-term regression.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Noninvasive Liver Disease Monitoring
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing concern in children.
- Vibration controlled transient elastography (VCTE) is used to monitor MASLD, but its interpretation in pediatric populations requires further definition.
- Optimal use of serial controlled attenuation parameter (CAP) and liver stiffness measurements (LSMs) for tracking disease progression or regression in children is not established.
Purpose of the Study:
- To characterize longitudinal trends of CAP and LSM in pediatric MASLD.
- To determine if changes in CAP and LSM correlate with validated indicators of MASLD regression or progression.
- To evaluate the utility of VCTE in monitoring disease trajectory in pediatric MASLD.
Main Methods:
- A longitudinal retrospective study involving 149 children with MASLD who had at least two VCTE assessments.
- Disease regression and progression were defined by changes in alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) levels.
- Longitudinal statistical models were employed to analyze trends and associations between VCTE parameters and liver enzyme outcomes.
Main Results:
- CAP and LSM demonstrated significant intraindividual variability over time.
- Changes in CAP and LSM were positively associated with continuous changes in ALT and GGT, independent of BMI.
- However, changes in CAP and LSM did not predict categorical improvements in ALT and GGT levels.
Conclusions:
- Longitudinal VCTE has potential for identifying disease progression in pediatric MASLD.
- The inherent variability of CAP and LSM may hinder the detection of short-term disease changes.
- Development of more precise noninvasive biomarkers is needed for effective pediatric MASLD management.
Objectives:
Vibration controlled transient elastography (VCTE) is increasingly used to monitor metabolic dysfunction-associated steatotic liver disease (MASLD), yet optimal interpretation of serial controlled attenuation parameter (CAP) and liver stiffness measurements (LSMs) in children is undefined. We aimed to characterize longitudinal trends in CAP and LSM and assess whether changes in these measures reflect validated measures of disease regression or progression.
Methods:
Longitudinal retrospective study of youth with MASLD who underwent ≥2 VCTE studies. Disease regression and progression were defined using categorical and continuous changes in alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) previously linked to histologic improvement or worsening. Spaghetti plots illustrated trends over time, while longitudinal linear mixed-effects models and proportional odds mixed models assessed associations between CAP, LSM, and liver enzyme outcomes.
Results:
The cohort included 149 children (72% male, 43% Hispanic) with a mean age of 14 ± 4 years and a mean follow-up of 1.4 years. CAP and LSM showed marked intraindividual variability. Independent predictors of CAP change included age, body mass index (BMI) percentile, and glycated hemoglobin (HbA1c); predictors of LSM change included ALT, BMI, and HbA1c. Changes in CAP and LSM did not predict categorical outcomes of ALT and GGT reduction, however were significantly positively associated with continuous ALT and GGT outcomes, independent of BMI percentile.
Conclusions:
Longitudinal VCTE in pediatric MASLD has the potential to identify disease progression. The intraindividual variability of CAP and LSM may limit the ability to detect short-term regression or progression, highlighting the need for more precise noninvasive biomarkers for pediatric MASLD.
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