Ultrasound-based attenuation imaging for assessing steatosis severity in overweight/obese children: a prospective
Tingting Liu1, Murong Chen1, Longlong Huang1
1Department of Ultrasound, Shenzhen Children' Hospital, No. 7019, Yitian Road, Futian District, Shenzhen, P.R. China.
Insights
Attenuation imaging (ATI) values increase with childhood overweight/obesity and correlate with liver fat. This non-invasive tool can assess metabolic-associated steatotic liver disease severity in children.
Area of Science:
- Pediatric Radiology
- Hepatology
- Medical Imaging
Background:
- Childhood obesity is a growing concern linked to metabolic-associated steatotic liver disease (MASLD).
- Accurate, non-invasive methods are needed to assess liver fat in pediatric populations.
- Attenuation imaging (ATI) shows potential for evaluating liver tissue characteristics.
Purpose of the Study:
- To evaluate the correlation between ATI parameters and hepatic steatosis in overweight/obese children.
- To establish normal ATI reference values in healthy children.
- To explore ATI's utility in assessing MASLD severity.
Main Methods:
- A prospective cohort of 653 children was categorized into overweight (OW), obese (OB), and normal control groups based on BMI.
- Ultrasonographic hepatic steatosis grading and ATI measurements were performed by two independent radiologists.
- Hepatic steatosis was visually graded as none, mild, moderate, or severe.
Main Results:
- Median ATI values were significantly different across healthy, OW, and OB groups (p < 0.001).
- ATI values positively correlated with age, BMI, and metabolic markers (ALT, AST, triglycerides, uric acid) in OW/OB children (p < 0.05).
- ATI values demonstrated a significant stepwise increase with increasing hepatic steatosis grade (η² = 0.626, p < 0.001).
Conclusions:
- ATI values show a significant stepwise increase in pediatric overweight and obese cohorts.
- ATI correlates with anthropometric/metabolic profiles and ultrasonographic steatosis severity.
- ATI is a promising non-invasive tool for grading MASLD severity and monitoring treatment response in children.
Objectives:
To prospectively evaluate the correlation between the attenuation imaging (ATI) parameter and hepatic steatosis in overweight (OW)/obese (OB) children, and to establish normal ATI reference values from a prospectively enrolled cohort of healthy children.
Materials And Methods:
A total of 653 prospectively enrolled children were categorized into OW, OB, and normal control groups based on body mass index (BMI). Ultrasonographic hepatic steatosis grading and ATI measurements were independently assessed by two radiologists. Hepatic steatosis was graded visually as none, mild, moderate, or severe.
Results:
The final study cohort consisted of 97 OW, 292 OB, and 264 control children. Median attenuation coefficient obtained with ATI for normal control group, OW group, and OB group were 0.51, 0.54, and 0.64 dB/cm/MHz, respectively. Statistically significant differences in ATI values were observed among all three groups (all p < 0.001). In the combined OW/OB subgroup, ATI values demonstrated a significant weak to strong positive correlation with age, height, weight, BMI, skin-to-liver distance, serum alanine aminotransferase, aspartate aminotransferase, triglycerides, and uric acid (all p < 0.05). Additionally, ATI values increased stepwise with the severity of hepatic steatosis and showed a statistically significant positive correlation with steatosis grade, with higher grades corresponding to greater ATI values (η² = 0.626, p < 0.001).
Conclusions:
ATI values exhibit a significant stepwise increase across healthy, OW, and OB pediatric cohorts, and correlate with anthropometric/metabolic profiles and ultrasonographic steatosis severity. This evidence positions ATI as a non-invasive tool to grade severity and monitor treatment response in metabolic-associated steatotic liver disease.
Critical Relevance Statement:
ATI shows significant increases across pediatric weight groups, correlating with metabolic profiles and steatosis severity, positioning it as a non-invasive metabolic-associated steatotic liver disease assessment tool.
Key Points:
The ATI value increased significantly in a stepwise manner from healthy controls to OW and OB children, confirming its sensitivity to fat-related liver changes. ATI correlates significantly with most metabolic and anthropometric parameters in OW and OB children, suggesting its utility in reflecting metabolic status. ATI values increase progressively with hepatic steatosis severity and show a strong positive correlation with ultrasonographic steatosis grade.
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