Abstract
Abstract
Background
Biopsy remains the gold standard for the diagnosis of hepatic steatosis, the leading cause of pediatric chronic liver disease; however, its costs call for less invasive methods.
Objective
This study examined the diagnostic accuracy and reliability of quantitative ultrasound (QUS) for the assessment of liver fat content in a pediatric population, using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard.
Materials and methods
We enrolled 36 patients. MRI-PDFF involved a 3-dimensional T2*-weighted with Dixon pulse multiple-echo sequence using iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL IQ). QUS imaging relied on the ultrasound system “RS85 A” (Samsung Medison, Seoul, South Korea) and the following software: Hepato-Renal Index with automated region of interest recommendation (EzHRI), Tissue Attenuation Imaging (TAI), and Tissue Scatter Distribution Imaging (TSI). For each QUS index, receiver operating characteristic (ROC) curve analysis against MRI-PDFF was used to identify the associated cut-off value and the area under the ROC curve (AUROC). Concordance between two radiologists was assessed by intraclass correlation coefficients (ICCs) and Bland–Altman analysis.
Results
A total of 61.1% of the sample (n=22) displayed a MRI-PDFF ≥ 5.6%; QUS cut-off values were TAI=0.625 (AUROC 0.90, confidence interval [CI] 0.77–1.00), TSI=91.95 (AUROC 0.99, CI 0.98–1.00) and EzHRI=1.215 (AUROC 0.98, CI 0.94–1.00). Inter-rater reliability was good-to-excellent for EzHRI (ICC 0.91, 95% C.I. 0.82–0.95) and TAI (ICC 0.94, 95% C.I. 0.88–0.97) and moderate to good for TSI (ICC 0.73; 95% C.I. 0.53–0.85).
Conclusion
Our results suggest that QUS can be used to reliably assess the presence and degree of pediatric hepatic steatosis.
Graphical abstract
Funder
Università degli Studi di Roma La Sapienza
Publisher
Springer Science and Business Media LLC
Subject
Radiology, Nuclear Medicine and imaging,Pediatrics, Perinatology and Child Health