Purpose or Case Report: To evaluate the diagnostic performance of attenuation imaging (ATI) with an ultrasound scanner (US) in the detection of pediatric hepatic steatosis.
Methods & Materials: Ninety-four prospectively enrolled children were classifed 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 signifcantly higher in the OW/OB group than in the normal weight group and showed a signifcant 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 signifcant 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 coefcient (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 padiatric patients with obesity.