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Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study

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A Correction to this article was published on 18 March 2023

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Abstract

Background

Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease.

Objective

In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference.

Materials and methods

A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data.

Results

While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84–0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test–retest reproducibility were calculated as 0.90 and 0.91, respectively.

Conclusion

Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors would like to thank Canon Medical Systems Corporation (Shimoishigami, Otawara-shi, Tochigi, Japan) for the 6 months of software support.

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Authors and Affiliations

  1. Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey

    Mesut Bulakci, Celal Caner Ercan, Edanur Karapinar & Artur Salmaslioglu

  2. Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

    Melike Zeynep Tugrul Aksakal & Aylin Yetim Sahin

  3. Department of Radiology, Faculty of Medicine, Istinye University, Istanbul, Turkey

    Shamil Aliyev

  4. Department of Radiology and Neuroradiology, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany

    Fuat Bicen

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  1. Mesut Bulakci
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Correspondence to Mesut Bulakci.

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The original online version of this article was revised: The previously published Fig 2b legend stated: "Please note that the bottom bar chart shows the mean R2 value of water, which correlates with hepatic iron content."

This was an error and the sentence should read: "Please note that the bottom bar chart shows the mean R2* value of water, which correlates with hepatic iron content."

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Bulakci, M., Ercan, C.C., Karapinar, E. et al. Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study. Pediatr Radiol 53, 1629–1639 (2023). https://doi.org/10.1007/s00247-023-05615-8

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