Noninvasive assessment of liver steatosis in children: the clinical value of controlled attenuation parameter

Abstract

BackgroundTo assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology.MethodsConsecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson’s or Spearman’s rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249 dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology.ResultsThree hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3%) children by US and in 77/289 (26.6%) by CAP. A moderate to good correlation was detected between CAP and BMI (r = 0.53), FLI (r = 0.55) and HSI (r = 0.56). In obese children a moderate to good correlation between CAP and insulin levels (r = 0.54) and HOMA-IR (r = 0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64–0.79]; specificity, 0.98 [0.97–0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42–0.50]; specificity, 0.91 [0.89–0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73–0.77]; specificity, 0.57 [0.55–0.60]) and FLI or HSI.ConclusionsFor the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249 dB/m rules in liver steatosis with a very high specificity.

Nonalcoholic Fatty Liver Disease in Children: Unique Considerations and Challenges

“…At this time, the majority of studies suggest that CAP is most useful in differentiating between marked steatosis and none, with a cutoff point of 225 dB/m (area under the curve, 0.93). 151,152 The advantage of CAP is that the user can simultaneously calculate the liver stiffness measurement with TE from the same region of interest.…”

Inflammation in Obesity-Related Complications in Children: The Protective Effect of Diet and Its Potential Role as a Therapeutic Agent

“…These modifications determine various histological patterns, ranging from simple steatosis to Non-Alcoholic Steatohepatitis (NASH), defined by necrotic inflammation and fibrogenesis caused by an increase in the production of ROS, which cause lipid peroxidation (oxidative degradation of lipids) and consequent production of pro-inflammatory cytokines (TNF-α, TGF-β, IL-8); the latter collect neutrophils, causing necrosis and collagen synthesis [60]. This situation could worsen, evolving to cirrhosis or hepatocellular carcinoma.…”

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“…ARFI was shown to be useful in determining liver fibrosis in pediatric patients with chronic liver disease [ 28 ] and showed high correlation with aspartate aminotransferase (AST)/ALT ratios and detecting NAFLD in childhood obesity [ 29 ]. The FibroScan has been validated for measuring liver steatosis in adults and children and is FDA approved for clinical and research applications [ 24 , 30 ]. There are small, medium, and extra-large probes that can be selected to accommodate the size of the patient, which obviously spans a large potential range from younger children to adolescents and young adults.…”