Ultrasonographic Quantitative Estimation of Hepatic Steatosis in Children With NAFLD

Abstract

Background & Aims The diagnostic accuracy of hepatic ultrasonography for detection and grading of hepatic steatosis in children with suspected nonalcoholic fatty liver disease (NAFLD) remains poorly characterized. The aim of this study was to prospectively evaluate the clinical utility of ultrasonographic quantification of hepatic steatosis. Methods Our cohort consisted of 208 consecutive pediatric patients with biopsy-proven NAFLD. Hepatic ultrasonography was performed within 1-month of the liver biopsy procedure. Steatosis identified by ultrasonography was scored using a 0 to 3 scale based on echogenicity and visualization of vasculature, parenchyma and diaphragm and compared to histological features based on Brunt’s classification. Results The median age at time of first visit was 10.8 years and 64% were boys. Sixty-nine percent had moderate to severe steatosis on histology. Ultrasonographic steatosis score (USS) had an excellent correlation with histological grade of steatosis (with a Spearman’s coefficient of 0.80). The area under the receiver operating characteristic (ROC) curve for ultrasonographic detection of moderate to severe steatosis was 0.87. The USS did not correlate significantly with inflammatory activity or fibrosis stage; however, there was significant correlation with the NAFLD activity score (NAS) albeit this was due in large part to the strong correlation with the steatosis component of NAS. Serum ALT and AST were not associated with histological grade of steatosis and showed no correlation with USS. Conclusions Our results, which represent the largest prospective pediatric study evaluating the role of hepatic ultrasonography in children with biopsy-proven NAFLD, demonstrate the utility of this technique for non-invasive diagnosis and estimation of hepatic steatosis in children.

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