Ultrasound attenuation imaging: a reproducible alternative for the noninvasive quantitative assessment of hepatic steatosis in children

Dardanelli, Esteban; Orozco, María Eugenia; Oliva, Vanesa; Lutereau, Juan Francisco; Ferrari, Facundo A.; Bravo, Mónica G; Ruvinsky, Silvina; Roel, Macarena; Barvosa, Pablo C; Armeno, Marisa; Kaplan, Julio

doi:10.1007/s00247-023-05601-0

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Despite these advantages, ultrasound has limitations. Its results can vary depending on the operator and the interpreter, making it somewhat subjective (12). Furthermore, conditions like hepatic fibrosis, which also increase hepatic echogenicity, can affect the accuracy of ultrasound in detecting hepatic steatosis (13).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasound and Unenhanced CT for diagnosis of Hepatic Steatosis

Fatima,

Ikhlaq,

Rafique

et al. 2023

JHRR

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Background: Hepatic steatosis, characterized by pathologically increased fat deposition in the liver, is a growing health concern, with Non-Alcoholic Fatty Liver Disease (NAFLD) being the most common manifestation. This condition, which may escalate to cirrhosis and steatohepatitis, underscores the need for effective diagnostic strategies. Various non-invasive imaging techniques are pivotal in detecting hepatic steatosis (HS). Objective: The aim of this study was to compare the efficacy of ultrasound and unenhanced CT in the diagnosis of hepatic steatosis, to determine the most reliable non-invasive imaging technique for early detection. Methods: A cross-sectional study was conducted at the Radiological Department of Combined Military Hospital (CMH), Lahore, using a convenience sampling method from April to June 2023. The study involved 100 participants who underwent both ultrasound (USG) and CT scans. Data collection was facilitated through structured performa, and the analysis was executed using SPSS version 26. Results: The study diagnosed hepatic steatosis through both USG and CT scans. Ultrasound assessments revealed that 23% of patients had Grade I HS, 38% had Grade II, and 20% had Grade III. Notably, 19% of the ultrasound examinations showed no signs of HS. In contrast, CT imaging results indicated 24% of participants had no disease with an L/S index greater than 1, while 62% presented with an L/S index between 0.5 to 1, indicative of HS. A critical finding was that 14% were diagnosed with Grade III steatosis, progressing to cirrhosis with an L/S index of less than 0.5. Discrepancies between imaging modalities were highlighted as 20% of patients displayed smooth liver parenchyma on USG contrasted with irregular textures on CT scans. Conclusion: Ultrasound emerges as a viable initial imaging modality for diagnosing hepatic steatosis in early stages due to its accessibility and non-invasiveness. However, for precise quantification of liver fat content, unenhanced CT scans provide superior accuracy. Such insights direct clinicians towards a tailored approach in the management of HS.

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Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasound and Unenhanced CT for diagnosis of Hepatic Steatosis

Fatima,

Ikhlaq,

Rafique

et al. 2023

JHRR

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Quantitative ultrasound fatty liver evaluation in a pediatric population: comparison with magnetic resonance imaging of liver proton density fat fraction

Polti,

Frigerio,

Del Gaudio

et al. 2023

Pediatr Radiol

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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

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Ultrasound attenuation imaging: a reproducible alternative for the noninvasive quantitative assessment of hepatic steatosis in children

Cited by 2 publications

References 27 publications

Comparison of Ultrasound and Unenhanced CT for diagnosis of Hepatic Steatosis

Comparison of Ultrasound and Unenhanced CT for diagnosis of Hepatic Steatosis

Quantitative ultrasound fatty liver evaluation in a pediatric population: comparison with magnetic resonance imaging of liver proton density fat fraction

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