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

Bulakci M., Ercan C. C., Karapinar E., Aksakal M. Z. T., Aliyev S., Bicen F., ...More

Pediatric Radiology, vol.53, no.8, pp.1629-1639, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 53 Issue: 8
  • Publication Date: 2023
  • Doi Number: 10.1007/s00247-023-05615-8
  • Journal Name: Pediatric Radiology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, Biotechnology Research Abstracts, CINAHL, EMBASE, MEDLINE
  • Page Numbers: pp.1629-1639
  • Keywords: Attenuation imaging, Children, Liver steatosis, Magnetic resonance imaging, Non-alcoholic fatty liver, Ultrasonography
  • Istanbul University Affiliated: Yes


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.