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

BMC Gastroenterology

Research Article

Annalisa De Silvestri¹  Carmine Tinelli¹  Marinella Guazzotti²  Gloria Pelizzo²  Daniela Larizza³  Corrado Regalbuto³  Valeria Calcaterra³  Raffaella Lissandrin⁴  Laura Maiocchi⁴  Carlo Filice⁴  Giovanna Ferraioli⁴ 

[1] Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;Pediatric Surgery Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy;Pediatric Unit, Department of the Mother and Child Health, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy;Ultrasound Unit, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy;

关键词: Liver steatosis;    Pediatric series;    NAFLD;    Obesity;    Controlled attenuation parameter;    Ultrasound;    Transient elastography;   

DOI  :  10.1186/s12876-017-0617-6

 received in 2017-01-27, accepted in 2017-04-20,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017