After an investigation in which 174 patients participated and an investment of $130,000 in high-tech equipment, the Garrahan Hospital, in the City of Buenos Aires, Argentina, implemented a novel non-invasive study for the detection of hepatic steatosis - fatty liver. in children and adolescents with risk factors. The results were published in the journal Pediatric Radiology.
According to a statement from the institution, the study allows the precise measurement of fat in the liver -hepatic steatosis- , a condition that can evolve into liver fibrosis. The evaluation, which was carried out with a biopsy or subjectively by comparing the brightness of the liver ultrasound with respect to the kidney, the portal vessels and the diaphragm, is now carried out with state-of-the-art ultrasound machines that allow a multiparametric evaluation in patients with obesity and overweight. .
"It is a source of pride and at the same time enormous satisfaction to continue innovating in non-invasive studies that improve the quality of diagnosis of children and adolescents through the incorporation of technology and the stimulation of research," indicated the executive medical director of Garrahan. , Patricia García Arrigoni.
The evaluation includes a B-mode ultrasound - in real time - that provides qualitative information; the doppler , which evaluates the vascular structure; the measurement of the attenuation coefficient -ATI-, which provides values of liver fat content and an elastography , which looks for fibrosis in the liver. All methods can be performed at the same time, without anesthesia or sedation and with the same equipment that is also used for all types of ultrasounds.
According to a statement from the Garrahan Hospital, the idea began in 2021, from a proposal to test the method for 4 months with similar equipment as a demonstration. At that time, the research was carried out with a group of 27 patients without risk factors for steatosis and another group of 147 with risk factors (obesity, overweight, diabetes, hypercholesterolemia, etc.) with conclusive results and without technical failures.
“The main benefit is the precise, quantitative and reproducible measurement of the degree of steatosis, especially in the early stages, which also allows evaluating the result of the treatment,” said Esteban Dardanelli , head of the Garrahan Ultrasound service and specialist in Diagnostic Imaging.
Summary Background Pediatric fatty liver disease is a global public health problem, as an increasing number of children are affected by this condition. Liver biopsy is the gold standard diagnostic method ; however, this procedure is invasive. Proton density fat fraction derived from magnetic resonance imaging (MRI) has been accepted as an alternative to biopsy. However, this method is limited by cost and availability. Ultrasound (US) attenuation imaging is an upcoming tool for non-invasive quantitative evaluation of hepatic steatosis in children. A limited number of publications have focused on ultrasound attenuation imaging and stages of hepatic steatosis in children. Aim To analyze the usefulness of attenuated ultrasound for the diagnosis and quantification of hepatic steatosis in children. Material and methods Between July and November 2021, 174 patients were included, divided into two groups: group 1, patients with risk factors for steatosis ( n = 147), and group 2, patients without risk factors for steatosis ( n = 27). In all cases, age, sex, weight, body mass index (BMI) and BMI percentile were determined. B-mode ultrasound (two observers) and attenuation ultrasound with attenuation coefficient acquisition (two independent sessions, two different observers) were performed in both groups. Steatosis was classified into four grades (0: absent, 1: mild, 2: moderate, and 3: severe) using B-mode ultrasound. The acquisition of the attenuation coefficient was correlated with the steatosis score according to Spearman’s correlation. Interobserver agreement of attenuation coefficient acquisition measurements was assessed using intraclass correlation coefficients (ICC). Results All attenuation coefficient acquisition measurements were satisfactory without technical failures. The mean values of group 1 for the first session were 0.64 (0.57-0.69) dB/cm/MHz and 0.64 (0.60-0.70) dB/cm/MHz for the second session . The mean values of group 2 for the first session were 0.54 (0.51-0.56) dB/cm/MHz and 0.54 (0.51-0.56) dB/cm/MHz for the second. The average attenuation coefficient acquisition was 0.65 (0.59–0.69) dB/cm/MHz for group 1 and 0.54 (0.52–0.56) dB/cm/MHz for group 2.
There was substantial agreement between both observers ( κ = 0.77, with P < 0.001). There was a positive correlation between ultrasound attenuation images and B-mode scores for both observers (r = 0.87, P < 0.001 for observer 1; r = 0.86, P < 0.001 for observer 2). The mean acquisition values of the attenuation coefficient were significantly different for each degree of steatosis (P < 0.001). In the evaluation of steatosis by B-mode US, the agreement between the two observers was moderate (κ = 0.49 and κ = 0.55, respectively, with P < 0.001 in both cases). Conclusion Attenuation ultrasound is a promising tool for the diagnosis and monitoring of pediatric steatosis, providing a more repeatable form of classification, especially at low levels of steatosis detectable on B-mode ultrasound. |
