Top

Published in:

Open Access 01-03-2021 | Obesity | Gastrointestinal

Accuracy of controlled attenuation parameter compared with ultrasound for detecting hepatic steatosis in children with severe obesity

Authors: Jurgen H. Runge, Jet van Giessen, Laura G. Draijer, Eline E. Deurloo, Anne M. J. B. Smets, Marc A. Benninga, Bart G. P. Koot, Jaap Stoker

Published in: European Radiology | Issue 3/2021

Abstract

Objectives

To determine the diagnostic accuracy of controlled attenuation parameter (CAP) on FibroScan^® in detecting and grading steatosis in a screening setting and perform a head-to-head comparison with conventional B-mode ultrasound.

Methods

Sixty children with severe obesity (median BMI z-score 3.37; median age 13.7 years) were evaluated. All underwent CAP and US using a standardized scoring system. Magnetic resonance spectroscopy proton density fat fraction (MRS-PDFF) was used as a reference standard.

Results

Steatosis was present in 36/60 (60%) children. The areas under the ROC (AUROC) of CAP for the detection of grade ≥ S1, ≥ S2, and ≥ S3 steatosis were 0.80 (95% CI: 0.67–0.89), 0.77 (95% CI: 0.65–0.87), and 0.79 (95% CI: 0.66–0.88), respectively. The AUROC of US for the detection of grade ≥ S1 steatosis was 0.68 (95% CI: 0.55–0.80) and not significantly different from that of CAP (p = 0.09). For detecting ≥ S1 steatosis, using the optimal cutoffs, CAP (277 dB/m) and US (US steatosis score ≥ 2) had a sensitivity of 75% and 61% and a specificity of 75% and 71%, respectively. When using echogenicity of liver parenchyma as only the scoring item, US had a sensitivity of 70% and specificity of 46% to detect ≥ S1 steatosis. The difference in specificity of CAP and US when using only echogenicity of liver parenchyma of 29% was significant (p = 0.04).

Conclusion

The overall performance of CAP is not significantly better than that of US in detecting steatosis in children with obesity, provided that the standardized scoring of US features is applied. When US is based on liver echogenicity only, CAP outperforms US in screening for any steatosis (≥ S1).

Key Points

• The areas under the ROC curves of CAP and ultrasound (US) for detecting grade ≥ S1 steatosis were 0.80 and 0.68, respectively, and were not significantly different (p = 0.09).

• For detecting grade ≥ S1 steatosis in severely obese children, CAP had a sensitivity of 75% and a specificity of 75% at its optimal cutoff value of 277 dB/m.

• For detecting grade ≥ S1 steatosis in clinical practice, both CAP and US can be used, provided that the standardized scoring of US images is used.

Wong RJ, Aguilar M, Cheung R et al (2015) Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 148:547–555PubMed

Nobili V, Reale A, Alisi A et al (2009) Elevated serum ALT in children presenting to the emergency unit: relationship with NAFLD. Dig Liver Dis 41:749–752PubMed

Anderson EL, Howe LD, Jones HE, Higgins JP, Lawlor DA, Fraser A (2015) The prevalence of non-alcoholic fatty liver disease in children and adolescents: a systematic review and meta-analysis. PLoS One 10:e0140908PubMedPubMedCentral

Vajro P, Lenta S, Socha P et al (2012) Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 54:700–713PubMed

Schwimmer JB, Newton KP, Awai HI et al (2013) Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease. Aliment Pharmacol Ther 38:1267–1277PubMedPubMedCentral

Hecht L, Weiss R (2014) Nonalcoholic fatty liver disease and type 2 diabetes in obese children. Curr Diab Rep 14:448PubMed

Armstrong MJ, Adams LA, Canbay A, Syn WK (2014) Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology 59:1174–1197PubMed

Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P (2009) The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut 58:1538–1544PubMedPubMedCentral

Molleston JP, White F, Teckman J, Fitzgerald JF (2002) Obese children with steatohepatitis can develop cirrhosis in childhood. Am J Gastroenterol 97:2460–2462PubMed

10.

Alkhouri N, Hanouneh IA, Zein NN et al (2016) Liver transplantation for nonalcoholic steatohepatitis in young patients. Transpl Int 29:418–424PubMed

11.

Koot BGP, Nobili V (2017) Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance? Obes Rev. https://doi.org/10.1111/obr.12556

12.

Bohte AE, Koot BG, van der Baan-Slootweg OH et al (2011) US cannot be used to predict the presence or severity of hepatic steatosis in severely obese adolescents. Radiology 262(1):327–334

13.

Pacifico L, Celestre M, Anania C, Paolantonio P, Chiesa C, Laghi A (2007) MRI and ultrasound for hepatic fat quantification:relationships to clinical and metabolic characteristics of pediatric nonalcoholic fatty liver disease. Acta Paediatr 96:542–547PubMed

14.

Pozzato C, Radaelli G, Dall’Asta C et al (2008) MRI in identifying hepatic steatosis in obese children and relation to ultrasonography and metabolic findings. J Pediatr Gastroenterol Nutr 47:493–499PubMed

15.

Shannon A, Alkhouri N, Carter-Kent C et al (2011) Ultrasonographic quantitative estimation of hepatic steatosis in children with NAFLD. J Pediatr Gastroenterol Nutr 53:190–195PubMedPubMedCentral

16.

Radetti G, Kleon W, Stuefer J, Pittschieler K (2006) Non-alcoholic fatty liver disease in obese children evaluated by magnetic resonance imaging. Acta Paediatr 95:833–837PubMed

17.

Burgert TS, Taksali SE, Dziura J et al (2006) Alanine aminotransferase levels and fatty liver in childhood obesity: associations with insulin resistance, adiponectin, and visceral fat. J Clin Endocrinol Metab 91:4287–4294PubMed

18.

Rehm JL, Connor EL, Wolfgram PM, Eickhoff JC, Reeder SB, Allen DB (2014) Predicting hepatic steatosis in a racially and ethnically diverse cohort of adolescent girls. J Pediatr 165:319–325.e311PubMedPubMedCentral

19.

Molleston JP, Schwimmer JB, Yates KP et al (2014) Histological abnormalities in children with nonalcoholic fatty liver disease and normal or mildly elevated alanine aminotransferase levels. J Pediatr 164:707–713 e703PubMed

20.

Draijer LG, Feddouli S, Bohte AE et al (2019) Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease. Eur J Pediatr. https://doi.org/10.1007/s00431-019-03362-3

21.

Bohte AE, van Werven JR, Bipat S, Stoker J (2011) The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol 21:87–97PubMed

22.

Awai HI, Newton KP, Sirlin CB, Behling C, Schwimmer JB (2014) Evidence and recommendations for imaging liver fat in children, based on systematic review. Clin Gastroenterol Hepatol 12:765–773PubMed

23.

Di Martino M, Pacifico L, Bezzi M et al (2016) Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents. World J Gastroenterol 22:8812–8819PubMedPubMedCentral

24.

Schwimmer JB, Middleton MS, Behling C et al (2015) Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease. Hepatology 61:1887–1895PubMedPubMedCentral

25.

Middleton MS, Van Natta ML, Heba ER et al (2018) Diagnostic accuracy of magnetic resonance imaging hepatic proton density fat fraction in pediatric nonalcoholic fatty liver disease. Hepatology 67:858–872PubMedPubMedCentral

26.

Rehm JL, Wolfgram PM, Hernando D, Eickhoff JC, Allen DB, Reeder SB (2015) Proton density fat-fraction is an accurate biomarker of hepatic steatosis in adolescent girls and young women. Eur Radiol 25:2921–2930PubMedPubMedCentral

27.

Noureddin M, Lam J, Peterson MR et al (2013) Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials. Hepatology 58:1930–1940PubMedPubMedCentral

28.

European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO) (2016) EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 64:1388–1402

29.

Sasso M, Miette V, Sandrin L, Beaugrand M (2012) The controlled attenuation parameter (CAP): a novel tool for the non-invasive evaluation of steatosis using Fibroscan. Clin Res Hepatol Gastroenterol 36:13–20PubMed

30.

Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 351:h5527

31.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243PubMedPubMedCentral

32.

Fredriks AM, van Buuren S, Wit JM, Verloove-Vanhorick SP (2000) Body index measurements in 1996-7 compared with 1980. Arch Dis Child 82:107–112PubMedPubMedCentral

33.

Runge JH, Smits LP, Verheij J et al (2018) MR spectroscopy-derived proton density fat fraction is superior to controlled attenuation parameter for detecting and grading hepatic steatosis. Radiology 286:547–556PubMed

34.

Saverymuttu SH, Joseph AE, Maxwell JD (1986) Ultrasound scanning in the detection of hepatic fibrosis and steatosis. Br Med J (Clin Res Ed) 292:13–15

35.

Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMed

36.

Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL (2014) Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease. Anal Cell Pathol (Amst) 2014:526979

37.

Bril F, Barb D, Portillo-Sanchez P et al (2017) Metabolic and histological implications of intrahepatic triglyceride content in nonalcoholic fatty liver disease. Hepatology 65:1132–1144PubMed

38.

Shi KQ, Tang JZ, Zhu XL et al (2014) Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: a meta-analysis of diagnostic accuracy. J Gastroenterol Hepatol 29:1149–1158PubMed

39.

Eddowes PJ, Sasso M, Allison M et al (2019) Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology 156:1717–1730PubMed

40.

Imajo K, Kessoku T, Honda Y et al (2016) Magnetic resonance imaging more accurately classifies Steatosis and fibrosis in patients with nonalcoholic fatty liver disease than transient elastography. Gastroenterology 150:626–637.e627PubMed

41.

de Ledinghen V, Vergniol J, Capdepont M et al (2014) Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 60:1026–1031PubMed

42.

Baumeler S, Jochum W, Neuweiler J, Bergamin I, Semela D (2019) Controlled attenuation parameter for the assessment of liver steatosis in comparison with liver histology: a single-centre real life experience. Swiss Med Wkly 149:w20077PubMed

43.

Caussy C, Alquiraish MH, Nguyen P et al (2018) Optimal threshold of controlled attenuation parameter with MRI-PDFF as the gold standard for the detection of hepatic steatosis. Hepatology 67:1348–1359PubMedPubMedCentral

44.

Pu K, Wang Y, Bai S et al (2019) Diagnostic accuracy of controlled attenuation parameter (CAP) as a non-invasive test for steatosis in suspected non-alcoholic fatty liver disease: a systematic review and meta-analysis. BMC Gastroenterol 19:51PubMedPubMedCentral

45.

Ferraioli G, Calcaterra V, Lissandrin R et al (2017) Noninvasive assessment of liver steatosis in children: the clinical value of controlled attenuation parameter. BMC Gastroenterol 17:61PubMedPubMedCentral

46.

Desai NK, Harney S, Raza R et al (2016) Comparison of controlled attenuation parameter and liver biopsy to assess hepatic steatosis in pediatric patients. J Pediatr 173:160–164.e161PubMedPubMedCentral

47.

Shin J, Kim MJ, Shin HJ et al (2019) Quick assessment with controlled attenuation parameter for hepatic steatosis in children based on MRI-PDFF as the gold standard. BMC Pediatr 19:112PubMedPubMedCentral

48.

Karlas T, Petroff D, Sasso M et al (2017) Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 66:1022–1030PubMed

Title: Accuracy of controlled attenuation parameter compared with ultrasound for detecting hepatic steatosis in children with severe obesity
Authors: Jurgen H. Runge
Jet van Giessen
Laura G. Draijer
Eline E. Deurloo
Anne M. J. B. Smets
Marc A. Benninga
Bart G. P. Koot
Jaap Stoker
Publication date: 01-03-2021
Publisher: Springer Berlin Heidelberg
Keywords: Obesity
Ultrasound
Obesity
Fatty Liver
Ultrasound
Published in: European Radiology / Issue 3/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07245-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Accuracy of controlled attenuation parameter compared with ultrasound for detecting hepatic steatosis in children with severe obesity

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 3/2021

Post-TACE changes in ADC histogram predict overall and transplant-free survival in patients with well-defined HCC: a retrospective cohort with up to 10 years follow-up

Whole-liver histogram and texture analysis on T1 maps improves the risk stratification of advanced fibrosis in NAFLD

Yttrium-90 radioembolization using MIRD dosimetry with resin microspheres

Prediction of revascularization by coronary CT angiography using a machine learning ischemia risk score

Changes in appearance of cortical formation abnormalities in the foetus detected on sequential in utero MR imaging

Patient preferences for development in MRI scanner design: a survey of claustrophobic patients in a randomized study