Awai Hannah I, Newton Kimberly P, Sirlin Claude B, Behling Cynthia, Schwimmer Jeffrey B
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California; Liver Imaging Group, Department of Radiology, University of California, San Diego School of Medicine, San Diego, California.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Department of Gastroenterology, Rady Children's Hospital San Diego, San Diego, California.
Clin Gastroenterol Hepatol. 2014 May;12(5):765-73. doi: 10.1016/j.cgh.2013.09.050. Epub 2013 Sep 30.
BACKGROUND & AIMS: Fatty liver is a common problem in children and increases their risk for cirrhosis, diabetes, and cardiovascular disease. Liver biopsy is the clinical standard for diagnosing and grading fatty liver. However, noninvasive imaging modalities are needed to assess liver fat in children. We performed a systematic review of studies that evaluated imaging liver fat in children.
We searched PubMed for original research articles in peer-reviewed journals from January 1, 1982, through December 31, 2012, using the key words "imaging liver fat." Studies included those in English, and those performed in children from birth to 18 years of age. To be eligible for inclusion, studies were required to measure hepatic steatosis via an imaging modality and a quantitative comparator as the reference standard.
We analyzed 9 studies comprising 610 children; 4 studies assessed ultrasonography and 5 studies assessed magnetic resonance imaging (MRI). Ultrasonography was used in the diagnosis of fatty liver with positive predictive values of 47% to 62%. There was not a consistent relationship between ultrasound steatosis score and the reference measurement of hepatic steatosis. Liver fat as measurements by MRI or by spectroscopy varied with the methodologies used. Liver fat measurements by MRI correlated with results from histologic analyses, but sample size did not allow for an assessment of diagnostic accuracy.
Available evidence does not support the use of ultrasonography for the diagnosis or grading of fatty liver in children. Although MRI is a promising approach, the data are insufficient to make evidence-based recommendations regarding its use in children for the assessment of hepatic steatosis.
脂肪肝在儿童中是一个常见问题，会增加他们患肝硬化、糖尿病和心血管疾病的风险。肝活检是诊断和评估脂肪肝分级的临床标准。然而，需要非侵入性成像方法来评估儿童的肝脏脂肪情况。我们对评估儿童肝脏脂肪成像的研究进行了系统评价。
我们在PubMed上检索了1982年1月1日至2012年12月31日期间同行评审期刊上的原创研究文章，使用关键词“肝脏脂肪成像”。研究包括英文研究以及针对从出生到18岁儿童开展的研究。为符合纳入标准，研究需通过一种成像方法测量肝脂肪变性，并以定量比较器作为参考标准。
我们分析了9项研究，共610名儿童；4项研究评估了超声检查，5项研究评估了磁共振成像（MRI）。超声检查用于脂肪肝诊断时的阳性预测值为47%至62%。超声脂肪变性评分与肝脂肪变性的参考测量值之间没有一致的关系。通过MRI或光谱学测量的肝脏脂肪因所使用的方法而异。MRI测量的肝脏脂肪与组织学分析结果相关，但样本量不足以评估诊断准确性。
现有证据不支持将超声检查用于儿童脂肪肝的诊断或分级。虽然MRI是一种有前景的方法，但数据不足以就其在儿童中用于评估肝脂肪变性提出基于证据的建议。
