Tas Emir, Sundararajan Divya, Lo Jaclyn S, Morelli Nazeen, Garcia-Reyes Yesenia, Ware Meredith A, Rahat Haseeb, Ou Xiawei, Na Xiaoxu, Sundaram Shikha, Severn Cameron, Pyle Laura L, Børsheim Elisabet, Vajravelu Mary Ellen, Muzumdar Radhika, Dranoff Jonathan A, Cree Melanie G
Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
Center for Childhood Obesity Prevention, Arkansas Children's Research Institute, Little Rock, AR 72202, USA.
J Endocr Soc. 2024 Jun 11;8(7):bvae110. doi: 10.1210/jendso/bvae110. eCollection 2024 May 23.
Steatotic liver disease is common but overlooked in childhood obesity; diagnostic methods are invasive or expensive.
We sought to determine the diagnostic accuracy of vibration-controlled transient elastography (VCTE) compared with magnetic resonance imaging (MRI) in adolescents with obesity and high risk for hepatosteatosis.
Baseline data in 3 clinical trials enrolling adolescents with obesity were included (NCT03919929, NCT03717935, NCT04342390). Liver fat was assessed using MRI fat fraction and VCTE-based controlled attenuation parameter (CAP). Hepatosteatosis was defined as MRI fat fraction ≥5.0%. The area under the receiver-operating characteristic curves (AUROCs) for CAP against MRI was calculated, and optimal CAP using the Youden index for hepatosteatosis diagnosis was determined.
Data from 82 adolescents (age 15.6 ± 1.4 years, body mass index 36.5 ± 5.9 kg/m, 81% female) were included. Fifty youth had hepatosteatosis by MRI (fat fraction 9.3% ; 95% CI 6.7, 14.0), and 32 participants did not have hepatosteatosis (fat fraction 3.1%; 95% CI 2.2, 3.9; < .001). The hepatosteatosis group had higher mean CAP compared with no hepatosteatosis (293 dB/m; 95% CI 267, 325 vs 267 dB/m; 95% CI 248, 282; = .0120). A CAP of 281 dB/m had the highest sensitivity (60%) and specificity (74%) with AUROC of 0.649 (95% CI 0.51-0.79; = .04) in the entire cohort. In a subset of participants with polycystic ovary syndrome (PCOS), a CAP of 306 dB/m had the highest sensitivity (78%) and specificity (52%) and AUROC of 0.678 (95% CI 0.45-0.90; = .108).
CAP of 281 dB/m has modest diagnostic performance for hepatosteatosis compared with MRI in youth with significant obesity. A higher CAP in youth with PCOS suggests that comorbidities might affect optimal CAP in hepatosteatosis diagnosis.
脂肪性肝病在儿童肥胖中很常见，但常被忽视；诊断方法具有侵入性或费用高昂。
我们试图确定与磁共振成像（MRI）相比，振动控制瞬时弹性成像（VCTE）在肥胖且有肝脂肪变性高风险的青少年中的诊断准确性。
纳入了3项招募肥胖青少年的临床试验的基线数据（NCT03919929、NCT03717935、NCT04342390）。使用MRI脂肪分数和基于VCTE的受控衰减参数（CAP）评估肝脏脂肪。肝脂肪变性定义为MRI脂肪分数≥5.0%。计算CAP相对于MRI的受试者操作特征曲线下面积（AUROC），并使用约登指数确定用于肝脂肪变性诊断的最佳CAP。
纳入了82名青少年的数据（年龄15.6±1.4岁，体重指数36.5±5.9kg/m²，81%为女性）。50名青少年通过MRI诊断为肝脂肪变性（脂肪分数9.3%；95%CI 6.7，14.0），32名参与者没有肝脂肪变性（脂肪分数3.1%；95%CI 2.2，3.9；P<0.001）。与无肝脂肪变性组相比，肝脂肪变性组的平均CAP更高（293dB/m；95%CI 267，325 vs 267dB/m；95%CI 248，282；P = 0.0120）。在整个队列中，CAP为281dB/m时具有最高的敏感性（60%）和特异性（74%），AUROC为0.649（95%CI 0.51 - 0.79；P = 0.04）。在多囊卵巢综合征（PCOS）参与者亚组中，CAP为306dB/m时具有最高的敏感性（78%）和特异性（52%），AUROC为0.678（95%CI 0.45 - 0.90；P = 0.108）。
与MRI相比，在严重肥胖的青少年中，281dB/m的CAP对肝脂肪变性的诊断性能一般。PCOS青少年中较高的CAP表明合并症可能会影响肝脂肪变性诊断中的最佳CAP。
