Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, USA.
Pediatr Radiol. 2024 Sep;54(10):1653-1660. doi: 10.1007/s00247-024-06021-4. Epub 2024 Aug 13.
Semiquantitative and quantitative sonographic techniques have the potential for screening and surveillance of children at risk of nonalcoholic fatty liver disease.
To determine diagnostic performance and interobserver agreement of hepatorenal index (HRI) for pediatric ultrasound-based liver fat quantification.
In an institutional review board (IRB)-approved retrospective study (April 2014 to April 2023), children (< 18 years) with clinically performed magnetic resonance imaging (MRI) scans for liver fat quantification were assessed. Inclusion criteria required availability of abdominal ultrasound within 3 months of quantitative MRI. Three blinded readers subjectively assessed for sonographic hepatic steatosis and calculated HRI. MRI proton density fat fraction (PDFF) was the reference standard. Interobserver agreement, correlation with PDFF, and optimal HRI (using ROC analysis) values were analyzed. The significance level was set at p < 0.05.
A total of 41 patients (25 male) with median (interquartile range (IQR)) age of 13 (10-15) years were included. Median (IQR) MRI PDFF was 11.30% (2.70-17.95%). Hepatic steatosis distribution by MRI PDFF included grade 0 (34%), grade 1 (15%), grade 2 (22%), and grade 3 (29%) patients. Intraclass correlation coefficient for HRI among the three readers was 0.61 (95% CI 0.43-0.75) (p < 0.001). Moderate correlation was observed between manually estimated HRI and PDFF for each reader (r = 0.62, 0.67, and 0.67; p < 0.001). Optimal HRI cutoff was found to be 1.99 to diagnose hepatic steatosis (sensitivity 89%, specificity 93%). Median (IQR) HRI for each MRI grade of hepatic steatosis (0-4) was as follows: 1.2 (1.1-1.5), 2.6 (1.1-3.3), 3.6 (2.6-5.4), 5.6 (2.6-10.9), respectively (p < 0.001).
Ultrasound-estimated HRI has moderate interobserver agreement and moderate correlation with MRI-derived PDFF. HRI of 1.99 maximizes accuracy for identifying pediatric liver fat.
半定量和定量超声技术具有筛查和监测非酒精性脂肪性肝病风险儿童的潜力。
确定基于儿童超声的肝脂肪定量的肝肾指数 (HRI) 的诊断性能和观察者间一致性。
在机构审查委员会 (IRB) 批准的回顾性研究中（2014 年 4 月至 2023 年 4 月），评估了临床上进行磁共振成像 (MRI) 扫描以进行肝脂肪定量的儿童。纳入标准要求在定量 MRI 后 3 个月内提供腹部超声检查。三位盲法读者主观评估超声肝脂肪变性并计算 HRI。MRI 质子密度脂肪分数 (PDFF) 是参考标准。分析了观察者间一致性、与 PDFF 的相关性以及最佳 HRI（使用 ROC 分析）值。显著性水平设为 p < 0.05。
共纳入 41 名患者（25 名男性），中位（四分位距 (IQR)）年龄为 13（10-15）岁。中位（IQR）MRI PDFF 为 11.30%（2.70-17.95%）。MRI PDFF 肝脂肪分布包括 0 级（34%）、1 级（15%）、2 级（22%）和 3 级（29%）患者。三位读者的 HRI 组内相关系数为 0.61（95%CI 0.43-0.75）（p < 0.001）。每位读者手动估计的 HRI 与 PDFF 之间观察到中度相关性（r = 0.62、0.67 和 0.67；p < 0.001）。发现 HRI 最佳截断值为 1.99 可诊断肝脂肪变性（敏感性 89%，特异性 93%）。每个 MRI 肝脂肪变性（0-4）等级的 HRI 中位数（IQR）如下：1.2（1.1-1.5）、2.6（1.1-3.3）、3.6（2.6-5.4）、5.6（2.6-10.9），分别为（p < 0.001）。
超声估计的 HRI 具有中等的观察者间一致性和与 MRI 衍生的 PDFF 的中度相关性。HRI 为 1.99 可最大限度地提高识别小儿肝脂肪的准确性。
