Bozbeyoglu Sabriye Gulcin, Asik Murat
Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Clinic of Radiology, Istanbul, Türkiye.
Medeni Med J. 2025 Jun 26;40(2):46-52. doi: 10.4274/MMJ.galenos.2025.34017.
The aim of this study is to demonstrate the reliability of Quantitative Ultrasound (QUS) in assessing liver fat content in children, using magnetic resonance imaging proton density fat fraction (MRI-PDFF) values as a reference, and to determine threshold values for QUS in grading hepatosteatosis.
The study group consisted of pediatric patients under 18 years of age without known liver disease who volunteered to participate. All patients underwent MRI-PDFF scanning, and QUS imaging was performed using the tissue attenuation imaging (TAI) ve tissue scatter distribution imaging (TSI) tools. The cut-off values for MRI-PDFF were set at ≥5%, ≥16.3%, and ≥21.7%, corresponding to mild, moderate, and severe steatosis, respectively. The diagnostic performance of TAI and TSI in detecting various degrees of hepatic steatosis was evaluated using the area under the ROC (AUROC) curves.
The frequencies of hepatosteatosis grading were as follows: S1: 19 (37%), S2: 5 (10%), S3: 22 (43%). The AUROCs for TAI and TSI tools in detecting QUS measurements (MRI PDFF ≥5%) were 0.95 [95% confidence interval (CI): 0.91-0.99] (p< 0.001) and 0.96 (95% CI: 0.93-0.99) (p<0.001), respectively. For distinguishing different degrees of steatosis, TAI showed values of 0.75, 0.86, and 0.96 dB/cm/MHz, corresponding to sensitivities of 88%, 88%, and 100%, respectively, while TSI showed values of 92.44, 96.64, and 99.45, with sensitivities of 90%, 92%, and 91.7%. The correlation test between QUS measurements [TAI, TSI, EzHRI (Hepato-Renal Index with Automated regions of interest Recommendation)] and MR-PDFF indicated a concordance in TAI and TSI values, but not with EzHR.
The TAI and TSI tools can accurately measure liver fat content and can be used reliably in children for the assessment and grading of hepatosteatosis.
本研究旨在以磁共振成像质子密度脂肪分数（MRI-PDFF）值为参照，论证定量超声（QUS）评估儿童肝脏脂肪含量的可靠性，并确定QUS对肝脂肪变性进行分级的阈值。
研究组由18岁以下无已知肝脏疾病且自愿参与的儿科患者组成。所有患者均接受了MRI-PDFF扫描，并使用组织衰减成像（TAI）和组织散射分布成像（TSI）工具进行QUS成像。MRI-PDFF的临界值分别设定为≥5%、≥16.3%和≥21.7%，分别对应轻度、中度和重度脂肪变性。使用ROC曲线下面积（AUROC）评估TAI和TSI检测不同程度肝脂肪变性的诊断性能。
肝脂肪变性分级的频率如下：S1：19例（37%），S2：5例（10%），S3：22例（43%）。TAI和TSI工具检测QUS测量值（MRI PDFF≥5%）的AUROC分别为0.95 [95%置信区间（CI）：0.91-0.99]（p<0.001）和0.96（95%CI：0.93-0.99）（p<0.001）。为区分不同程度的脂肪变性，TAI显示的值为0.75、0.86和0.96 dB/cm/MHz，对应的敏感度分别为88%、88%和100%，而TSI显示的值为92.44、96.64和99.45，敏感度分别为90%、92%和91.7%。QUS测量值[TAI、TSI、EzHRI（带自动感兴趣区域推荐的肝肾指数）]与MR-PDFF之间的相关性测试表明，TAI和TSI值具有一致性，但与EzHR不一致。
TAI和TSI工具可准确测量肝脏脂肪含量，可可靠地用于儿童肝脂肪变性的评估和分级。
