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Real-time ultrasound-derived fat fraction in pediatric population: feasibility validation with MR-PDFF

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. To avoid limitations of liver biopsy and MRI, quantitative ultrasound has become a research focus. Ultrasound-derived fat fraction (UDFF) is based on a combination of backscatter coefficient and attenuation parameter.

Objective

The objectives of the study were to determine (1) agreement between UDFF/MRI proton density fat fraction (MR-PDFF) and (2) whether BMI and age are predictive for UDFF.

Materials and methods

This cross-sectional prospective study included a convenience sample of 46 children referred for clinically indicated abdominal MRI. MR-PDFF and five acquisitions of UDFF were collected. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to assess agreement between MR-PDFF and UDFF. Receiver operating characteristic curves were calculated for UDFF prediction of liver steatosis (MR-PDFF ≥ 6%). Multivariable regression was performed to assess BMI and age as predictors for UDFF.

Results

Twenty-two participants were male, 24 were female, and the mean age was 14 ± 3 (range: 7-18) years. Thirty-six out of 46 participants had normal liver fat fraction <6%, and 10/46 had liver steatosis. UDFF was positively associated with MR-PDFF (ICC 0.92 (95% CI, 0.89-0.96). The mean bias between UDFF and MR-PDFF was 0.64% (95% LOA, -5.3-6.6%). AUROC of UDFF for steatosis was of 0.95 (95% CI, 0.89-0.99). UDFF cutoff of 6% had a sensitivity of 90% (95% CI, 55-99%) and a specificity of 94% (95% CI, 81-0.99%). BMI was an independent predictor of UDFF (correlation: 0.55 (95% CI, 0.35-0.95)).

Conclusions

UDFF shows strong agreement with MR-PDFF in children. A UDFF cutoff of 6% provides good sensitivity and specificity for detection of MR-PDFF of ≥ 6%.

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Data availability

The data that support the findings of this study are not openly available due to reasons of individuals’ privacy and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Stanford University.

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Authors and Affiliations

  1. Department of Radiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA

    Max Zalcman, Richard A. Barth & Erika Rubesova

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  1. Max Zalcman
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  2. Richard A. Barth
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Correspondence to Max Zalcman.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Stanford University (Date: 30/06/2020/No. IRB-46543).

Conflicts of interest

Max Zalcman has received partial financial research support from the Belgian American Educational Foundation (B.A.E.F.) to conduct this study. No funds, grants, or other support was received by Richard Barth and Erika Rubesova. The authors declare they have no financial interests.

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Zalcman, M., Barth, R.A. & Rubesova, E. Real-time ultrasound-derived fat fraction in pediatric population: feasibility validation with MR-PDFF. Pediatr Radiol 53, 2466–2475 (2023). https://doi.org/10.1007/s00247-023-05752-0

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