Noninvasive assessment of liver steatosis in children: The clinical value of controlled attenuation parameter

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Abstract

Background: To assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology. Methods: Consecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson's or Spearman's rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology. Results: Three hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3%) children by US and in 77/289 (26.6%) by CAP. A moderate to good correlation was detected between CAP and BMI (r=0.53), FLI (r=0.55) and HSI (r=0.56). In obese children a moderate to good correlation between CAP and insulin levels (r=0.54) and HOMA-IR (r=0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64-0.79]; specificity, 0.98 [0.97-0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42-0.50]; specificity, 0.91 [0.89-0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73-0.77]; specificity, 0.57 [0.55-0.60]) and FLI or HSI. Conclusions: For the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249dB/m rules in liver steatosis with a very high specificity.

Original languageEnglish
Article number61
JournalBMC Gastroenterology
Volume17
Issue number1
DOIs
Publication statusPublished - May 4 2017

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Fatty Liver
Body Mass Index
Liver
Minor Surgical Procedures
Touch
Paris
Nonparametric Statistics
France
Obesity
Insulin
Pediatrics
Equipment and Supplies

Keywords

  • Controlled attenuation parameter
  • Liver steatosis
  • NAFLD
  • Obesity
  • Pediatric series
  • Transient elastography
  • Ultrasound

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{f6631e09072741bca18e80ce7545d466,
title = "Noninvasive assessment of liver steatosis in children: The clinical value of controlled attenuation parameter",
abstract = "Background: To assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology. Methods: Consecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson's or Spearman's rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology. Results: Three hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3{\%}) children by US and in 77/289 (26.6{\%}) by CAP. A moderate to good correlation was detected between CAP and BMI (r=0.53), FLI (r=0.55) and HSI (r=0.56). In obese children a moderate to good correlation between CAP and insulin levels (r=0.54) and HOMA-IR (r=0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64-0.79]; specificity, 0.98 [0.97-0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42-0.50]; specificity, 0.91 [0.89-0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73-0.77]; specificity, 0.57 [0.55-0.60]) and FLI or HSI. Conclusions: For the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249dB/m rules in liver steatosis with a very high specificity.",
keywords = "Controlled attenuation parameter, Liver steatosis, NAFLD, Obesity, Pediatric series, Transient elastography, Ultrasound",
author = "Giovanna Ferraioli and Valeria Calcaterra and Raffaella Lissandrin and Marinella Guazzotti and Laura Maiocchi and Carmine Tinelli and {De Silvestri}, Annalisa and Corrado Regalbuto and Gloria Pelizzo and Daniela Larizza and Carlo Filice",
year = "2017",
month = "5",
day = "4",
doi = "10.1186/s12876-017-0617-6",
language = "English",
volume = "17",
journal = "BMC Gastroenterology",
issn = "1471-230X",
publisher = "BioMed Central Ltd.",
number = "1",

}

TY - JOUR

T1 - Noninvasive assessment of liver steatosis in children

T2 - The clinical value of controlled attenuation parameter

AU - Ferraioli, Giovanna

AU - Calcaterra, Valeria

AU - Lissandrin, Raffaella

AU - Guazzotti, Marinella

AU - Maiocchi, Laura

AU - Tinelli, Carmine

AU - De Silvestri, Annalisa

AU - Regalbuto, Corrado

AU - Pelizzo, Gloria

AU - Larizza, Daniela

AU - Filice, Carlo

PY - 2017/5/4

Y1 - 2017/5/4

N2 - Background: To assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology. Methods: Consecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson's or Spearman's rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology. Results: Three hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3%) children by US and in 77/289 (26.6%) by CAP. A moderate to good correlation was detected between CAP and BMI (r=0.53), FLI (r=0.55) and HSI (r=0.56). In obese children a moderate to good correlation between CAP and insulin levels (r=0.54) and HOMA-IR (r=0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64-0.79]; specificity, 0.98 [0.97-0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42-0.50]; specificity, 0.91 [0.89-0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73-0.77]; specificity, 0.57 [0.55-0.60]) and FLI or HSI. Conclusions: For the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249dB/m rules in liver steatosis with a very high specificity.

AB - Background: To assess the clinical validity of controlled attenuation parameter (CAP) in the diagnosis of hepatic steatosis in a series of overweight or obese children by using the imperfect gold standard methodology. Methods: Consecutive children referred to our institution for auxological evaluation or obesity or minor elective surgery were prospectively enrolled. Anthropometric and biochemical parameters were recorded. Ultrasound (US) assessment of steatosis was carried out using ultrasound systems. CAP was obtained with the FibroScan 502 Touch device (Echosens, Paris, France). Pearson's or Spearman's rank correlation coefficient were used to test the association between two study variables. Optimal cutoff of CAP for detecting steatosis was 249dB/m. The diagnostic performance of dichotomized CAP, US, body mass indexes (BMI), fatty liver index (FLI) and hepatic steatosis index (HSI) was analyzed using the imperfect gold standard methodology. Results: Three hundred five pediatric patients were enrolled. The data of both US and CAP were available for 289 children. Steatosis was detected in 50/289 (17.3%) children by US and in 77/289 (26.6%) by CAP. A moderate to good correlation was detected between CAP and BMI (r=0.53), FLI (r=0.55) and HSI (r=0.56). In obese children a moderate to good correlation between CAP and insulin levels (r=0.54) and HOMA-IR (r=0.54) was also found. Dichotomized CAP showed a performance of 0.70 (sensitivity, 0.72 [0.64-0.79]; specificity, 0.98 [0.97-0.98], which was better than that of US (performance, 0.37; sensitivity, 0.46 [0.42-0.50]; specificity, 0.91 [0.89-0.92]), BMI (performance, 0.22; sensitivity, 0.75 [0.73-0.77]; specificity, 0.57 [0.55-0.60]) and FLI or HSI. Conclusions: For the evaluation of liver steatosis in children CAP performs better than US, which is the most widely used imaging technique for screening patients with a suspicion of liver steatosis. A cutoff value of CAP of 249dB/m rules in liver steatosis with a very high specificity.

KW - Controlled attenuation parameter

KW - Liver steatosis

KW - NAFLD

KW - Obesity

KW - Pediatric series

KW - Transient elastography

KW - Ultrasound

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U2 - 10.1186/s12876-017-0617-6

DO - 10.1186/s12876-017-0617-6

M3 - Article

AN - SCOPUS:85019159744

VL - 17

JO - BMC Gastroenterology

JF - BMC Gastroenterology

SN - 1471-230X

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