Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.