Abstract
Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents, and its prevalence increases with obesity. Magnetic resonance imaging (MRI) and transient elastography (TE) have been widely used to non-invasively evaluate NAFLD in adults. This study aimed to determine the efficacy and accuracy of MRI-proton density fat fraction (MRI-PDFF) and TE-controlled attenuation parameter (TE-CAP) in distinguishing hepatic steatosis in children and adolescents.Materials and Methods: In this meta-analysis, the PubMed, Cochrane Library, Embase, Medline, and Web of Science databases were searched for articles that reported studies on the accuracy of MRI-PDFF or TE-CAP in grading the steatosis in children and adolescents with NAFLD. This study compared the sensitivity, specificity, and hierarchical summary receiver operating characteristic curves (HSROCs) of MRI-PDFF and TE-CAP in distinguishing between steatosis grades S0 and S1–3.Results: A total of eight articles involving 874 children and adolescents with NAFLD were included in this study. The proportions of steatosis grades were 5 and 95% for S0 and S1–3, respectively. MRI-PDFF accurately diagnosed S1–3 steatosis, with a summary sensitivity of 0.95 (95% CI, 0.92–0.97), specificity of 0.92 (95% CI, 0.77–0.98), and HSROC of 0.96 (95% CI, 0.94–0.98). Likewise, TE-CAP accurately diagnosed S1–3 steatosis, with a summary sensitivity of 0.86 (95% CI, 0.70–0.94), specificity of 0.88 (95% CI, 0.71–0.96), and HSROC of 0.94 (95% CI, 0.91–0.95). Following a “positive” measurement (over the threshold value) for S1–3, the corresponding post-test probabilities of MRI-PDFF and TE-CAP for the presence of steatosis reached 92 and 88%, respectively, at the pretest probability of 50%. When the values were below the mentioned threshold values (“negative” results), the post-test probabilities of MRI-PDFF and TE-CAP became 5 and 13%, respectively.Conclusion: Both MRI-PDFF and TE-CAP are highly accurate non-invasive methods to grade the hepatic steatosis in children and adolescents with NAFLD. Furthermore, MRI-PDFF is significantly more accurate in assessing steatosis grade than TE-CAP.Systematic Review Registration: PROSPERO, identifier: CRD42021220422.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease in children and adolescents and the second most common cause of liver transplantation [1]
The criteria for the inclusion of articles were the following: (a) the article evaluated the accuracy of MRIPDFF or transient elastography (TE)-controlled attenuation parameter (CAP), in comparison with histological assessment, magnetic resonance spectroscopy (MRS)-PDFF, or any other detection method as the reference, in diagnosing the Hepatic steatosis (HS) in children and adolescents with NAFLD; (b) the article provided sufficient information to construct a 2 × 2 contingency table and reported the rates of true and false positives and negatives; (c) the article included ≥20 patients to obtain good reliability; and (d) the article was published in English
It was found that four articles used Magnetic resonance imaging (MRI)-PDFF [24,25,26,27], and four used TE-controlled attenuation parameter (TE-CAP) [9, 19, 22, 23]
Summary
Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease in children and adolescents and the second most common cause of liver transplantation [1]. Worldwide, ∼2.6–11.3% of children and adolescents, and ∼40–70% of obese children and adolescents have been reported to be diagnosed with NAFLD [1] It is the leading cause of liver disease among children in China [2, 3]. Hepatic steatosis (HS) refers to an essential histological hallmark of NAFLD. It represents the first stage of hepatic disease and results from the accumulation of excessive intrahepatocellular fat [4]. Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adolescents, and its prevalence increases with obesity. This study aimed to determine the efficacy and accuracy of MRI-proton density fat fraction (MRI-PDFF) and TE-controlled attenuation parameter (TE-CAP) in distinguishing hepatic steatosis in children and adolescents
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