Jurgen H Runge1, Jet van Giessen1, Laura G Draijer2,3,4, Eline E Deurloo1, Anne M J B Smets1, Marc A Benninga5, Bart G P Koot5, Jaap Stoker1. 1. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands. l.g.draijer@amsterdamumc.nl. 3. Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands. l.g.draijer@amsterdamumc.nl. 4. Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, The Netherlands. l.g.draijer@amsterdamumc.nl. 5. Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
OBJECTIVES: To determine the diagnostic accuracy of controlled attenuation parameter (CAP) on FibroScan® in detecting and grading steatosis in a screening setting and perform a head-to-head comparison with conventional B-mode ultrasound. METHODS: Sixty children with severe obesity (median BMI z-score 3.37; median age 13.7 years) were evaluated. All underwent CAP and US using a standardized scoring system. Magnetic resonance spectroscopy proton density fat fraction (MRS-PDFF) was used as a reference standard. RESULTS: Steatosis was present in 36/60 (60%) children. The areas under the ROC (AUROC) of CAP for the detection of grade ≥ S1, ≥ S2, and ≥ S3 steatosis were 0.80 (95% CI: 0.67-0.89), 0.77 (95% CI: 0.65-0.87), and 0.79 (95% CI: 0.66-0.88), respectively. The AUROC of US for the detection of grade ≥ S1 steatosis was 0.68 (95% CI: 0.55-0.80) and not significantly different from that of CAP (p = 0.09). For detecting ≥ S1 steatosis, using the optimal cutoffs, CAP (277 dB/m) and US (US steatosis score ≥ 2) had a sensitivity of 75% and 61% and a specificity of 75% and 71%, respectively. When using echogenicity of liver parenchyma as only the scoring item, US had a sensitivity of 70% and specificity of 46% to detect ≥ S1 steatosis. The difference in specificity of CAP and US when using only echogenicity of liver parenchyma of 29% was significant (p = 0.04). CONCLUSION: The overall performance of CAP is not significantly better than that of US in detecting steatosis in children with obesity, provided that the standardized scoring of US features is applied. When US is based on liver echogenicity only, CAP outperforms US in screening for any steatosis (≥ S1). KEY POINTS: • The areas under the ROC curves of CAP and ultrasound (US) for detecting grade ≥ S1 steatosis were 0.80 and 0.68, respectively, and were not significantly different (p = 0.09). • For detecting grade ≥ S1 steatosis in severely obese children, CAP had a sensitivity of 75% and a specificity of 75% at its optimal cutoff value of 277 dB/m. • For detecting grade ≥ S1 steatosis in clinical practice, both CAP and US can be used, provided that the standardized scoring of US images is used.
OBJECTIVES: To determine the diagnostic accuracy of controlled attenuation parameter (CAP) on FibroScan® in detecting and grading steatosis in a screening setting and perform a head-to-head comparison with conventional B-mode ultrasound. METHODS: Sixty children with severe obesity (median BMI z-score 3.37; median age 13.7 years) were evaluated. All underwent CAP and US using a standardized scoring system. Magnetic resonance spectroscopy proton density fat fraction (MRS-PDFF) was used as a reference standard. RESULTS:Steatosis was present in 36/60 (60%) children. The areas under the ROC (AUROC) of CAP for the detection of grade ≥ S1, ≥ S2, and ≥ S3 steatosis were 0.80 (95% CI: 0.67-0.89), 0.77 (95% CI: 0.65-0.87), and 0.79 (95% CI: 0.66-0.88), respectively. The AUROC of US for the detection of grade ≥ S1 steatosis was 0.68 (95% CI: 0.55-0.80) and not significantly different from that of CAP (p = 0.09). For detecting ≥ S1 steatosis, using the optimal cutoffs, CAP (277 dB/m) and US (US steatosis score ≥ 2) had a sensitivity of 75% and 61% and a specificity of 75% and 71%, respectively. When using echogenicity of liver parenchyma as only the scoring item, US had a sensitivity of 70% and specificity of 46% to detect ≥ S1 steatosis. The difference in specificity of CAP and US when using only echogenicity of liver parenchyma of 29% was significant (p = 0.04). CONCLUSION: The overall performance of CAP is not significantly better than that of US in detecting steatosis in children with obesity, provided that the standardized scoring of US features is applied. When US is based on liver echogenicity only, CAP outperforms US in screening for any steatosis (≥ S1). KEY POINTS: • The areas under the ROC curves of CAP and ultrasound (US) for detecting grade ≥ S1 steatosis were 0.80 and 0.68, respectively, and were not significantly different (p = 0.09). • For detecting grade ≥ S1 steatosis in severely obesechildren, CAP had a sensitivity of 75% and a specificity of 75% at its optimal cutoff value of 277 dB/m. • For detecting grade ≥ S1 steatosis in clinical practice, both CAP and US can be used, provided that the standardized scoring of US images is used.
Authors: Tania S Burgert; Sara E Taksali; James Dziura; T Robin Goodman; Catherine W Yeckel; Xenophon Papademetris; R Todd Constable; Ram Weiss; William V Tamborlane; Mary Savoye; Aisha A Seyal; Sonia Caprio Journal: J Clin Endocrinol Metab Date: 2006-08-15 Impact factor: 5.958
Authors: Anneloes E Bohte; Bart G P Koot; Olga H van der Baan-Slootweg; Jochem R van Werven; Shandra Bipat; Aart J Nederveen; Peter L M Jansen; Marc A Benninga; Jaap Stoker Journal: Radiology Date: 2011-11-21 Impact factor: 11.105
Authors: Jeffrey B Schwimmer; Michael S Middleton; Cynthia Behling; Kimberly P Newton; Hannah I Awai; Melissa N Paiz; Jessica Lam; Jonathan C Hooker; Gavin Hamilton; John Fontanesi; Claude B Sirlin Journal: Hepatology Date: 2015-02-05 Impact factor: 17.425
Authors: Thomas Karlas; David Petroff; Magali Sasso; Jian-Gao Fan; Yu-Qiang Mi; Victor de Lédinghen; Manoj Kumar; Monica Lupsor-Platon; Kwang-Hyub Han; Ana C Cardoso; Giovanna Ferraioli; Wah-Kheong Chan; Vincent Wai-Sun Wong; Robert P Myers; Kazuaki Chayama; Mireen Friedrich-Rust; Michel Beaugrand; Feng Shen; Jean-Baptiste Hiriart; Shiv K Sarin; Radu Badea; Kyu Sik Jung; Patrick Marcellin; Carlo Filice; Sanjiv Mahadeva; Grace Lai-Hung Wong; Pam Crotty; Keiichi Masaki; Joerg Bojunga; Pierre Bedossa; Volker Keim; Johannes Wiegand Journal: J Hepatol Date: 2016-12-28 Impact factor: 25.083
Authors: Peter J Eddowes; Magali Sasso; Michael Allison; Emmanouil Tsochatzis; Quentin M Anstee; David Sheridan; Indra N Guha; Jeremy F Cobbold; Jonathan J Deeks; Valérie Paradis; Pierre Bedossa; Philip N Newsome Journal: Gastroenterology Date: 2019-01-25 Impact factor: 22.682