https://pubmed.ncbi.nlm.nih.gov/40380181/ NAFLD

BMC Pediatr. 2025 May 16;25(1):390.
doi: 10.1186/s12887-025-05750-1.

Applicability of multiple quantitative ultrasound liver biomarkers in children and adolescents with severe obesity

Ivan Cetinic 1 2, Charlotte de Lange 3 4, Kerstin Lagerstrand 5 6, Jenny M Kindblom 7 8 9, Lovisa Sjögren 7 9, Hanna Hebelka 3 4
Affiliations expand
PMID: 40380181

PMCID: PMC12083147

DOI: 10.1186/s12887-025-05750-1
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Abstract

Background: Obesity is associated with chronic liver disease, which is why improved non-invasive diagnostic assessment of liver affection is desirable. The ultrasound-based biomarkers Attenuation Imaging coefficient (ATI), Shear Wave Elastography (SWE), and Shear Wave Dispersion (SWD) have the potential to assess liver steatosis, fibrosis and inflammation/oedema respectively. The aim was therefore to evaluate the feasibility of applying ultrasound-based liver biomarkers in children and adolescents with severe obesity.

Methods: Ultrasound was performed, before treatment, in 56 patients with childhood obesity (< 18 years) referred for bariatric surgery or treatment with glucagon-like peptide-1 receptor agonists. An ultrasound visualisation score (A: no limitations - D: severe limitations) was used. ATI, SWE and SWD were measured, irrespective of visualisation score, and compared to clinical data, serological measures and depth of measurement. Scan-rescan reproducibility measurements were performed, both for continuous measures using intraclass correlation coefficient (ICC) and for kappa coefficient using proposed reference thresholds for elevated/pathological values in children during fasting and free-breathing: > ATI 0.56 dB/cm/MHz, > SWE 4.9 kPa and > SWD 11.9 (m/s)/kHz.

Results: The median (min-max) age of the 56 patients (51.8% male) was 16.2 years (9.9; 18) and the median BMI standard deviation score (SDS) was 4.4 (2.7; 7.3). The distribution of the visibility score was A 5.5%, B 50%, C 41% and D 3.5%. The median (min-max) ATI, SWE and SWD values were 0.58 dB/cm/MHz (0.32; 0.97), 7.2 kPa (4.3; 19.6) and 14.3 (m/s)/kHz (8.9; 24.3) respectively. Both ATI (β = -4.2; r2 = 0.3; p < 0.0001) and SWD (β = 0.14; r2 = 0.17; p = 0.0033) were influenced by depth of measurement. A weak association was found between ATI and serum triglycerides (β = 0.07; r2 = 0.12; p = 0.015). SWE was associated with BMI-SDS (β = 0.71; r2 = 0.09; p = 0.035). No other significant associations were found. ICC was moderate for ATI (0.61), fair for SWE (0.46) and fair for SWD (0.51). Kappa coefficient was substantial for ATI (0.77), excellent for SWE (1.0) and moderate for SWD (0.53).

Conclusion: When accounting for visualization score, multiple ultrasound liver biomarkers appear applicable in most children and adolescents with severe obesity. Median ATI, SWE and SWD values were all increased, compared to currently known paediatric normal values. However, median ATI was likely underestimated due to depth dependence of measurement. Although caution is advised in clinical decision-making due to fair-moderate reproducibility between scans, most importantly, the biomarkers appear capable of differentiating between non-affected and affected liver in children with severe obesity.