Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2015 Jun;61(6):1887-95.
doi: 10.1002/hep.27666. Epub 2015 Feb 5.

Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease

Jeffrey B Schwimmer  1   2   3 , Michael S Middleton  3 , Cynthia Behling  1   4 , Kimberly P Newton  1   2 , Hannah I Awai  1   2   3 , Melissa N Paiz  1 , Jessica Lam  3   5 , Jonathan C Hooker  3 , Gavin Hamilton  3 , John Fontanesi  6   7   8 , Claude B Sirlin  3
Affiliations
Clinical Trial

Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease

Jeffrey B Schwimmer et al. Hepatology. 2015 Jun.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. In order to advance the field of NAFLD, noninvasive imaging methods for measuring liver fat are needed. Advanced magnetic resonance imaging (MRI) has shown great promise for the quantitative assessment of hepatic steatosis but has not been validated in children. Therefore, this study was designed to evaluate the correlation and diagnostic accuracy of MRI-estimated liver proton density fat fraction (PDFF), a biomarker for hepatic steatosis, compared to histologic steatosis grade in children. The study included 174 children with a mean age of 14.0 years. Liver PDFF estimated by MRI was significantly (P < 0.01) correlated (0.725) with steatosis grade. The correlation of MRI-estimated liver PDFF and steatosis grade was influenced by both sex and fibrosis stage. The correlation was significantly (P < 0.01) stronger in girls (0.86) than in boys (0.70). The correlation was significantly (P < 0.01) weaker in children with stage 2-4 fibrosis (0.61) than children with no fibrosis (0.76) or stage 1 fibrosis (0.78). The diagnostic accuracy of commonly used threshold values to distinguish between no steatosis and mild steatosis ranged from 0.69 to 0.82. The overall accuracy of predicting the histologic steatosis grade from MRI-estimated liver PDFF was 56%. No single threshold had sufficient sensitivity and specificity to be considered diagnostic for an individual child.

Conclusions: Advanced magnitude-based MRI can be used to estimate liver PDFF in children, and those PDFF values correlate well with steatosis grade by liver histology. Thus, magnitude-based MRI has the potential for clinical utility in the evaluation of NAFLD, but at this time no single threshold value has sufficient accuracy to be considered diagnostic for an individual child.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Magnetic resonance imaging-estimated liver proton density fat fraction parametric maps are shown for individual children in each of the four histologically-determined steatosis grades
Figure 2
Figure 2
Box and whiskers plot of magnetic resonance imaging-estimated liver proton density fat fraction by histologic steatosis grade. Box shows median and interquartile range, lines show minimum and maximum.
Figure 3
Figure 3
Heat map shows the probability of a given magnetic resonance imaging-estimated liver proton density fat fraction corresponding to a histologic steatosis grade of 0, 1, 2, or 3.
Figure 4
Figure 4
Receiver operating characteristic curves for each of 4 published cutoff points to separate between histologic steatosis grades of 0 and 1.
See this image and copyright information in PMC

Comment in

References

    1. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of fatty liver in children and adolescents. Pediatrics. 2006;118:1388–1393. - PubMed
    1. Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, Benson JT, Enders FB, Angulo P. The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009;58:1538–1544. - PMC - PubMed
    1. Alexander J, Torbenson M, Wu TT, Yeh MM. Non-alcoholic fatty liver disease contributes to hepatocarcinogenesis in non-cirrhotic liver: a clinical and pathological study. J Gastroenterol Hepatol. 2013;28:848–854. - PubMed
    1. Schwimmer JB, Pardee PE, Lavine JE, Blumkin AK, Cook S. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation. 2008;118:277–283. - PMC - PubMed
    1. Rubinstein E, Lavine JE, Schwimmer JB. Hepatic, cardiovascular, and endocrine outcomes of the histological subphenotypes of nonalcoholic fatty liver disease. Semin Liver Dis. 2008;28:380–385. - PubMed

Publication types