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. 2022 Jul 11:10:837116.
doi: 10.3389/fped.2022.837116. eCollection 2022.

Performance of Imaging Techniques in Non-invasive Diagnosis of Non-alcoholic Fatty Liver Disease in Children: A Systematic Review and Meta-Analysis

Qun Yu  1   2 , Yiwei Liu  1   2 , Peipei Hu  1 , Feng Gao  1 , Guoqing Huang  1
Affiliations

Performance of Imaging Techniques in Non-invasive Diagnosis of Non-alcoholic Fatty Liver Disease in Children: A Systematic Review and Meta-Analysis

Qun Yu et al. Front Pediatr. .

Abstract

Background and aim: Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in children. With the continuous emergence of various non-invasive diagnostic methods, imaging techniques have always been considered as potential alternative methods to liver biopsy. This study aimed to evaluate the diagnostic performance of imaging techniques so as to search for the most promising technology.

Methods: We searched English and Chinese databases. English databases included Cochran library, Embase, PubMed, and Web of Science, while Chinese databases included the Wanfang database and China National Knowledge Internet.

Results: Finally, 11 articles were included (12 studies, one of which included studies on both fibrosis and steatosis). Further, 26.2% of the participants had mild steatosis, 34.1% had moderate steatosis, and 34.9% had severe steatosis. Also, 64.0% had any fibrosis, 29.1% had significant fibrosis, 13.8% had advanced fibrosis, and 2.8% had cirrhosis. Irrespective of the grade of fibrosis, transient elastography (TE) had higher sensitivity (97-100%), whereas magnetic resonance elastography (MRE) had the lowest sensitivity (58-63%). The pooled sensitivity and specificity of imaging techniques in diagnosing steatosis were 89% (95% CI, 71-96) and 89% (95% CI, 72-96), and AUROC 0.95 (95% CI, 93-97), multifrequency magnetic resonance elastography-hepatic fat fraction (mMRE-HFF) had the highest sensitivity (87%, 95% CI 77-97), ultrasonography (US) had the lowest specificity (96%, 95% CI 92-98%).

Conclusion: Imaging techniques have a good diagnostic performance for children with NAFLD, especially the diagnosis of liver fibrosis based on ultrasound or magnetic resonance elastography. Compared with different imaging techniques, TE has the best performance in diagnosing significant fibrosis. Liver stiffness measurement (LSM) is expected to become a biological indicator for routine screening, dynamic monitoring of disease changes, and prognostic evaluation.

Keywords: children; elastography; imaging techniques; non-alcoholic fatty liver disease; non-invasive diagnosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study selection process.
FIGURE 2
FIGURE 2
Quality assessment per study.
FIGURE 3
FIGURE 3
Summary of quality assessment.
FIGURE 4
FIGURE 4
Publication bias.
FIGURE 5
FIGURE 5
Sensitivity and specificity of elastography in the diagnosis of any fibrosis.
FIGURE 6
FIGURE 6
Summary ROC curve of diagnostic performance of elastography for any fibrosis.
FIGURE 7
FIGURE 7
Sensitivity and specificity of elastography in the diagnosis of significant fibrosis.
FIGURE 8
FIGURE 8
Summary ROC curve of diagnostic performance of elastography for significant fibrosis.
FIGURE 9
FIGURE 9
Sensitivity and specificity of elastography in the diagnosis of advanced fibrosis.
FIGURE 10
FIGURE 10
Summary ROC curve of diagnostic performance of elastography for advanced fibrosis.
FIGURE 11
FIGURE 11
Sensitivity and specificity of imaging techniques for the diagnosis of steatosis.
FIGURE 12
FIGURE 12
Summary ROC curve of diagnostic performance of image techniques for steatosis.
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References

    1. Sharma V, Coleman S, Nixon J, Sharples L, Hamilton-Shield J, Rutter H, et al. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev. (2019) 20:1341–9. 10.1111/obr.12904 - DOI - PMC - PubMed
    1. Dong Y, Jan C, Ma Y, Dong B, Zou Z, Yang Y, et al. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys. Lancet Diabetes Endocrinol. (2019) 7:288–99. 10.1016/s2213-8587(19)30075-0 - DOI - PubMed
    1. Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128⋅9 million children, adolescents, and adults. Lancet. (2017) 390:2627–42. 10.1016/s0140-6736(17)32129-3 - DOI - PMC - PubMed
    1. Mandelia C, Kabbany MN, Conjeevaram Selvakumar PK, Alkhouri N. The search for noninvasive methods to identify liver fibrosis in children with nonalcoholic fatty liver disease. Biomark Med. (2018) 12:265–73. 10.2217/bmm-2017-0038 - DOI - PubMed
    1. Nobili V, Alisi A, Valenti L, Miele L, Feldstein AE, Alkhouri N. NAFLD in children: new genes, new diagnostic modalities and new drugs. Nat Rev Gastroenterol Hepatol. (2019) 16:517–30. 10.1038/s41575-019-0169-z - DOI - PubMed

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