Diagnostic accuracy of transient elastography in hepatosteatosis in youth with obesity

Authors: TAS, EMIR - University Of Pittsburgh Medical Center; SUNDARARAJAN, DIVYA - University Of Colorado; LO, JACLYNS - University Of Colorado; MORELLI, NAZEEN - University Of Colorado; GARCIA-REYES, YESENIA - University Of Colorado; WARE, MEREDITH - University Of Colorado; RAHAT, HASEEB RAHAT - University Of Colorado; OU, XIAWEI - Arkansas Children'S Nutrition Research Center (ACNC); NA, XIAOXU - University Arkansas For Medical Sciences (UAMS); SUNDARAM, SHIKHA - University Of Colorado

Submitted to: Journal of Endocrine Society
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/31/2024
Publication Date: 6/11/2024
Citation: Tas, E., Sundararajan, D., Lo, J.S., Morelli, N., Garcia-Reyes, Y., Ware, M.A., Rahat, H., Ou, X., Na, X., Sundaram, S. 2024. Diagnostic accuracy of transient elastography in hepatosteatosis in youth with obesity. Journal of Endocrine Society. 8(7). Article bvae110. https://doi.org/10.1210/jendso/bvae110.
DOI: https://doi.org/10.1210/jendso/bvae110

Interpretive Summary: Steatotic liver disease, which involves excess fat in the liver, is common in children with obesity but often goes unnoticed. Diagnosing it usually requires invasive or costly methods. We aimed to check how accurate a less invasive method, vibration-controlled transient elastography (VCTE), is compared to the more expensive magnetic resonance imaging (MRI) in diagnosing liver fat in teenagers with obesity. We used data from three clinical trials that included obese teenagers. To measure liver fat, we used MRI and VCTE-based (CAP) data. We defined liver fat disease as having a fat fraction of 5% or more in theliver as measured by MRI. We calculated how well CAP could diagnose liver fat compared to MRI and found the best CAP value for diagnosing liver fat. We analyzed data from 82 teenagers (average age 15.6 years, 81% females). Fifty of these teenagers had liver fat disease according to MRI, while 32 did not. The liver fat group had a higher average CAP value compared to those without liver fat disease. A CAP value of 281 dB/m was best for diagnosing liver fat. We found that teenagers with polycystic ovarian syndrome may need a higher CAP value for accurate diagnosis, indicating that other health conditions can influence the optimal CAP value for diagnosing liver fat.

Technical Abstract: Background Steatotic liver disease is common but overlooked in childhood obesity; diagnostic methods are invasive or expensive. We sought to determine the diagnostic accuracy of vibration-controlled transient elastography (VCTE) compared to magnetic resonance imaging (MRI) in adolescents with obesity and high risk for hepatosteatosis. Methods Baseline data in three clinical trials enrolling adolescents with obesity were included (NCT03919929, NCT03717935, NCT04342390). Liver fat was assessed using MRI fat-fraction and VCTE-based controlled attenuation parameter (CAP). Hepatosteatosis was defined as MRI fat-fraction = 5.0%. The area under the receiver-operating characteristic curves (AUROC) for CAP against MRI was calculated, and optimal CAP using the Youden index for hepatosteatosis diagnosis was determined. Results Data from 82 adolescents (age 15.6±1.4 years, BMI 36.5±5.9 kg/m2, 81% female) were included. Fifty youth had hepatosteatosis by MRI (Fat-Fraction 9.3% [6.7,14.0]), and 32 participants did not have hepatosteatosis (Fat-Fraction 3.1% [2.2, 3.9]; p<0.001). The hepatosteatosis group had higher mean CAP compared to no-hepatosteatosis (293 dB/m [267, 325] vs. 267 dB/m [248, 282]; p=0.0120). A CAP of 281 dB/m had the highest sensitivity (60%) and specificity (74%) with AUROC of 0.649 (95%CI:0.51-0.79; p=0.04) in the entire cohort. In a subset of participants with polycystic ovary syndrome (PCOS), a CAP of 306 dB/m had the highest sensitivity (78%) and specificity (52%) and AUROC of 0.678 (95%CI:0.45-0.90; p=0.108). Conclusions CAP of 281 dB/m has modest diagnostic performance for hepatosteatosis compared to MRI in youth with significant obesity. A higher CAP in youth with PCOS suggests that comorbidities might affect optimal CAP in hepatosteatosis diagnosis.