Di Martino M, Pacifico L, Bezzi M, Di Miscio R, Sacconi B, Chiesa C, Catalano C. Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents. World J Gastroenterol 2016; 22(39): 8812-8819 [PMID: 27818597 DOI: 10.3748/wjg.v22.i39.8812]
Corresponding Author of This Article
Michele Di Martino, PhD, MD, Department of Radiological Sciences, Oncology and Anatomical Pathology, “Sapienza” University of Rome, V.le Regina Elena 324, 00161 Roma, Italy. micdimartino@hotmail.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 21, 2016; 22(39): 8812-8819 Published online Oct 21, 2016. doi: 10.3748/wjg.v22.i39.8812
Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents
Michele Di Martino, Lucia Pacifico, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Claudio Chiesa, Carlo Catalano
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, “Sapienza” University of Rome, 00161 Rome, Italy
Lucia Pacifico, Department of Pediatrics and Child Neuropsychiatry, “Sapienza” University of Rome, 00161 Rome, Italy
Claudio Chiesa, Institute of Translational Pharmacology, National Research Council, 00133 Rome, Italy
Author contributions: Di Martino M and Pacifico L contributed to study conception and design; Di Miscio R and Sacconi B contributed to data acquisition; Di Martino M, Pacifico L and Bezzi M contributed to data analysis and interpretation, and writing of article; Bezzi M, Chiesa C and Catalano C contributed to editing, reviewing and final approval of article.
Institutional review board statement: The study was reviewed and approved by the “Sapienza” University of Rome Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Nothing to disclosure.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michele Di Martino, PhD, MD, Department of Radiological Sciences, Oncology and Anatomical Pathology, “Sapienza” University of Rome, V.le Regina Elena 324, 00161 Roma, Italy. micdimartino@hotmail.it
Telephone: +39-6-49974511 Fax: +39-6-490243
Received: May 4, 2016 Peer-review started: May 5, 2016 First decision: May 27, 2016 Revised: June 30, 2016 Accepted: July 31, 2016 Article in press: July 31, 2016 Published online: October 21, 2016 Processing time: 168 Days and 21.4 Hours
Abstract
AIM
To establish a threshold value for liver fat content between healthy children and those with non-alcoholic fatty liver disease (NAFLD) by using magnetic resonance imaging (MRI), with liver biopsy serving as a reference standard.
METHODS
The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel point-resolved ¹H MR-Spectroscopy (¹H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Lin coefficient test was used to evaluate the correlation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables.
RESULTS
According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.
CONCLUSION
MRS is an accurate and precise method for detecting NAFLD in children.
Core tip: Differentiating normal from pathologic liver fat storage in children could depend on technical measurements. Using MR-spectroscopy, a cut-off value of 6% demonstrates the best diagnostic performance, otherwise magnetic resonance imaging (MRI)-PDFF cut-off value of 3.5% better discriminates normal weight from obese children. It is confirmed that MRS is an accurate and precise method for detecting non-alcoholic fatty liver disease in children. However, MRI-PDFF- is a feasible alternative to MRS for quantifying liver steatosis.
