Title: Quantitative ultrasound-derived fat fraction for identifying pediatric patients with metabolic dysfunction-associated steatotic liver disease: a prospective study
Source: Pediatric Radiology 2025, Aug 1. [E–publication]
Date of publication: August 2025
Publication type: Prospective cohort study
Abstract: Background: Metabolic dysfunction-associated steatotic liver disease is increasingly affecting younger populations. Ultrasound-derived fat fraction is a technique used in ultrasound to quantify liver fat content. The diagnostic performance of ultrasound-derived fat fraction in pediatric patients with metabolic dysfunction-associated steatotic liver disease is yet to be evaluated.
Objective: To evaluate the diagnostic performance of ultrasound-derived fat fraction measurement in detecting and grading hepatic steatosis in pediatric patients with metabolic dysfunction-associated steatotic liver disease.
Materials and methods: In this prospective study, pediatric patients diagnosed with metabolic dysfunction-associated steatotic liver disease were enrolled. Six acquisitions of ultrasound-derived fat fraction were obtained. Taking magnetic resonance imaging (MRI)-proton density fat fraction as a reference standard, the area under the receiver operating characteristic curve (AUC) was performed to evaluate the diagnostic performance of ultrasound-derived fat fraction. Youden index was used to determine the cutoff value of ultrasound-derived fat fraction. Correlation coefficient and Bland-Altman plot were performed.
Results: From April 2024 to March 2025, 32 patients (median age, 12 years; median body mass index, 29.7 kg/m2) were included. The ultrasound-derived fat fraction values showed a positive correlation with MRI-proton density fat fraction (r = 0.72). The ultrasound-derived fat fraction values and MRI-proton density fat fraction had a mean bias of 3.3% (95% limits of agreement: -16.4, 23.1). Using MRI-proton density fat fractions ≥ 5%, ≥ 15%, and ≥ 25% as the reference standard for diagnosing hepatic steatosis grade ≥ S1, ≥ S2, and S3, the AUCs of ultrasound-derived fat fraction were 0.84, 0.88, and 0.88, with the cutoff values of 9.5%, 10.5%, and 12.8%, respectively.
Conclusion: Ultrasound-derived fat fraction demonstrates promising diagnostic performance for detecting and grading hepatic steatosis in pediatric patients with metabolic dysfunction-associated steatotic liver disease within this cohort.
