ESPE Abstracts

Background: Transient elastography (TE) uses pulsed echo ultrasound to measure the hardness of the liver, showing excellent accuracy in the assessment of fibrosis, and is considered a useful test in nonalcoholic fatty liver disease (NAFLD). Ultrasound fatty liver indicator (US-FLI) is proposed as a non-invasive, semi-quantitative method for predicting hepatitis in children with NAFLD and may reflect the severity of liver histological changes. US-FLI ≥4 or 6 has been suggested as a predictive finding for NASH. These non-invasive imaging tests have been proposed to predict the diagnosis of NASH as an alternative to liver biopsy.

Objects: This study aimed to investigate the relationship between US-FLI and TE, which indicate the severity of NAFLD.

Methods: We enrolled 87 participants aged 11.42±2.19 years who were diagnosed with fatty liver on ultrasound. US-FLI is a scoring system ranging from 2-8, assessing the following items: liver/kidney contrast, posterior attenuation of ultrasound beam, difficulty visualizing the gallbladder wall, vessel blurring, difficult visualization of the diaphragm and areas of focal sparing. NAFLD is diagnosed with a minimum score of ≥2. TE was used to evaluate liver fibrosis in terms of liver stiffness measurement (LSM). The association between US-FLI and TE was analyzed by dividing into two groups using US-FLI ≥4 and ≥6 as predictive findings for NASH.

Results: The TE was significantly correlated in both NASH groups by US-FLI ≥4(r=0.251, P<0.019) and ≥6(r=0.376, P<0.001). As a result of univariate logistic regression analysis, TE was significantly associated with NASH diagnosed by US-FLI ≥4(OR 1.927; P=0.028) and ≥6(OR 3.277; P=0.003). In the receiver operating characteristic analysis, the TE showed good performance in detecting NASH diagnosed by US-FLI, with area under the curve [AUC] of 0.674(P=0.015) in NASH by US-FLI ≥4 and AUC of 0.794(P=0.004) in NASH by US-FLI ≥6.

Conclusions: TE is significantly associated with US-FLI in pediatric NASH. TE and US-FLI are expected to complement each other in the evaluation of the severity of NAFLD, and further studies are needed.