Quantitative ultrasound envelope statistics imaging as a screening approach for pediatric hepatic steatosis and liver fibrosis: using biomarker and transient elastography as reference standards

Chiao-Shan Hsieh; Ming-Wei Lai; Chien-Chang Chen; Hsun-Chin Chao; Chiao-Yin Wang; Yung-Liang Wan; Zhuhuang Zhou; Po-Hsiang Tsui

doi:10.1016/j.heliyon.2023.e22743

Quantitative ultrasound envelope statistics imaging as a screening approach for pediatric hepatic steatosis and liver fibrosis: using biomarker and transient elastography as reference standards

Heliyon. 2023 Nov 23;9(12):e22743. doi: 10.1016/j.heliyon.2023.e22743. eCollection 2023 Dec.

Authors

Chiao-Shan Hsieh¹, Ming-Wei Lai^{2

3}, Chien-Chang Chen², Hsun-Chin Chao², Chiao-Yin Wang⁴, Yung-Liang Wan^{4

5}, Zhuhuang Zhou⁶, Po-Hsiang Tsui^{2

3

4}

Affiliations

¹ Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.
² Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Liver Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴ Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁶ Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.

Abstract

Quantitative ultrasound (QUS) envelope statistics imaging is an emerging technique for the assessment of hepatic steatosis in adults. Blood tests are currently recommended as the screening tool for pediatric hepatic steatosis, a condition that can lead to liver fibrosis in children. This study examined the utility of QUS envelope statistics imaging in grading biomarker-diagnosed hepatic steatosis and detecting liver fibrosis in a pediatric population. A total of 173 subjects was enrolled (Group A) for QUS envelope statistics imaging using two statistical distributions, Nakagami and homodyned K (HK) models, and information entropy. QUS parameter values were compared with the hepatic steatosis index (HSI) and steatosis grade (G0: HSI <30; G1: 30 ≤ HSI <36; G2: 36 ≤ HSI <41.6; G3: ≥41.6). An additional cohort of 63 subjects (Group B) was recruited to undergo both QUS envelope statistics imaging and liver stiffness measurements (LSM) obtained from the transient elastography (Fibroscan), with a cutoff value set at 5 kPa to indicate liver fibrosis. The diagnostic performances were evaluated using the area under the receiver operating characteristic curve (AUROC). QUS envelope statistics imaging generated the AUROC values for steatosis grading at levels ≥ G1, ≥ G2, and ≥ G3 ranged from 0.94 to 0.97, 0.91 to 0.93, and 0.83 to 0.87, respectively, and produced an AUROC range of between 0.82 and 0.84 for identifying liver fibrosis. QUS envelope statistics imaging integrates the benefits of both biomarkers and elastography, enabling the screening of hepatic steatosis and detection of liver fibrosis in a pediatric population.

Keywords: Children; Fibrosis; Liver; Steatosis; Ultrasound.