Diagnostic Accuracy of Transient Elastography in Hepatosteatosis in Youth With Obesity

Emir Tas; Divya Sundararajan; Jaclyn S Lo; Nazeen Morelli; Yesenia Garcia-Reyes; Meredith A Ware; Haseeb Rahat; Xiawei Ou; Xiaoxu Na; Shikha Sundaram; Cameron Severn; Laura L Pyle; Elisabet Børsheim; Mary Ellen Vajravelu; Radhika Muzumdar; Jonathan A Dranoff; Melanie G Cree

doi:10.1210/jendso/bvae110

Diagnostic Accuracy of Transient Elastography in Hepatosteatosis in Youth With Obesity

J Endocr Soc. 2024 Jun 11;8(7):bvae110. doi: 10.1210/jendso/bvae110. eCollection 2024 May 23.

Authors

Emir Tas^{1

2}, Divya Sundararajan³, Jaclyn S Lo³, Nazeen Morelli³, Yesenia Garcia-Reyes³, Meredith A Ware³, Haseeb Rahat³, Xiawei Ou⁴, Xiaoxu Na⁴, Shikha Sundaram⁵, Cameron Severn⁶, Laura L Pyle^{3

6}, Elisabet Børsheim², Mary Ellen Vajravelu¹, Radhika Muzumdar¹, Jonathan A Dranoff⁷, Melanie G Cree^{3

8}

Affiliations

¹ Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
² Center for Childhood Obesity Prevention, Arkansas Children's Research Institute, Little Rock, AR 72202, USA.
³ Pediatric Endocrinology, University of Colorado Anschutz, Aurora, CO 80045, USA.
⁴ Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
⁵ Pediatric Gastroenterology, University of Colorado Anschutz, Aurora, CO 80045, USA.
⁶ Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO 80045, USA.
⁷ Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, USA.
⁸ Ludeman Center for Women's Health, Aurora, CO 80045, USA.

Abstract

Context: Steatotic liver disease is common but overlooked in childhood obesity; diagnostic methods are invasive or expensive.

Objective: We sought to determine the diagnostic accuracy of vibration-controlled transient elastography (VCTE) compared with magnetic resonance imaging (MRI) in adolescents with obesity and high risk for hepatosteatosis.

Methods: Baseline data in 3 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 (AUROCs) 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, body mass index 36.5 ± 5.9 kg/m², 81% female) were included. Fifty youth had hepatosteatosis by MRI (fat fraction 9.3% ; 95% CI 6.7, 14.0), and 32 participants did not have hepatosteatosis (fat fraction 3.1%; 95% CI 2.2, 3.9; P < .001). The hepatosteatosis group had higher mean CAP compared with no hepatosteatosis (293 dB/m; 95% CI 267, 325 vs 267 dB/m; 95% CI 248, 282; P = .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 = .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 = .108).

Conclusion: CAP of 281 dB/m has modest diagnostic performance for hepatosteatosis compared with MRI in youth with significant obesity. A higher CAP in youth with PCOS suggests that comorbidities might affect optimal CAP in hepatosteatosis diagnosis.

Keywords: PCOS; controlled attenuation parameter; magnetic resonance imaging; receiver operating characteristics; steatotic liver disease.

Abstract

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