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Recommendations for imaging liver fat in children

May's issue of the Clinical Gastroenterology and Hepatology examines the evidence and recommendations for imaging liver fat in children.

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Fatty liver is a common problem in children and increases their risk for cirrhosis, diabetes, and cardiovascular disease. Liver biopsy is the clinical standard for diagnosing and grading fatty liver.

However, noninvasive imaging modalities are needed to assess liver fat in children.

Dr Jeffrey Schwimmer and colleagues from california, USA performed a systematic review of studies that evaluated imaging liver fat in children.

The research team searched PubMed for original research articles in peer-reviewed journals from 1982 through 2012, using the key words “imaging liver fat.”

The team included studies in English, and those performed in children from birth to 18 years of age.

Ultrasonography for diagnosis of fatty liver had positive predictive values of 47% to 62%
Clinical Gastroenterology & Hepatology

To be eligible for inclusion, studies were required to measure hepatic steatosis via an imaging modality and a quantitative comparator as the reference standard.

The team analyzed 9 studies comprising 610 children.

The researchers found that 4 studies assessed ultrasonography, and 5 studies assessed magnetic resonance imaging (MRI).

Ultrasonography was used in the diagnosis of fatty liver with positive predictive values of 47% to 62%.

There was not a consistent relationship between ultrasound steatosis score, and the reference measurement of hepatic steatosis.

Liver fat as measurements by MRI or by spectroscopy varied with the methodologies used.

The team observed that liver fat measurements by MRI correlated with results from histologic analyses, but sample size did not allow for an assessment of diagnostic accuracy.

Dr Schwimmer's team concludes, "Available evidence does not support the use of ultrasonography for the diagnosis or grading of fatty liver in children."

"Although MRI is a promising approach, the data are insufficient to make evidence-based recommendations regarding its use in children for the assessment of hepatic steatosis."

Clin Gastroenterol Hepatol 2014: 12(5): 765-773
24 April 2014

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