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Abstract Details
Diagnostic Accuracy of Magnetic Resonance Imaging Hepatic Proton Density Fat Fraction in Pediatric Nonalcoholic Fatty Liver Disease
Middleton MS1, Van Natta ML2, Heba ER1, Alazraki A3, Trout AT4, Masand P5, Brunt EM6, Kleiner DE7, Doo E8, Tonascia J2, Lavine JE9, Shen W9, Hamilton G1, Schwimmer JB10, Sirlin CB1; NASH Clinical Research Network. Hepatology. 2017 Oct 13. doi: 10.1002/hep.29596. [Epub ahead of print]
Author information
1
Liver Imaging Group, Department of Radiology, UCSD School of Medicine, San Diego, California.
2
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
3
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
4
Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio.
5
Texas Children's Hospital, Houston, Texas.
6
Emeritus, Washington University School of Medicine, St. Louis, Missouri.
7
Laboratory of Pathology, National Cancer Institute.
8
Liver Diseases Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases.
9
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, New York.
10
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California; and Department of Gastroenterology, Rady Children's Hospital, San Diego, California.
Abstract
We assessed the performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in children to stratify hepatic steatosis grade before and after treatment in the Cysteamine Bitartrate Delayed-Release for the Treatment of Nonalcoholic Fatty Liver Disease in Children (CyNCh) trial, using centrally-scored histology as reference. Participants had multi-echo 1.5T or 3T MRI on scanners from three manufacturers. Of 169 enrolled children, 110 (65%) and 83 (49%) had MRI and liver biopsy at baseline and at end-of-treatment (EOT; 52-weeks), respectively. At baseline, 17% (19/110), 28% (31/110), and 55% (60/110) of liver biopsies showed grades 1, 2, and 3 histologic steatosis; corresponding PDFF (mean ± standard deviation) values were 10.9 ± 4.1%, 18.4 ± 6.2%, and 25.7 ± 9.7%, respectively. PDFF classified grade 1 vs. 2-3 and 1-2 vs. 3 steatosis with areas under receiving operator characteristic curves (AUROCs) of 0.87 (95% confidence interval [CI]: 0.80, 0.94) and 0.79 (0.70, 0.87), respectively. PDFF cut-offs at 90% specificity were 17.5% for grades 2-3 steatosis, and 23.3% for grade 3 steatosis. At EOT, 47% (39/83), 41% (34/83), and 12% (10/83) of biopsies showed improved, unchanged, and worsened steatosis grade, respectively, with corresponding PDFF (mean ± standard deviation) changes of -7.8 ± 6.3%, -1.2 ± 7.8% and 4.9 ± 5.0%, respectively. PDFF change classified steatosis grade improvement and worsening with AUROCs (95% CIs) of 0.76 (0.66, 0.87) and 0.83 (0.73, 0.92), respectively. PDFF change cut-off values at 90% specificity were -11.0% and +5.5% for improvement and worsening.
CONCLUSION:
MRI-estimated PDFF has high diagnostic accuracy to both classify and predict histologic steatosis grade, and change in histologic steatosis grade in children with NAFLD.