Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents.
OBJECTIVE
To establish a threshold value for liver fat content between healthy children and those with non-alcoholic fatty liver disease (NAFLD) by using magnetic resonance imaging (MRI), with liver biopsy serving as a reference standard.


METHODS
The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel point-resolved ¹H MR-Spectroscopy (¹H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Lin coefficient test was used to evaluate the correlation between histology, MRS and MRI-PDFF. A Mann-WhitneyU-test and multivariate analysis were performed to analyze the continuous variables.


RESULTS
According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.


CONCLUSIONS
MRS is an accurate and precise method for detecting NAFLD in children.
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Michele
M
Di Martino
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Lucia
L
Pacifico
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Mario
M
Bezzi
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Rossella
R
Di Miscio
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Beatrice
B
Sacconi
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Claudio
C
Chiesa
Michele Di Martino, Mario Bezzi, Rossella Di Miscio, Beatrice Sacconi, Carlo Catalano, Department of Radiological Sciences, Oncology and Anatomical Pathology, "Sapienza" University of Rome, 00161 Rome, Italy.
Carlo
C
Catalano
D000293:Adolescent; D001706:Biopsy; D002648:Child; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D009765:Obesity / Q000150:complications; D011522:Protons; D012372:ROC Curve; D012016:Reference Values
D011522:Protons
Children; Magnetic resonance imaging-PDFF; Magnetic resonance spectroscopy; Non-alcoholic fatty liver disease; Obesity