The Effectiveness of Shear-wave Elastography in Childhood Hepatosteatosis Grading and Comparison with Sonographic Grading

Objective: To assess acoustic radiation force impulse (ARFI) elastography-measured liver stiffness with respect to its relationships with hepatic steatosis presence and severity in pediatric non-alcoholic fatty liver disease (NAFLD), while identifying clinical factors associated with altered liver elasticity.Methods: This cross-sectional observational study included 31 children with ultrasonographically diagnosed NAFLD and 12 healthy controls aged 7-16 years.Clinical, anthropometric, laboratory, and imaging data were obtained from hospital records.Laboratory parameters included alanine aminotransferase, aspartate aminotransferase, fasting glucose, insulin, lipid profile, and homeostasis model assessment of insulin resistance.Liver stiffness was assessed using ARFI elastography by a single operator, with shear wave velocity (SWV) measurements acquired from segments 5-8 of the liver, excluding the left lobe.Results: Mean age was 12.943.20years in the hepatosteatosis group and 11.002.73years in the control group (p=0.072);females comprised 35.5% and 58.3% of each group, respectively (p=0.309).The hepatosteatosis group had significantly higher body mass index (BMI) (p=0.001),height (p=0.001), and liver craniocaudal length (p=0.002)than controls.Among hepatosteatosis patients, those with grade 2 steatosis had significantly higher BMI (p=0.001) and liver size (p=0.004)than those with grade 1. ARFI SWV values were similar between groups and steatosis grades, and SWV values did not correlate with anthropometric or laboratory parameters. Conclusion:ARFI elastography measurements are unaffected by hepatic steatosis severity in pediatric NAFLD and values do not correlate with clinical or laboratory parameters.As such, ARFI is a reliable non-invasive tool for fibrosis assessment, irrespective of other patient characteristics.