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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2018; 72(6): 473–478. doi:10.14735/amgh2018473.

Evaluation of liver steatosis in obese paediatric patients using ultrasonography

Marek Pršo1, Marek Kozár2, Terézia Kráľová1, Zuzana Michnová1, Zuzana Havlíčeková3, Lýdia Zúbriková1, Peter Bánovčin1

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In healthy children, tissue echogenicity of the liver parenchyma is comparable to that of the kidneys or spleen. With obesity, the most prominent risk factor for non-alcoholic fatty liver disease (NAFLD), overall liver tissue echogenicity increases with the severity of steatosis. Currently, ultrasonographic quantification of liver steatosis using the hepatorenal index (HRI) is coming to the forefront. The HRI value is defined as a histogram ratio between tissue echogenicities of the liver and those of the right kidney, and its increase is proportional to the severity of steatosis, while overall liver tissue elasticity tends to decrease in more advanced stages of steatosis. In this study, we evaluated the significance and possible use of noninvasive ultrasonography for the assessment of the presence and stages of liver steatosis in paediatric patients with exogenous obesity. The obese children cohort showed higher HRI values than the healthy patient group (HRI = 1.43 ± 0.19 vs.  1.12 ± 0.07; p < 0,0001), and lower tissue elasticity than the control group (liver fibrosis index (LFI) = 1.64 ± 0.43 vs. 1.02 ± 0.27). The ultrasonograms also revealed that patients with higher body mass indexes and waist circumferences had more steatosis and lower liver elasticity. Liver elasticity was lower in obese patients with increased serum LDL and triglyceride levels, and the decrease also tended to be proportional to the decrease in serum vitamin D concentration. Based on these results, we conclude that obesity is a significant risk factor for the onset and development of NAFLD, and that noninvasive ultrasonographic methods can be used to diagnose and monitor obese patients with a high risk  of NAFLD.


childhood, elastography, non-alcoholic fatty liver disease, obesity, ultrasonography

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