Comparison of Ultrasound Attenuation Imaging and Conventional Ultrasonography Detection Rates for Hepatosteatosis in Obese Children

PURPOSE: This study aimed to evaluate the diagnostic performance of ultrasound attenuation imaging (USAT) in detecting and grading hepatosteatosis in obese pediatric patients, and to compare its findings with conventional B-mode ultrasonography and relevant laboratory parameters. METHODS: This prospective cross-sectional study enrolled 95 obese or morbidly obese children aged 8 to 18 years who presented to a pediatric endocrinology clinic with a preliminary diagnosis of hepatosteatosis. All patients underwent both B-mode ultrasonography and USAT using the Mindray Resona9 device. Hepatosteatosis was graded using device-specific attenuation cutoff values for USAT and standard echogenicity-based criteria for B-mode ultrasonography. Laboratory parameters, including alanine aminotransferase (ALT), triglycerides (TG), and homeostasis model assessment of insulin resistance (HOMA-IR), were recorded for each patient. RESULTS: USAT identified hepatosteatosis in 70 of 95 patients (73.7%), whereas B-mode ultrasonography detected steatosis in only 36 of 95 (37.9%). Among the 59 patients classified as steatosis-free by B-mode ultrasonography, USAT identified steatosis in 36 (61%; P<0.001). Interobserver agreement was excellent for USAT (ICC=0.939; 95% CI: 0.903-0.962) and substantial for B-mode ultrasonography (weighted kappa=0.793). Patients who were USAT-positive but B-mode-negative demonstrated significantly higher ALT and HOMA-IR values, as well as a greater prevalence of hepatomegaly (P<0.05 for all). CONCLUSIONS: USAT is capable of detecting low-grade hepatic steatosis in obese children more effectively than conventional B-mode ultrasonography and shows significant correlations with key metabolic laboratory parameters. Given its objectivity, excellent reproducibility, and practical ease of use, routine incorporation of USAT alongside B-mode ultrasonography is warranted in the evaluation of hepatic steatosis in the pediatric population.