Abstract Background MASLD is suspected when hepatic steatosis is identified (e.g., on ultrasound) in a child with cardiometabolic risk factors (such as overweight/obesity), with or without elevated aminotransferase levels, while aminotransferases serve as supportive rather than defining markers. Ultrasound elastography serves as a valuable, non-invasive technique to quantitatively assess liver stiffness as a surrogate marker of fibrosis. It has comparable applications in pediatric populations, though variations exist in contributing factors and the underlying causes of liver disease. However, standardized pediatric reference values and consensus-based recommendations for routine clinical use of elastography remain limited. In the current study, we explore the effectiveness of shear wave elastography as a non-invasive tool to assess liver stiffness in both adolescents and children with suspected MASLD. Methods This research involved pediatric participants with overweight or obesity referred from the Endocrinology Clinic who had cardiometabolic risk factor elevation of serum aminotransferases for more than 3 months and/or hepatic steatosis on imaging. All patients underwent a full medical history and examination, liver function tests, lipid profile, and Hemoglobin A1c. These patients were compared with 77 age- and sex-matched normal control subjects (normal body mass index) regarding shear wave elastography and abdominal subcutaneous fat measurements obtained by abdominal ultrasonography. All controls had normal aminotransferases and normal hepatic ultrasonography (no steatosis grade 0 and no hepatomegaly). Results Regarding the hepatic echogenicity–based steatosis grade on ultrasound, we found that patients with severe increased hepatic echogenicity (steatosis grade III) had a significantly higher prevalence of elevated aminotransferases (ALT and AST), lower mean HDL level / higher prevalence of impaired HDL, and more frequent hepatomegaly on ultrasound compared with those with mild to moderate increased hepatic echogenicity (steatosis grades I–II) (p=0.03, p=0.03, p=0.01, and p=0.03, respectively). Two-dimensional shear-wave elastography values were significantly elevated in the case group relative to the control group (p<0.001). There was a significant positive correlation between abdominal subcutaneous fat measurement, left lobe of liver subcutaneous fat thickness, and umbilical region subcutaneous fat thickness in ultrasound and shear wave elastography value, with p-values (0.006 and 0.003, respectively). Conclusion Shear wave elastography is a reliable, and non-invasive method for detecting increased liver stiffness in children with suspected metabolic steatotic liver disease. Importantly, liver stiffness should be interpreted in context because it may be influenced by steatosis and necroinflammatory activity in addition to fibrosis.
Yassin et al. (2026) studied this question.