Objective:

To explore the value of acoustic attenuation imaging (ATI) technology in the detection and grading of non-alcoholic fatty liver disease (NAFLD) in obese children.

Methods:

A total of 70 obese children were consecutively recruited at Xinhua Hospital

Shanghai Jiao Tong University School of Medicine from September 2022 to November 2023. ATI was performed by two independent operators to calculate attenuation coefficient (AC) of the liver. Using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard

patients were divided into four groups (S0

S1

S2

S3) according to the mean MRI-PDFF of right lobe of liver. Spearman correlation analysis was employed to study the correlation between AC values and MRI-PDFF. ANOVA analysis was used to compare AC values in S0

S1

S2

and S3. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) for the categories of steatosis. Two-way mixed-model intraclasscorrelation coefficients (ICC) were used to assess interrater reliability between operators.

Results:

The Spearman correlation coefficients between AC and MRI-PDFF were 0.822 and 0.809 for operator 1 and operator 2

respectively. The AC values of S0

S1

S2

and S3 were (0.59±0.05)

(0.73±0.11)

(0.82±0.09) and (0.89±0.08) dB·cm

-1

·MHz

-1

respectively for operator 1(

P

＜0.05)

and (0.61±0.07)

(0.74±0.10)

(0.82±0.10) and (0.89±0.07) dB·cm

-1

·MHz

-1

respectively for operator 2 (

P

＜0.05). The AUC for the detection of S≥1

S≥2 and S3 steatosis were 0.954

0.887 and 0.877 respectively by operator 1

and 0.938

0.880 and 0.882 respectively by operator 2. The ICC between operators was 0.897 (95% CI 0.939-0.934).

Conclusion:

The AC measured by ATI could accurately detected and quantified NAFLD in obese children

and showed potential applic

ation in the diagnosis

grading and clinical management of pediatric NAFLD.