Noninvasive quantitative assessment of pediatric nonalcoholic fatty liver disease and its severity using acoustic radiation force impulse imaging

Abstract

Abstract: Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in pediatric nonalcoholic fatty liver disease (NAFLD) and to evaluate its ability to noninvasively and quantitatively assess disease severity, particularly significant fibrosis. Methods A total of 84 pediatric subjects who underwent ARFI examination were analyzed in the Children′s Hospital of Soochow University, including a normal control group (n=12), a simple steatosis (NAFL) group (n=33), a nonalcoholic steatohepatitis (NASH) group without significant fibrosis (n=25), and a NASH group with significant fibrosis (n=14). Differences in ARFI-derived shear wave velocity (SWV) among groups were compared. Multivariate logistic regression analysis was performed to identify factors associated with significant fibrosis, and receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of ARFI across different disease stages. Results Significant differences in ARFI-derived shear wave velocity (SWV) were observed among different disease stages (P<0.05). The mean ARFI values were (1.08±0.12) m/s in the control group, (1.24±0.15) m/s in the NAFL group, (1.48±0.18) m/s in the NASH group without significant fibrosis, and (1.86±0.22) m/s in the NASH group with significant fibrosis, showing a stepwise increase with disease severity. Multivariate logistic regression analysis demonstrated that ARFI was an independent predictor of significant fibrosis (F≥2) (OR=1.42 , 95% CI: 1.18~1.71, P<0.001), whereas age, BMI, and ALT were not independently associated (all P>0.05). ROC analysis indicated that an ARFI cutoff value of 1.62 m/s yielded the best diagnostic performance for significant fibrosis, with an AUC of 0.91, sensitivity of 85.7%, and specificity of 88.4%. Conclusion ARFI enables noninvasive and quantitative assessment of liver stiffness changes across different stages of pediatric NAFLD and serves as an independent predictor of significant fibrosis, demonstrating high clinical value for disease severity assessment and risk stratification in pediatric NAFLD.

Key words: Acoustic radiation force impulse imaging, Nonalcoholic fatty liver disease, Children, Liver fibrosis

Chen Xiaoyue, Sun Xin, Liu Yufang. Noninvasive quantitative assessment of pediatric nonalcoholic fatty liver disease and its severity using acoustic radiation force impulse imaging[J]. Chinese Hepatolgy, 2026, 31(7): 1024-1027.

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