背景:儿科NAFLD是一个日益增长的全球健康问题,可以通过早期检测来有效管理。筛选,使用准确,负担得起的,建议进行可访问的测试,然而,目前对最合适的测试没有共识。尽管超声技术被广泛使用,他们对参考测试的表现尚未得到充分评估。
方法:对2010年1月至2024年3月发表的同行评审原创文章的相关数据库进行文献检索。使用适当的工具来系统化和记录搜索结果,并对选定的研究进行质量评估和严格评估。提取的数据进行了主题分析和叙事综合。
结果:18篇文章符合纳入标准。将B型和定量超声技术与MR光谱学进行了比较,MRI-PDFF和肝活检。
结论:肝脏回声和Steato评分是使用的B模式方法。前者效果较差,最大报告灵敏度为70%。后者达到了100%的灵敏度,特异性>80%。中重度脂肪变性的超声表现更好。没有足够的证据支持脂肪变性分级,可能是由于样本量小和缺乏既定的临界值。QUS(定量超声))方法,包括连续衰减参数(CAP),衰减系数(AC),超声衍生脂肪分数(UDFF),组织散射成像(TSI)肝肾指数(HRI),异质性指数(HIA),计算机辅助超声(CAUS)和图片存档和通信系统(基于PACS的图像分析比B模式方法表现更好。尽管QUS表现出优异的性能,灵敏度和特异性高达100%,这将需要在实际实施之前进一步核实。
结论:超声技术可有效用于儿科NAFLD筛查,尤其是在高危人群中。目前值得推荐的是Steato-scores方法,具有使用QUS的巨大潜力,在截止值和验证要求得到解决后。
BACKGROUND: Paediatric NAFLD is an increasing global health concern, which can be effectively managed with early detection. Screening, using accurate, affordable, and accessible tests is recommended, however, there is currently no consensus on the most appropriate tests. Although ultrasound techniques are widely used, their performance against reference tests have not been fully assessed.
METHODS: A literature search of related databases for peer-reviewed original articles published from January 2010-March 2024 was conducted. Appropriate tools were used to systematise and document the search results and selected studies were quality assessed and critically appraised. Extracted data was subjected to thematic analysis and narrative synthesis.
RESULTS: Eighteen articles met the inclusion criteria. B-mode and Quantitative ultrasound techniques were compared against MR spectroscopy, MRI-PDFF and Liver biopsy.
CONCLUSIONS: Liver echogenicity and Steato-scores were the B-mode methods used. The former was less effective, with a maximum reported sensitivity of 70%. The latter reached up to 100% sensitivity, and >80% specificity. Ultrasound performed better with moderate-severe steatosis. There was not enough evidence to support steatosis grading, possibly due to small sample sizes and lack of established cut-off values. QUS (Quantitative Ultrasound)) methods including Continuous Attenuation Parameter (CAP), Attenuation Coefficient (AC), Ultrasound derived fat fraction (UDFF), Tissue Scatter Imaging (TSI) Hepato-Renal Index (HRI), Heterogeneity Index (HIA), Computer Assisted Ultrasound (CAUS) and Picture Archiving and Communication System (PACS-based Image analysis performed better than B-mode methods. Although QUS demonstrated excellent performance, with sensitivity and specificity of up to 100%, this will require further verification before implementation in practice.
CONCLUSIONS: Ultrasound techniques can effectively be used for paediatric NAFLD screening, especially in higher-risk subjects. The steato-scores method is currently recommendable for this, with excellent potential for the use of QUS, after cut-off values and validation requirements have been addressed.