Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease.

Alanine aminotransferase (ALT) and ultrasound (US) are the most commonly used tools for detecting non-alcoholic fatty liver disease (NAFLD). No direct comparison of these two modalities in children exists. We aimed to compare head-to-head the diagnostic accuracy of ALT and US and their combination for detecting NAFLD in children with obesity. Ninety-nine children with severe obesity underwent simultaneous serum-ALT and abdominal ultrasound (US steatosis score 0-3). Proton magnetic resonance spectroscopy was used as reference standard for detecting steatosis/NAFLD. ROC curve analyses were performed to determine diagnostic performance and to determine optimum screening cut-points aiming for a specificity ≥ 80%. The area under the ROC (AUROC) of ALT and US were not significantly different (0.74 and 0.70, respectively). At the optimal ALT threshold (≥40 IU/L), sensitivity was 44% and specificity was 89%. At the optimal US steatosis score (≥ 2), sensitivity was 51% and specificity was 80%. Combining ALT and US did not result in better accuracy than ALT or US alone.Conclusion: ALT and US have comparable and only moderate diagnostic accuracy for detecting hepatic steatosis in children with obesity. A stepwise screening strategy combining both methods does not improve diagnostic accuracy. What is Known: • Alanine aminotransferase (ALT) and ultrasound (US) are the most commonly used tools for detecting non-alcoholic fatty liver disease (NAFLD). • ALT and ultrasound have mediocre accuracy in detecting steatosis in children with obesity. What is New: • In a head-to-head comparison, the difference in diagnostic accuracy of ALT and ultrasound in detecting steatosis is not significant. • A stepwise screening strategy combining both methods does not improve diagnostic accuracy.

Changes in bone scans after anterior cruciate ligament reconstruction: a prospective study.

BACKGROUND: Whether anterior cruciate ligament reconstruction retards the progression of osteoarthrosis is not established. Bone scintigraphy can be useful for monitoring the course of osteoarthrosis. Bone scan findings are abnormal in the majority of patients with anterior cruciate ligament deficiency. Three uptake patterns can be distinguished. HYPOTHESIS: Reconstruction corrects the three abnormal bone scan patterns seen in patients with anterior cruciate ligament deficiency. STUDY DESIGN: Prospective cohort study. METHODS: We performed bone scintigraphy in 80 patients, before and 2 years after anterior cruciate ligament reconstruction. RESULTS: Reconstruction consistently corrected type 2 bone scan pattern (meniscus scan) but not type 1 and 3 patterns (osteoarthrosis and cartilage ulcer scan). Correction of all three patterns decreased among patients who had longer duration of anterior cruciate ligament deficiency and was more reliable for the combined uptake of all three patterns among patients who had less than 6 months of deficiency. CONCLUSION: These findings indicate anterior cruciate ligament reconstruction protects the menisci. Reconstruction may be best performed within 6 months after injury.