Ultrasound hepatic elastography: A non-invasive indicator of insulin resistance in the pediatric population: A systematic review

Table 2 Characteristics of pediatric studies evaluating the correlation between elastography measures and insulin resistance metrics

Ref.	Country	Population characteristics	Age	n (total)	Elastography modality	Devise/probe	Elastography measure	IR metric	Correlation (r)	Covariate adjustments
Giannouli et al[10], 2023	Greece	Adolescent females with PCOS (47), control (40)	12.3-20.4	87	TE	Fibroscan device	LFS, FLI, LAP, LSM, HSI, (stiffness)	HOMA-IR	0.61	PCOS status, LFS, FAI
D'Hondt et al[11], 2021	Belgium	Obese, liver fat quantification	7-17	48	MRI PDFF, SWE, QUS	EPIQ-7G	Attenuation	HOMA-IR	0.48	None reported
Ferraioli et al[12], 2017	Italy	Control (106), overweight (100)/obese (99)	4.1-17.4	305	TE	FibroScan 502 Touch device	CAP (attenuation)	HOMA-IR	0.54	BMI, FLI, HSI
Lefere et al[13], 2025	United States, (multi-center)	MASLD cohort	8-18	327	TE	FibroScan 502 Touch	CAP (attenuation)	Fasting glucose	0.5	pFIB score, ethnicity
Song et al[14], 2025	South Korea	NHANES cohort	12-18	260	TE	FibroScan model 502 V2 Touch	CAP	METS-IR	0.49	BMI, waist circumference
Tas et al[15], 2024	United States	Youth with obesity (72%), control (28%)	14.1-17.2	114	MRI and TE	FibroScan	CAP (attenuation)	HOMA-IR	0.30	Obesity status
Arsoy et al[16], 2024	Turkey	Obese (53%), suspected NAFLD	9-18	95 patients, and 116 control	Vibration-controlled TE	Hitachi Hi-Vision Preirus device	CAP and LSM	HOMA-IR	0.45	Age, BMI
Ata et al[17], 2023	Egypt	Obese/overweight children and adolescents with NAFLD	6-16	60	TE	FibroScan-502 echosen-France-M, XL probs- CAP enabled	LSM and CAP	HOMA-IR	0.32	None reported
Brunnert et al[18], 2022	Germany	General pediatric, population-based	10-18	482	TE	M or XL probe	LSM and CAP	HOMA-IR	0.35	Age, sex, puberty
Heldens et al[19], 2024	Belgium	Severe obesity (56% had steatosis)	9-16	200	TE	FibroScan Mini+ 430 with M and XL probe and LogiQ S7 device with a C1-6-D probe	LSM and CAP	Adipo-IR and HOMA-IR	0.65	Lifestyle intervention
Kwon et al[20], 2019	South Korea	NAFLD/NASH	5-15	106	TE	FibroScan® device	LSM and CAP	HOMA-IR	0.42	Fibrosis stage
Rose et al[21], 2023	South Africa	Healthy controls	7.9-17.7	104	TE	FibroScan with standard M probe	LSM and CAP	Fasting glucose	0.25	Age, BMI
Bailey et al[22], 2017	United States	Obese (59%) and controls	0.06-18.9	300	SWE	IU-22 ElastPQ system	SWV (stiffness)	Fasting insulin	0.51	Age, sex
Çakır and Acunaş[23], 2025	Turkey	NAFLD (31) and controls (12)	7-16	43	ARFI	Siemens ACUSON S3000™	SWV (stiffness)	HOMA-IR	0.55	BMI, height, liver craniocaudal length
Karaman et al[24], 2022	Turkey	Obese/overweight (131), MetS, control (50)	6.2-18.9	181	SWE	Siemens Acuson S3000 using a 6C1 transducer	SWV	HOMA-IR	0.2	MetS status
Pawar et al[25], 2016	India	Overweight/obese	11-15	660	SWE	Fibroscan 3.5 MHz Probe	SWV	HOMA-IR	0.37	BMI

Correlation (r): The strength of the linear relationship between the elastography measure and the insulin resistance metric, with a value closer to 1 or -1 indicating a stronger correlation; IR Metric: The measure of insulin resistance used in the study (e.g., homeostatic model assessment for insulin resistance, adipose tissue insulin resistance, fasting insulin, metabolic score for insulin resistance); PCOS: Polycystic ovary syndrome; TE: Transient elastography, a modality often using a FibroScan device; LFS: Liver fat score; FLI: Fatty liver index; LAP: Lipid accumulation product, LSM: Liver stiffness measurement; an output from transient elastography, typically used to assess liver fibrosis (stiffness); HSI: Hepatic steatosis index; HOMA-IR: Homeostatic model assessment for insulin resistance; calculated as the product of fasting insulin (mIU/L) × glucose (mg/dL)/405; FAI: Free androgen index; MRI PDFF: Magnetic resonance imaging-proton density fat fraction; SWE: Shear wave elastography, a modality often incorporated into standard ultrasound machines; QUS: Quantitative ultrasound, a modality that can measure attenuation (for steatosis); CAP: Controlled attenuation parameter; an output from transient elastography, typically used to assess liver steatosis (fat content/attenuation); BMI: Body mass index; MASLD: Metabolic dysfunction-associated steatotic liver disease; pFIB score: Pediatric fibrosis score; NHANES: National Health and Nutrition Examination Survey; METS-IR: Metabolic score for insulin resistance; NAFLD: Non-alcoholic fatty liver disease; Adipo-IR: Adipose tissue insulin resistance, calculated as fasting insulin (mIU/L) × free fatty acids (mmol/L); NASH: Non-alcoholic steatohepatitis; SWV: Shear wave velocity, the measure for stiffness; ARFI: Acoustic radiation force impulse, another ultrasound-based elastography method; MetS: Metabolic syndrome.