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

Table 4 Comparative overview of controlled attenuation parameter, liver stiffness measurement, and shear wave elastography

Feature	CAP	LSM-transient elastography)	SWE/ARFI
Biological target	Hepatic fat accumulation (steatosis)	Fibrosis, inflammation, and parenchymal stiffness	Fibrosis and parenchymal elasticity distribution
Primary determinant	Fat-induced ultrasound attenuation	Shear-wave propagation velocity (mechanical vibration)	Acoustic radiation force impulse-induced shear-wave velocity
Measurement unit	dB/m	kPa	m/second (or converted to kPa)
1Correlation with insulin resistance	Moderate (r approximately 0.30-0.40)	Strong (r approximately 0.50-0.65)	Strong (r approximately 0.45-0.60)
Best correlated IR index	HOMA-IR, fasting insulin	Adipo-IR, METS-IR	Adipo-IR, METS-IR
Clinical role	Early detection and metabolic risk screening	Disease staging and progression monitoring	Quantitative fibrosis mapping with spatial visualization
Affected by	Obesity, hepatic heterogeneity	Inflammation, postprandial state	Depth of measurement, acoustic window, probe alignment
Main advantage	Sensitive to early metabolic derangements	Well validated for fibrosis; rapid and reproducible	Provides 2D stiffness map; higher spatial resolution; real-time visualization
Main limitation	Limited fibrosis prediction	Limited assessment of steatosis	Operator-dependent; affected by motion and depth artifacts
Optimal use	Screening and monitoring of steatosis regression	Prognostic follow-up and fibrosis surveillance	Advanced fibrosis characterization and research applications in heterogeneous tissues

¹The correlation coefficients (r) presented are the representative ranges reported across the studies included in this systematic review, not the single pooled estimate from the meta-analysis. The ranges are provided to illustrate the typical strength of the relationship observed in the pediatric literature for each elastography modality.

CAP: Controlled attenuation parameter; LSM: Liver stiffness measurement; SWE: Shear wave elastography; ARFI: Acoustic radiation force impulse; IR: Insulin resistance; HOMA-IR: Homeostatic model assessment of insulin resistance; Adipo-IR: Adipose tissue insulin resistance index; METS-IR: Metabolic score for insulin resistance.