Abstract: Objective The purpose of this study was to investigate ultrasound attenuation coefficient imaging (ATI) in the evaluation of liver damage in children and adolescents with hepatolenticular degeneration (HLD). Methods Sixty children and adolescents with HLD, including Child class A in 38 cases, Child class B in 13 cases and Child class C in 9 cases, were encountered in our hospital between February 2021 and February 2024, and all underwent ultrasound attenuation coefficient and elastography imaging for ATI and liver stiffness measurement (LSM). The receiver operating characteristic (ROC) curve was applied to assess diagnostic performance of liver damage. Results LSM, ATI, Fib-4 and APRI in patients with Child-Pugh class C were (16.6±3.3)kPa, (0.8±0.3)dB/cm/MHz, (1.4±0.6) and (0.4±0.2), all significantly higher than [(11.0±2.2)kPa, (0.6±0.2)dB/cm/MHz, (1.0±0.5) and (0.3±0.1), respectively, P<0.05] in those with Child class B or [(7.1±1.2)kPa, (0.4±0.1)dB/cm/MHz, (0.7±0.3) and (0.2±0.1), respectively, P<0.05] in those with Child class A; ROC analysis showed that the AUCs were 0.88 and 0.90, respectively, when ATI and LSM were applied to predict severe liver injuries of Child-Pugh class B/C in patients with HLD, both much superior to 0.74 by Fib-4 or 0.72 by APRI. Conclusion ATI and LSM have a high diagnostic efficacy in the evaluation of liver damage in children and adolescents with HLD, and clinicians might select one of them to assess.

Key words: Hepatolenticular degeneration, Ultrasound attenuation coefficient imaging, Liver stiffness measurement, Diagnosis, Children, Adolescents