Gray-Scale vs. Color-Doppler Ultrasound in Pediatric Fatty Liver: A Diagnostic Disparity.

Introduction: Fatty liver disease is a growing cause of chronic liver disorders in children, largely attributed to the increasing prevalence of obesity. Accurate, non-invasive diagnosis is important to prevent progression to fibrosis or cirrhosis. While liver biopsy is the gold standard, ultrasonography remains the most widely used diagnostic tool. This study compared the diagnostic efficacy of Gray-scale and color-Doppler ultrasound, alongside biochemical markers, in overweight and obese children. Methods: In this cross-sectional study, 67 children aged 2-15 years with body mass index (BMI) above the 85th percentile underwent both Gray-scale and color-Doppler ultrasound examinations. Serum levels of cholesterol, triglyceride, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and other liver-related biochemical parameters were also assessed. Results: Gray-scale ultrasound detected fatty liver in 41.79% of the children, with 29.85% having grade 1 and 11.94% grade 2 steatosis. Color-Doppler ultrasound revealed no diagnostic abnormalities. Serum ALT, AST, cholesterol, and triglyceride levels were significantly elevated in children with sonographic evidence of fatty liver compared with those with normal findings ( Conclusion: Gray-scale ultrasound is effective for diagnosing pediatric fatty liver, whereas color-Doppler imaging adds no diagnostic benefit. Biochemical markers, while useful, lack sensitivity in differentiating disease severity.