Correspondence and Reprint requests : Dr. Samil Hizli, MD, Yeditepe Mah. Universite Bulvari Gurel Apart No: 335/4, Sahinbey Gaziantep. [DOI-10.1007/s12098-010-0045-x] [Received May 15, 2009; Accepted January 6, 2010] Original Article Hepatic Artery Resistance in Children with Obesity and Fatty Liver S. Hizli, A. Koçyigit 1 , N. Arslan 2 , S.A. Tuncel 1 , F. Demircioglu 2 , H. Çakmakçi 1 and B. Büyükgebiz 3 MH Ankara Keçiören Research and Training Hospital, Pediatric Gastroenterology, Hepatology and Nutrition Clinic, Ankara, Dokuz Eylül University, Faculty of Medicine, Departments of 1 Radiodiagnostic and 2 Pediatric Gastroenterology, Hepatology and Nutrition, Izmir, 3 0-18Klinik, Growth and Feeding Disorders Center, Ýstanbul, Turkey ABSTRACT Objective. To assess correlation between hepatic artery resistive index (HARI) and increase of body mass index and hepatosteatosis grading in children with non-alcoholic fatty liver disease (NAFLD). Methods. Thirty three healthy children [body mass index(BMI): mean± standart deviation(SD), min-max: 20.1±1.14(18.5-23.7), 33 overweight [BMI:25.1±2.2 (18.5-23.7)] and 66 obese [BMI:31.1±2(25.6-40)] adolescents were enrolled into the study. To search the relation of HARI with fatty liver degree, study subjects subdivided into groups according to their degree of fatty liver at ultrasonography(US). Results. Increase of HARI was correlated with increase in BMI (p<0.0001, r=0.533). Increase of HARI was well correlated with increase in degree of fatty liver (p<0.0001, r=0.630). Conclusion. The present study results suggest that there are positive correlations of HARI with BMI and hepatoseatosis grade in obese children with NAFLD. HARI may be a candidate parameter to determine early alarming hemodynamic changes in hepatic tissue of obese children with fatty liver before development of severe stages NAFLD. [Indian J Pediatr 2010; 77 (4): 407-411] E-mail: shizli@yahoo.com Key words: Child; Obesity; Fatty liver; Hepatic artery resistive index Chronic liver disease most commonly associated with obesity is called non-alcoholic fatty liver disease (NAFLD) which has shown to be increasing all over the world both in adult and pediatric population. 1-3 NAFLD pathology starts with fatty liver. Steatohepatitis develops when fatty liver persists for a long time and may progress to fibrosis, cirrhosis, and even to hepatocellular carcinoma. 4 Early detection is important since hepatic findings may progress to fibrotic stage unless suitable measures are adopted to reduce obesity. 5 Clinical examination is unreliable in differentiating different stages of NAFLD. In previous pediatric studies of obesity-related liver disease, 5 detection of isolated hypetransaminasemia has been the usual mode of noninvasive screening and follow-up of this condition. However, since serum transaminase level is a late finding and usually fluctuate and/or is slightly elevated, occasional cases may be missed. As a consequence, the true incidence of liver damage in obese children is not yet well established. 6 Liver histology is considered the gold standard for NAFLD diagnosis 7-10 but liver biopsy is associated with risks of complications, patient discomfort, and expense. 8,10 Therefore, tracking of liver disease progression cannot rely on repeated biopsies. 10 The presence of a marked alteration of hepatic microcirculation, secondarily affecting larger hepatic vessels, is a typical part of the architectural derangement of chronic liver diseases that both the portal venous and arterial vessels are influenced by the changes of sinusoidal resistances. 11 Doppler ultrasonography(US) of liver is useful test to evaluate arterial perfusion via calculation of resistance and pulsatility indexes. 11 In fatty liver and cirrhosis, it has been reported that there are changes in hemodynamics leading to increase in intrahepatic vascular resistance. 11-14 High hepatic artery resistive index(HARI) was detected at Doppler US in adult chronic hepatitis patients with different etiologies even earlier Indian Journal of Pediatrics, Volume 77—April, 2010 407