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Jeong S, Park SJ, Na SK, Park SM, Song BC, Oh YH. Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan. Hepatobiliary Pancreat Dis Int 2024; 23:353-360. [PMID: 36870896 DOI: 10.1016/j.hbpd.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease (K-NAFLD) score was recently developed with the intent to operationally define nonalcoholic fatty liver disease (NAFLD). However, there remained an external validation that confirmed its diagnostic performance, especially in patients with alcohol consumption or hepatitis virus infection. METHODS Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®. Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score, fatty liver index (FLI), and hepatic steatosis index (HSI). RESULTS K-NAFLD-moderate [adjusted odds ratio (aOR) = 2.53, 95% confidence interval (CI): 1.13-5.65] and K-NAFLD-high (aOR = 4.14, 95% CI: 1.69-10.13) groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics, and FLI-moderate and FLI-high groups revealed aORs of 2.05 (95% CI: 1.22-3.43) and 1.51 (95% CI: 0.78-2.90), respectively. In addition, the HSI was less predictive for Fibroscan®-defined fatty liver. Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection, and the adjusted area under curve values were comparable between K-NAFLD and FLI. CONCLUSIONS Externally validation of the K-NAFLD and FLI showed that these scores may be a useful, noninvasive, and non-imaging modality for the identification of fatty liver. In addition, these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.
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Affiliation(s)
- Seogsong Jeong
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea; Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam 13488, Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea
| | - Seong Kyun Na
- Department of Internal Medicine, Inje University College of Medicine, Seoul 50834, Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea; Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju 63241, Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju 63241, Korea; Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong 14353, Korea.
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Collin R, Magnin B, Gaillard C, Nicolas C, Abergel A, Buchard B. Prospective study comparing hepatic steatosis assessment by magnetic resonance imaging and four ultrasound methods in 105 successive patients. World J Gastroenterol 2023; 29:3548-3560. [PMID: 37389233 PMCID: PMC10303516 DOI: 10.3748/wjg.v29.i22.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is becoming a major health problem, resulting in hepatic, metabolic and cardio-vascular morbidity.
AIM To evaluate new ultrasonographic tools to detect and measure hepatic steatosis.
METHODS We prospectively included 105 patients referred to our liver unit for NAFLD suspicion or follow-up. They underwent ultrasonographic measurement of liver sound speed estimation (SSE) and attenuation coefficient (AC) using Aixplorer MACH 30 (Supersonic Imagine, France), continuous controlled attenuation parameter (cCAP) using Fibroscan (Echosens, France) and standard liver ultrasound with hepato-renal index (HRI) calculation. Hepatic steatosis was then classified according to magnetic resonance imaging proton density fat fraction (PDFF). Receiver operating curve (ROC) analysis was performed to evaluate the diagnostic performance in the diagnosis of steatosis.
RESULTS Most patients were overweight or obese (90%) and had metabolic syndrome (70%). One third suffered from diabetes. Steatosis was identified in 85 patients (81%) according to PDFF. Twenty-one patients (20%) had advanced liver disease. SSE, AC, cCAP and HRI correlated with PDFF, with respective Spearman correlation coefficient of -0.39, 0.42, 0.54 and 0.59 (P < 0.01). Area under the receiver operating characteristic curve (AUROC) for detection of steatosis with HRI was 0.91 (0.83-0.99), with the best cut-off value being 1.3 (Se = 83%, Sp = 98%). The optimal cCAP threshold of 275 dB/m, corresponding to the recent EASL-suggested threshold, had a sensitivity of 72% and a specificity of 80%. Corresponding AUROC was 0.79 (0.66-0.92). The diagnostic accuracy of cCAP was more reliable when standard deviation was < 15 dB/m with an AUC of 0.91 (0.83-0.98). An AC threshold of 0.42 dB/cm/MHz had an AUROC was 0.82 (0.70-0.93). SSE performed moderately with an AUROC of 0.73 (0.62-0.84).
CONCLUSION Among all ultrasonographic tools evaluated in this study, including new-generation tools such as cCAP and SSE, HRI had the best performance. It is also the simplest and most available method as most ultrasound scans are equipped with this module.
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Affiliation(s)
- Remi Collin
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges 87000, France
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Benoit Magnin
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Constance Gaillard
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Carine Nicolas
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Armand Abergel
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Benjamin Buchard
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
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Zeng KY, Bao WYG, Wang YH, Liao M, Yang J, Huang JY, Lu Q. Non-invasive evaluation of liver steatosis with imaging modalities: New techniques and applications. World J Gastroenterol 2023; 29:2534-2550. [PMID: 37213404 PMCID: PMC10198053 DOI: 10.3748/wjg.v29.i17.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/26/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the world, nonalcoholic fatty liver disease (NAFLD) accounts for majority of diffuse hepatic diseases. Notably, substantial liver fat accumulation can trigger and accelerate hepatic fibrosis, thus contributing to disease progression. Moreover, the presence of NAFLD not only puts adverse influences for liver but is also associated with an increased risk of type 2 diabetes and cardiovascular diseases. Therefore, early detection and quantified measurement of hepatic fat content are of great importance. Liver biopsy is currently the most accurate method for the evaluation of hepatic steatosis. However, liver biopsy has several limitations, namely, its invasiveness, sampling error, high cost and moderate intraobserver and interobserver reproducibility. Recently, various quantitative imaging techniques have been developed for the diagnosis and quantified measurement of hepatic fat content, including ultrasound- or magnetic resonance-based methods. These quantitative imaging techniques can provide objective continuous metrics associated with liver fat content and be recorded for comparison when patients receive check-ups to evaluate changes in liver fat content, which is useful for longitudinal follow-up. In this review, we introduce several imaging techniques and describe their diagnostic performance for the diagnosis and quantified measurement of hepatic fat content.
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Affiliation(s)
- Ke-Yu Zeng
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wu-Yong-Ga Bao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yun-Han Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min Liao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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5
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Wear KA, Han A, Rubin JM, Gao J, Lavarello R, Cloutier G, Bamber J, Tuthill T. US Backscatter for Liver Fat Quantification: An AIUM-RSNA QIBA Pulse-Echo Quantitative Ultrasound Initiative. Radiology 2022; 305:526-537. [PMID: 36255312 DOI: 10.1148/radiol.220606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is believed to affect one-third of American adults. Noninvasive methods that enable detection and monitoring of NAFLD have the potential for great public health benefits. Because of its low cost, portability, and noninvasiveness, US is an attractive alternative to both biopsy and MRI in the assessment of liver steatosis. NAFLD is qualitatively associated with enhanced B-mode US echogenicity, but visual measures of B-mode echogenicity are negatively affected by interobserver variability. Alternatively, quantitative backscatter parameters, including the hepatorenal index and backscatter coefficient, are being investigated with the goal of improving US-based characterization of NAFLD. The American Institute of Ultrasound in Medicine and Radiological Society of North America Quantitative Imaging Biomarkers Alliance are working to standardize US acquisition protocols and data analysis methods to improve the diagnostic performance of the backscatter coefficient in liver fat assessment. This review article explains the science and clinical evidence underlying backscatter for liver fat assessment. Recommendations for data collection are discussed, with the aim of minimizing potential confounding effects associated with technical and biologic variables.
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Affiliation(s)
- Keith A Wear
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Aiguo Han
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Jonathan M Rubin
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Jing Gao
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Roberto Lavarello
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Guy Cloutier
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Jeffrey Bamber
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
| | - Theresa Tuthill
- From the Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, WO62, Room 2114, Silver Spring, MD 20993 (K.A.W.); Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, Ill (A.H.); Department of Radiology, University of Michigan, Ann Arbor, Mich (J.M.R.); Ultrasound Research and Education, Rocky Vista University, Ivins, Utah (J.G.); Department of Engineering, Pontificia Universidad Católica del Perú, Lima, Peru (R.L.); Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Canada (G.C.); Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Division of Radiotherapy and Imaging, Joint Department of Physics, London, UK (J.B.); and Pfizer, Cambridge, Mass (T.T.)
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