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Ferraioli G, Barr RG, Berzigotti A, Sporea I, Wong VWS, Reiberger T, Karlas T, Thiele M, Cardoso AC, Ayonrinde OT, Castera L, Dietrich CF, Iijima H, Lee DH, Kemp W, Oliveira CP, Sarin SK. WFUMB Guidelines/Guidance on Liver Multiparametric Ultrasound. Part 2: Guidance on Liver Fat Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1088-1098. [PMID: 38658207 DOI: 10.1016/j.ultrasmedbio.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has promoted the development of this document on multiparametric ultrasound. Part 2 is a guidance on the use of the available tools for the quantification of liver fat content with ultrasound. These are attenuation coefficient, backscatter coefficient, and speed of sound. All of them use the raw data of the ultrasound beam to estimate liver fat content. This guidance has the aim of helping the reader in understanding how they work and interpret the results. Confounding factors are discussed and a standardized protocol for measurement acquisition is suggested to mitigate them. The recommendations were based on published studies and experts' opinion but were not formally graded because the body of evidence remained low at the time of drafting this document.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Richard Gary Barr
- Department of Radiology, Northeastern Ohio Medical University, Youngstown, OH, USA
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ioan Sporea
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ana Carolina Cardoso
- Hepatology Division, School of Medicine, Federal University of Rio de Janeiro, Clementino, Fraga Filho Hospital, Rio de Janeiro, RJ, Brazil
| | - Oyekoya Taiwo Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia; Medical School, The University of Western Australia, Crawley, WA, Australia; Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Laurent Castera
- Université Paris-Cité, Inserm UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland
| | - Hiroko Iijima
- Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Disease, Hyogo Medical University, Nishinomiya, Hyogo, Japan; Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Dong Ho Lee
- Department of Radiology, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Claudia P Oliveira
- Gastroenterology Department, Laboratório de Investigação (LIM07), Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Zhou Y, Nie M, Mao F, Zhou H, Zhao L, Ding J, Kan Y, Jing X. Associations Between Multiparametric US-Based Indicators and Pathological Status in Patients with Metabolic Associated Fatty Liver Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00224-2. [PMID: 38871490 DOI: 10.1016/j.ultrasmedbio.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/05/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Noninvasive evaluation of metabolic dysfunction-associated fatty liver disease (MAFLD) using ultrasonography holds significant clinical value. The associations between ultrasound (US)-based parameters and the pathological spectra remain unclear and controversial. This study aims to investigate the associations thoroughly. METHODS The participants with MAFLD undergoing liver biopsy and multiparametric ultrasonography were prospectively recruited from December 2020 to September 2022. Three US-based parameters, namely attenuation coefficient (AC), liver stiffness (LS) and dispersion slope (DS) were obtained. The relationship between these parameters and steatosis grades, inflammation grades and fibrosis stages was examined. RESULTS In this study with 116 participants, AC values significantly differed across distinct steatosis grades (p < 0.001), while DS and LS values varied among inflammation grades (p < 0.001) and fibrosis stages (p < 0.001). The area under the receiver operating characteristic curves (AUCs) of AC ranged from 0.82 to 0.84 for differentiating steatosis grades, while AUCs of LS ranged from 0.62 to 0.76 for distinguishing inflammation grades and 0.83-0.95 for discerning fibrosis stages. AUCs for DS ranged from 0.79 to 0.81 in discriminating inflammation grades and 0.80-0.88 for differentiating fibrosis stages. Subgroup analysis revealed that LS demonstrated different trends in inflammation grade but consistent trends in fibrosis stage across subgroups, whereas DS showed consistent trends for both inflammation grade and fibrosis stage across all subgroups. CONCLUSION AC values indicate the degree of hepatic steatosis but not inflammation or fibrosis. LS values are determined only by fibrosis stage and are not associated with inflammation grades. DS values are associated with both fibrosis and inflammation grades.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Mengjin Nie
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yanmin Kan
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China.
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Ueda N, Mokuda S, Kawaoka T, Uchikawa S, Amioka K, Tsuge M, Asada K, Okada Y, Kobayashi Y, Ishikawa M, Arase T, Arihiro K, Oka S. Influence of dispersion slope on the diagnosis of liver fibrosis by the shear wave in metabolic dysfunction-associated steatotic liver disease. Hepatol Res 2024. [PMID: 38806293 DOI: 10.1111/hepr.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
AIM Shear wave (SW) elastography is used to evaluate metabolic dysfunction-associated steatotic liver disease (MASLD) pathophysiology. Increased elasticity due to fibrosis and increased viscosity due to necrosis and inflammation affect SW. Assessing fibrosis, the most prognostically relevant pathology, is critical. Viscosity is evaluated using the dispersion slope (DS); however, cut-off values that affect SW values are unclear. We compared the ultrasound imaging parameters (SW for viscoelasticity; DS for viscosity) with pathological findings. METHODS Patients (n = 159) who underwent liver biopsy and SW and DS assessments at our hospital were included. Fibrosis stage and inflammation grade cut-off values were calculated from SW, DS, and liver biopsy results using receiver operating characteristic curves. Cases in which liver biopsy results were inconsistent with SW results were used to determine the effect of viscosity on SW values. DS was examined in the Correct and Incorrect Diagnosis groups, which were categorized based on the concordance between SW and liver biopsy results. Dispersion slope cut-off values between the two groups were calculated. RESULTS Fibrosis stage cut-off values by SW (m/s) were: ≥F2, 1.62; ≥F3, 1.74; and F4, 1.97. Inflammation grade cut-off values by DS (m/s/kHz) were: ≥A1, 11.6; ≥A2, 14.5; and A3, 16.1. The Correct/Incorrect Diagnosis groups had 25/70 patients. The DS cut-off value for both groups was 13.2 m/s/kHz. CONCLUSIONS Shear wave and DS are useful for evaluating liver fibrosis and inflammation in MASLD. For DS > 13.2 m/s/kHz, SW may be affected by the increased viscosity owing to inflammation. In such patients, caution should be used when determining/interpreting values.
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Affiliation(s)
- Naoyuki Ueda
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Mokuda
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinsuke Uchikawa
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kei Amioka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Masataka Tsuge
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kana Asada
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuri Okada
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yui Kobayashi
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Mai Ishikawa
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Arase
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
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Mandal M, Ghosh S, Roy S, Mandal S, Dasgupta A. Association of Diabetic Retinopathy with Midlife Hepatic Steatosis Diagnosed by Elastography and Hepatic Steatosis Index in Type 2 Diabetes in an Indian Population. Metab Syndr Relat Disord 2024; 22:214-221. [PMID: 38417047 DOI: 10.1089/met.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Aims: People with type 2 diabetes mellitus are at increased risk of developing hepatic steatosis. We determined the prevalence of hepatic steatosis in middle-aged patients with and without diabetic retinopathy (DR) in an Indian population. We feel this information is critical, with trends of increasing chronic liver disease-related mortality at younger ages. Method: Institution-based analytical cross-sectional study with 114 middle-aged type 2 diabetes patients; 57 in each group with <15 years of duration of DM and without excessive drinking. Hepatic steatosis was determined by the hepatic steatosis index (HSI), hepatic ultrasonography (USG), and elastography. Result: The HSI in DR (37.9 ± 3.9) was more (P = 0.012) than in without diabetic retinopathy (NODR) (36.3 ± 3.3). There was no difference between two groups in liver span (P = 0.829) or in the prevalence of fatty liver (P = 0.562) as determined by conventional USG. Elastography value (kPa) was more (P = 0.001) in DR (6.51 ± 1.85) than in NODR (5.14 ± 1.60). On elastography, 50.9% in DR had a likelihood ratio (Metavir score for a stiffness value) for stage 2 Metavir score. In DR, 11.8% of those missed by USG had a likelihood ratio for ≥ stage 2 Metavir score on elastography. The presence of DR was independently correlated with kPa value (P < 0.001). Conclusion: A significantly higher prevalence of hepatic steatosis was observed in DR in this population. DR can be a useful biomarker for early hepatic screening in midlife, particularly with hepatic elastography, so that timely diagnosis of hepatic steatosis can be made.
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Affiliation(s)
- Mily Mandal
- Department of Ophthalmology, Calcutta National Medical College, Kolkata, India
| | - Sambuddha Ghosh
- Department of Ophthalmology, Calcutta National Medical College, Kolkata, India
| | - Satarupa Roy
- Department of Radiodiagnosis, Calcutta National Medical College, Kolkata, India
| | - Sayani Mandal
- Department of Radiodiagnosis, Calcutta National Medical College, Kolkata, India
| | - Anindya Dasgupta
- Department of Biochemistry, Jhargram Government Medical College, Jhargram, India
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Liu F, Bi M, Jing X, Ding H, Zeng J, Zheng R, Chen Y, Wang W, Xie X, Mi C, Chen M, Cheng W, Zhang S, Wang Z, Zhang C, Zhou H, Cheng Z, Han Z, Yu J, Liang P. Multiparametric US for Identifying Metabolic Dysfunction-associated Steatohepatitis: A Prospective Multicenter Study. Radiology 2024; 310:e232416. [PMID: 38501954 DOI: 10.1148/radiol.232416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Background Noninvasive evaluation of metabolic dysfunction-associated fatty liver disease (MAFLD) with multiparametric US is essential, but multicenter studies are lacking. Purpose To evaluate the ability of multiparametric US with attenuation imaging (ATI) and two-dimensional (2D) shear-wave elastography (SWE) for predicting metabolic dysfunction-associated steatohepatitis (MASH) in participants with MAFLD, regardless of hepatitis B virus infection status. Materials and Methods This prospective cross-sectional multicenter study of consecutive adults with MAFLD who underwent multiparametric US with ATI and 2D SWE, as well as liver biopsy, from September 2020 to June 2022 was conducted in 12 tertiary hospitals in China. Multivariable logistic regression was performed to assess risk factors associated with MASH. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate diagnostic performance in predicting MASH in training and validation groups (6:4 ratio of participants), and for a post hoc subgroup analysis of hepatitis B virus infection and diabetes. Results A total of 424 participants (median age, 47 years; IQR, 34-59 years; 244 male) were evaluated, including 332 participants (78%) with MASH and 92 (22%) without. Attenuation coefficient (AC) (odds ratio [OR], 3.32 [95% CI: 1.94, 5.71]; P < .001), alanine aminotransferase (ALT) level (OR, 4.42 [95% CI: 1.78, 10.94]; P = .001), and international normalized ratio (INR) (OR, 0.59 [95% CI: 0.37, 0.95]; P = .03) were independently associated with MASH. A combined model (AC, ALT, and INR) had AUCs of 0.85 (95% CI: 0.79, 0.91) and 0.77 (95% CI: 0.69, 0.85) for predicting MASH in the training and validation groups, respectively. AUC values for the subgroups with and without diabetes were 0.83 (95% CI: 0.72, 0.94) and 0.81 (95% CI: 0.75, 0.87) and for the subgroups with and without hepatitis B were 0.82 (95% CI: 0.74, 0.90) and 0.79 (95% CI: 0.71, 0.87), respectively. Conclusion A model combining AC, ALT level, and INR showed good discrimination ability for predicting MASH in participants with MAFLD. Clinical trial registration no. NCT04551716 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Reuter in this issue.
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Affiliation(s)
- Fangyi Liu
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Mingsen Bi
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Xiang Jing
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Hong Ding
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Jie Zeng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Rongqin Zheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Yaqing Chen
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Wenping Wang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Xiaoyan Xie
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Chengrong Mi
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Man Chen
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Wen Cheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Shuhua Zhang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhanbo Wang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Chunquan Zhang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Hongyu Zhou
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhigang Cheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhiyu Han
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
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Hänni O, Ruby L, Paverd C, Frauenfelder T, Rominger MB, Martin A. Confounders of Ultrasound Attenuation Imaging in a Linear Probe Using the Canon Aplio i800 System: A Phantom Study. Diagnostics (Basel) 2024; 14:271. [PMID: 38337786 PMCID: PMC10855333 DOI: 10.3390/diagnostics14030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
There have been studies showing attenuation imaging (ATI) with ultrasound as an approach to diagnose liver diseases such as steatosis or cirrhosis. So far, this technique has only been used on a convex probe. The goal of the study was to investigate the feasibility of ATI measurements using the linear array on a canon Aplio i800 scanner on certified phantoms. Three certified liver tissue attenuation phantoms were measured in five different positions using a linear probe. The effects of positioning and depth were explored and compared. The values were compared to the certified expected value for each phantom as well as the different measurement values for each measurement position. The ATI measurements on phantoms showed significant effect for the different probe positions and region of interest (ROI) depths. Values taken in the center with the probe perpendicular to the phantom were closest to certified values. Median values at 2.5-4.5 cm depth for phantoms 1 and 2 and 0.5-2.5 cm for phantom 3 were comparable with certified values. Measurements taken at a depth greater than 6 cm in any position were the least representative of the certified values (p-value < 0.01) and had the widest range throughout the different sessions. ATI measurements can be performed with the linear probe in phantoms; however, careful consideration should be given to depth dependency, as it can significantly affect measurement values. Remaining measurements at various depths within the 0.5-6.0 cm range showed deviation from the certified values of approximately 25%.
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Affiliation(s)
- Olivia Hänni
- Faculty of Medicine, University of Zurich, Dekanat Pestalozzistrasse 3, 8032 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Catherine Paverd
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Marga B. Rominger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Alexander Martin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
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Torkzaban M, Wessner CE, Halegoua-DeMarzio D, Lyshchik A, Nam K. Diagnostic Performance of Quantitative Ultrasound Parameters in Non-alcoholic Fatty Liver Disease. Acad Radiol 2024; 31:199-211. [PMID: 37507328 DOI: 10.1016/j.acra.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE AND OBJECTIVES Marked liver steatosis, steatohepatitis, and significant fibrosis are risk factors for unfavorable outcomes in non-alcoholic fatty liver disease (NAFLD). In this study, the diagnostic performance of attenuation coefficient (AC), liver stiffness (LS), and dispersion slope (DS) was evaluated separately and combined in the diagnosis of liver steatosis and fibrosis in NAFLD suspects using biopsy or magnetic resonance imaging (MRI) as a reference standard. MATERIALS AND METHODS Seventy-four NAFLD suspects were prospectively imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). AC, LS, and DS measurements were obtained from the right liver lobe. RESULTS Thirty-four patients underwent liver biopsy, and 40 had MRI. There were 32 patients (43%) with liver steatosis and fibrosis (S + F), 22 (30%) with steatosis (S), 5 (7%) with fibrosis (F), and 15 (20%) with normal liver (N). Mean ACs were significantly higher in steatotic livers (n = 54) than in non-steatotic livers (n = 20) (P < 0.0001). LS and DS were significantly higher in patients with liver fibrosis (n = 37) compared to non-fibrotic livers (n = 37) (P = 0.0004 and P = 0.0002, respectively). In detecting (S + F), the area under the receiver operating characteristic curve (AUROCC) was 0.87 for combined ultrasound parameters of LS and AC (negative predictive value [NPV]: 75%, positive predictive value [PPV]: 77%, P < 0.0001). In detecting patients with liver steatosis and fibrosis stage ≥2, LS had an AUROCC of 0.93 (NPV: 87%, PPV: 82%, P < 0.0001). In the biopsy group, 32% (11/34) were diagnosed with non-alcoholic steatohepatitis (NASH). DS values showed a significant difference among patients with (n = 23) or without (n = 11) hepatocellular ballooning (P = 0.02). AUROCC was 0.87 for combined ultrasound parameters of AC, LS, and DS with body mass index (BMI) in detecting NASH (NPV: 80%, PPV: 87%, P = 0.0006). CONCLUSION AC and LS showed high diagnostic value in detecting liver steatosis and fibrosis, respectively. The combined AC and LS values further improved the diagnostic accuracy in detecting NAFLD and high-risk NAFLD patients.
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Affiliation(s)
- Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania (D.H.)
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.).
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Thomas M, Dighe M, Kolokythas O, Zecevic M, Wilson A, Erpelding T, Dubinsky TJ. Ultrasound Attenuation Imaging vs MRI-PDFF, Echogenicity and Liver Function for Assessing Degree of Steatosis in NAFLD and Non-NAFLD Patients. Ultrasound Q 2023; 39:188-193. [PMID: 37543732 DOI: 10.1097/ruq.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Nonalcoholic fatty liver disease (NAFLD) is a primary cause of parenchymal liver disease globally. There are currently several methods available to test the degree of steatosis in NAFLD patients, but all have drawbacks that limit their use.The objective of this study is to determine if a new technique, ultrasound (US) attenuation imaging (ATI), correlates with magnetic resonance proton density fat fraction imaging and hepatic echogenicity as seen on gray scale US imaging.Fifty-four patients were recruited at the University of Washington Medical Center from individuals who had already been scheduled for hepatic US or magnetic resonance imaging (MRI). All participants then underwent both hepatic MRI proton density fat fraction and US. Ultrasound images were then evaluated using ATI with 2 observers who individually determined relative grayscale echogenicity.Analysis showed positive correlation between ATI- and MRI-determined fat percentage in the case group (Spearman correlation: 0.50; P = 0.015). Furthermore, participants with NAFLD tended to have a higher ATI than controls (median: 0.70 vs 0.54 dB/cm/MHz; P < 0.001).This study demonstrates that US ATI combined with grayscale imaging is an effective way of assessing the degree of steatosis in patients with moderate to severe NAFLD.
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Ozturk A, Kumar V, Pierce TT, Li Q, Baikpour M, Rosado-Mendez I, Wang M, Guo P, Schoen S, Gu Y, Dayavansha S, Grajo JR, Samir AE. The Future Is Beyond Bright: The Evolving Role of Quantitative US for Fatty Liver Disease. Radiology 2023; 309:e223146. [PMID: 37934095 PMCID: PMC10695672 DOI: 10.1148/radiol.223146] [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: 11/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common cause of morbidity and mortality. Nonfocal liver biopsy is the historical reference standard for evaluating NAFLD, but it is limited by invasiveness, high cost, and sampling error. Imaging methods are ideally situated to provide quantifiable results and rule out other anatomic diseases of the liver. MRI and US have shown great promise for the noninvasive evaluation of NAFLD. US is particularly well suited to address the population-level problem of NAFLD because it is lower-cost, more available, and more tolerable to a broader range of patients than MRI. Noninvasive US methods to evaluate liver fibrosis are widely available, and US-based tools to evaluate steatosis and inflammation are gaining traction. US techniques including shear-wave elastography, Doppler spectral imaging, attenuation coefficient, hepatorenal index, speed of sound, and backscatter-based estimation have regulatory clearance and are in clinical use. New methods based on channel and radiofrequency data analysis approaches have shown promise but are mostly experimental. This review discusses the advantages and limitations of clinically available and experimental approaches to sonographic liver tissue characterization for NAFLD diagnosis as well as future applications and strategies to overcome current limitations.
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Affiliation(s)
- Arinc Ozturk
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Viksit Kumar
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Theodore T Pierce
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Qian Li
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Masoud Baikpour
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Ivan Rosado-Mendez
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Michael Wang
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Peng Guo
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Scott Schoen
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Yuyang Gu
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Sunethra Dayavansha
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Joseph R Grajo
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Anthony E Samir
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
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Bae JS, Lee DH, Suh KS, Lee KW, Yi NJ, Hong SK. Application of attenuation imaging for the detection of fatty liver in potential liver donors. Eur J Radiol 2023; 166:110958. [PMID: 37451137 DOI: 10.1016/j.ejrad.2023.110958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE In living donor liver transplantation (LDLT), fatty liver adversely affects the outcome in donors or in recipients. The attenuation imaging (ATI) may be valuable for detecting fatty liver in potential liver donors. We aimed to investigate the role of ATI in screening liver donors. METHOD In this prospective study, potential liver donors undergoing MR examination, including proton MR spectroscopy (1H-MRS), were enrolled between January 2020 and December 2021 (study identifier: KCT0004486). All participants underwent ATI examinations to assess fatty liver disease. The reference standard for fatty liver was the hepatic fat fraction (HFF) on 1H-MRS, with 8% defined as the threshold for significant fatty liver. The correlation between attenuation coefficient (AC) and HFF was evaluated using Spearman's correlation coefficient. The diagnostic performance of AC for the detection of fatty liver disease was evaluated using receiver operating characteristic curve analysis. RESULTS A total of 102 participants (median age, 37 [range, 20-61] years; 65 men) were enrolled. Nineteen participants (18.6%) had significant fatty liver on 1H-MRS. AC significantly correlated with HFF on 1H-MRS (ρ = 0.674, P < 0.001), and was significantly higher in patients with HFF on 1H-MRS ≥ 8% than in patients with HFF on 1H-MRS < 8% (0.76 vs. 0.59, P < 0.001). By using the cutoff value of 0.66, the area under the curve of AC for the detection of significant fatty liver on 1H-MRS was 0.923 (95% confidence interval [CI]: 0.853-0.967), with sensitivity, specificity, and negative predictive values of 89.5% (95% CI: 66.9-98.7%), 83.1% (95% CI: 73.3-90.5%), and 97.2% (95% CI: 90.3-99.2%), respectively. CONCLUSIONS ATI showed good diagnostic performance with a high negative predictive value for the detection of significant fatty liver among potential liver donors.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Torkzaban M, Wessner CE, Halegoua-DeMarzio D, Rodgers SK, Lyshchik A, Nam K. Diagnostic Performance Comparison Between Ultrasound Attenuation Measurements From Right and Left Hepatic Lobes for Steatosis Detection in Non-alcoholic Fatty Liver Disease. Acad Radiol 2023; 30:1838-1845. [PMID: 36586759 PMCID: PMC10307925 DOI: 10.1016/j.acra.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is currently diagnosed by liver biopsy or MRI proton density fat fraction (MRI-PDFF) from left hepatic lobe (LTHL) and/or right hepatic lobe (RTHL). The objective of this study was to compare the diagnostic value of ultrasound attenuation coefficients (ACs) from RTHL and LTHL in detecting hepatic steatosis using biopsy or MRI-PDFF as a reference standard. MATERIALS AND METHODS Sixty-six patients with suspected NAFLD were imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). Five AC measurements from RTHL and LTHL were averaged separately and together to be compared with the reference standard. RESULTS Forty-seven patients (71%) were diagnosed with NAFLD. Mean ACs were significantly higher in fatty livers than non-fatty livers (RTHL: 0.73 ± 0.10 vs. 0.63 ± 0.07 dB/cm/MHZ; p < 0.0001, LTHL: 0.78 ± 0.11 vs. 0.63 ± 0.06 dB/cm/MHz; p < 0.0001, RTHL & LTHL: 0.76 ± 0.09 vs. 0.63 ± 0.05 dB/cm/MHz; p < 0.0001). Biopsy steatosis grades (n =31) were better correlated with the mean ACs of RTHL & LTHL (r = 0.72) compared to LTHL (r = 0.67) or RTHL (r = 0.61). Correlation between MRI-PDFF (n = 35) and mean ACs was better for LTHL (r = 0.69) compared to the RTHL & LTHL (r = 0.66) or RTHL (r = 0.45). Higher diagnostic accuracy was shown for the mean ACs of RTHL & LTHL (AUC 0.89, specificity 94%, sensitivity 78%) compared to LTHL (AUC 0.89, specificity 88%, sensitivity 82%) or RTHL (AUC 0.81, specificity 89%, sensitivity 68%). CONCLUSION Ultrasound ACs from RTHL and LTHL showed comparable diagnostic values in detection of hepatic steatosis with the highest diagnostic accuracy when they were averaged together.
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Affiliation(s)
- Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology & Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shuchi K Rodgers
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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12
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Huang YL, Bian H, Zhu YL, Yan HM, Wang WP, Xia MF, Dong Y, Gao X. Quantitative Diagnosis of Nonalcoholic Fatty Liver Disease with Ultrasound Attenuation Imaging in a Biopsy-Proven Cohort. Acad Radiol 2023; 30 Suppl 1:S155-S163. [PMID: 37407373 DOI: 10.1016/j.acra.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of attenuation imaging (ATI) based on ultrasound for detection of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS This prospective study was approved by our institutional review board (B2021-092R). Written informed consent was obtained from all patients. This study included 60 patients who had clinical suspicion of NAFLD and were referred for liver biopsy after ATI and controlled attenuation parameter (CAP) examinations between September 2020 and December 2021. The histologic hepatic steatosis was graded. The area under curve (AUC) analysis was performed. RESULTS The success rate of the ATI examination was 100%. The intraobserver reproducibility of ATI was 0.981. The AUCs of ATI for detecting ≥S1, ≥S2, and S3 were 0.968 (cut-off value of 0.671 dB/cm/MHz), 0.911 (cut-off value of 0.726 dB/cm/MHz), and 0.766 (cut-off value of 0.757 dB/cm/MHz), respectively. The AUCs of CAP for detecting ≥S1, ≥S2, and S3 were 0.916 (cut-off value of 258.5 dB/m), 0.872 (cut-off value of 300.0 dB/m), and 0.807 (cut-off value of 315.0 dB/m), respectively. The diagnostic values showed no significant difference between ATI and CAP in detecting ≥S1, ≥S2, and S3 (P = .281, P = .254, and P = .330, respectively). The ATI had significant correlations with high-density lipoprotein cholesterol (P < .001), and with triglycerides (P = .015). CONCLUSION ATI showed good feasibility and diagnostic performance in the detection of varying degrees of hepatic steatosis in NAFLD patients.
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Affiliation(s)
- Yun-Lin Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.); Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665th Kongjiang Road, Shanghai 200092, China (Y.-L.H., Y.D.)
| | - Hua Bian
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Yu-Li Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.)
| | - Hong-Mei Yan
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.)
| | - Ming-Feng Xia
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665th Kongjiang Road, Shanghai 200092, China (Y.-L.H., Y.D.).
| | - Xin Gao
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
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Obrist A, Ruby L, Martin A, Frauenfelder T, Rominger M, Paverd C. Influence of Measurement Depth and Acquisition Parameters on Shear Wave Speed and Shear Wave Dispersion in Certified Phantoms Using a Canon Aplio Clinical Ultrasound Scanner. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1742-1759. [PMID: 37156674 DOI: 10.1016/j.ultrasmedbio.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of the work described here was to investigate the relative contribution of confounding factors on liver shear wave speed (SWS) and shear wave dispersion slope (SWDS) measurements in three certified phantoms using a Canon Aplio clinical ultrasound scanner. METHODS A Canon Aplio i800 i-series ultrasound system (Canon Medical Systems Corporation, Otawara, Tochigi, Japan) with i8CX1 convex array (center frequency = 4 MHz) was used to examine dependencies caused by the depth, width and height of the acquisition box (AQB), the depth and size of the region of interest (ROI), the AQB angle and the pressure of the ultrasound probe on the surface of the phantom. RESULTS Results revealed that depth is the most significant confounder in both SWS and SWDS measurements. AQB angle, height and width and ROI size exhibited minimal confounding effects on measurements. For SWS, the most consistent measurement depth is when the top of the AQB is placed between 2 and 4 cm, and the ROI is located between 3 and 7 cm deep. For SWDS, results indicate that measurement values significantly decrease with depth from the surface of the phantom until approximately 7 cm deep, and consequently no stable area of AQB placement or ROI depth exists. CONCLUSION In contrast to SWS, the same ideal acquisition depth range cannot necessarily be applied to SWDS measurements because of a significant depth dependency.
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Affiliation(s)
- Anika Obrist
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Alexander Martin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Marga Rominger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Catherine Paverd
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland.
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Wu L, Wu Y, Jin J, Li X, Zhang N, Jie Y, Zheng R, Chong Y, Ren J. An Optimal Prognostic Model Based on Multiparameter Ultrasound for Acute-on-Chronic Liver Failure. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00208-9. [PMID: 37451951 DOI: 10.1016/j.ultrasmedbio.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Acute-on-chronic liver failure (ACLF) is associated with a considerably high mortality, and accurate prognosis prediction is critical to navigate intervention decisions and improve clinical outcomes. The objective of this study was to establish a better prognostic model for ACLF based on multiparameter ultrasound in combination with clinical features. METHODS A total of 149 patients with ACLF were prospectively enrolled and underwent conventional ultrasound, 2-D shear wave elastography (SWE), attenuation imaging, color Doppler sonography, superb microvascular imaging and contrast-enhanced ultrasound (CEUS). Univariate and multivariate analyses were performed to identify independent ultrasound signatures for the prognosis of ACLF, which, when integrated with clinical characteristics, were used to establish a prognostic model. RESULTS Hepatic perfusion features of CEUS differed significantly between the poor and good prognosis groups, among which the time interval (TI) between peak portal vein (PV) velocity and liver parenchyma (LP) enhancement, TI(PV, LP), was independently associated with the prognosis of ACLF. A prediction model comprising TI(PV, LP) and the international normalized ratio was established, and the area under the curve (AUC) was 0.851, which is greater than those of the Model for End-stage Liver Disease (0.785), fall time of LP model (0.754), 2-D SWE nomogram (0.708) and TI(PV, LP) (0.352). Furthermore, the performance of the model was verified in an independent validation cohort (AUC = 0.920). CONCLUSION The newly developed model performs better than existing tested models; thus, it has potential as a better non-invasive model for predicting the prognosis of patients with ACLF. A future multicenter, large-sample study is required to validate the performance of this model.
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Affiliation(s)
- Lili Wu
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yuankai Wu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jieyang Jin
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Xinhua Li
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nanxiang Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yusheng Jie
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China
| | - Yutian Chong
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Ren
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-sen University, Guangdong Key Laboratory of Liver Disease Research, Guangzhou, China.
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Bulakci M, Ercan CC, Karapinar E, Aksakal MZT, Aliyev S, Bicen F, Sahin AY, Salmaslioglu A. Quantitative evaluation of hepatic steatosis using attenuation imaging in a pediatric population: a prospective study. Pediatr Radiol 2023; 53:1629-1639. [PMID: 36881143 DOI: 10.1007/s00247-023-05615-8] [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: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Obesity and fatty-liver disease are increasingly common in children. Hepatic steatosis is becoming the most common cause of chronic liver disease during childhood. There is a need for noninvasive imaging methods that are easily accessible, safe and do not require sedation in the diagnosis and follow-up of the disease. OBJECTIVE In this study, the diagnostic role of ultrasound attenuation imaging (ATI) in the detection and staging of fatty liver in the pediatric age group was investigated using the magnetic resonance imaging (MRI)-proton density fat fraction as the reference. MATERIALS AND METHODS A total of 140 children with both ATI and MRI constituted the study group. Fatty liver was classified as mild (S1, defined as ≥ 5% steatosis), moderate (S2, defined as ≥ 10% steatosis), or severe (S3, defined as ≥ 20% steatosis) according to MRI-proton density fat fraction values. MRI studies were performed on the same 1.5-tesla (T) MR device without sedation and contrast agent. Ultrasound examinations were performed independently by two radiology residents blinded to the MRI data. RESULTS While no steatosis was detected in half of the cases, S1 steatosis was found in 31 patients (22.1%), S2 in 29 patients (20.7%) and S3 in 10 patients (7.1%). A strong correlation was found between attenuation coefficient and MRI-proton density fat fraction values (r = 0.88, 95% CI 0.84-0.92; P < 0.001). The area under the receiver operating characteristic curve values of ATI were calculated as 0.944 for S > 0, 0.976 for S > 1 and 0.970 for S > 2, based on 0.65, 0.74 and 0.91 dB/cm/MHz cut-off values, respectively. The intraclass correlation coefficient values for the inter-observer agreement and test-retest reproducibility were calculated as 0.90 and 0.91, respectively. CONCLUSION Ultrasound attenuation imaging is a promising noninvasive method for the quantitative evaluation of fatty liver disease.
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Affiliation(s)
- Mesut Bulakci
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey.
| | - Celal Caner Ercan
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey
| | - Edanur Karapinar
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey
| | | | - Shamil Aliyev
- Department of Radiology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Fuat Bicen
- Department of Radiology and Neuroradiology, Klinikum Barnim GmbH, Werner Forssmann Hospital, Eberswalde, Germany
| | - Aylin Yetim Sahin
- Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Topkapi Mahallesi, Turgut Ozal Caddesi, No:118, 34093, Fatih, Istanbul, Turkey
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Dardanelli EP, Orozco ME, Oliva V, Lutereau JF, Ferrari FA, Bravo MG, Ruvinsky S, Roel M, Barvosa PC, Armeno M, Kaplan JS. Ultrasound attenuation imaging: a reproducible alternative for the noninvasive quantitative assessment of hepatic steatosis in children. Pediatr Radiol 2023; 53:1618-1628. [PMID: 36869263 DOI: 10.1007/s00247-023-05601-0] [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: 10/20/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Pediatric hepatic steatosis is a global public health concern, as an increasing number of children are affected by this condition. Liver biopsy is the gold standard diagnostic method; however, this procedure is invasive. Magnetic resonance imaging (MRI)-derived proton density fat fraction has been accepted as an alternative to biopsy. However, this method is limited by cost and availability. Ultrasound (US) attenuation imaging is an upcoming tool for noninvasive quantitative assessment of hepatic steatosis in children. A limited number of publications have focused on US attenuation imaging and the stages of hepatic steatosis in children. OBJECTIVE To analyze the usefulness of ultrasound attenuation imaging for the diagnosis and quantification of hepatic steatosis in children. MATERIAL AND METHODS Between July and November 2021, 174 patients were included and divided into two groups: group 1, patients with risk factors for steatosis (n = 147), and group 2, patients without risk factors for steatosis (n = 27). In all cases, age, sex, weight, body mass index (BMI), and BMI percentile were determined. B-mode US (two observers) and US attenuation imaging with attenuation coefficient acquisition (two independent sessions, two different observers) were performed in both groups. Steatosis was classified into four grades (0: absent, 1: mild, 2: moderate and 3: severe) using B-mode US. Attenuation coefficient acquisition was correlated with steatosis score according to Spearman's correlation. Attenuation coefficient acquisition measurements' interobserver agreement was assessed using intraclass correlation coefficients (ICC). RESULTS All attenuation coefficient acquisition measurements were satisfactory without technical failures. The median values for group 1 for the first session were 0.64 (0.57-0.69) dB/cm/MHz and 0.64 (0.60-0.70) dB/cm/MHz for the second session. The median values for group 2 for the first session were 0.54 (0.51-0.56) dB/cm/MHz and 0.54 (0.51-0.56) dB/cm/MHz for the second. The average attenuation coefficient acquisition was 0.65 (0.59-0.69) dB/cm/MHz for group 1 and 0.54 (0.52-0.56) dB/cm/MHz for group 2. There was excellent interobserver agreement at 0.94 (95% CI 0.92-0.96). There was substantial agreement between both observers (κ = 0.77, with a P < 0.001). There was a positive correlation between ultrasound attenuation imaging and B-mode scores for both observers (r = 0.87, P < 0.001 for observer 1; r = 0.86, P < 0.001 for observer 2). Attenuation coefficient acquisition median values were significantly different for each steatosis grade (P < 0.001). In the assessment of steatosis by B-mode US, the agreement between the two observers was moderate (κ = 0.49 and κ = 0.55, respectively, with a P < 0.001 in both cases). CONCLUSION US attenuation imaging is a promising tool for the diagnosis and follow-up of pediatric steatosis, which provides a more repeatable form of classification, especially at low levels of steatosis detectable in B-mode US.
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Affiliation(s)
- Esteban P Dardanelli
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina.
| | - María Eugenia Orozco
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Vanesa Oliva
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Juan Francisco Lutereau
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Facundo Agustín Ferrari
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Mónica G Bravo
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Department of Research and Development, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Macarena Roel
- Department of Research and Development, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Pablo C Barvosa
- Department of Pediatrics, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Marisa Armeno
- Department Nutrition, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Julio S Kaplan
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
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Sun L, Li N, Zhang L, Chen J. The Role of ElastPQ in Assessing Liver Stiffness for Non-Alcoholic Fatty Liver Disease in Patients Treated with Atypical Antipsychotic Drugs. Neuropsychiatr Dis Treat 2023; 19:1491-1502. [PMID: 37408709 PMCID: PMC10319346 DOI: 10.2147/ndt.s409210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Objective To evaluate the role of elastography point quantification (ElastPQ) for the quantitative assessment of stiffness in the fatty liver disease in mental disorder patients and to provide a noninvasive detection method for non-alcoholic fatty liver (NAFLD) caused by atypical antipsychotics drugs (AAPDs). Methods A total number of 168 mental disorder patients treated with AAPDs and 58 healthy volunteers were enrolled in this study. All the subjects underwent ultrasound and ElastPQ tests. The basic data of the patients were analyzed. Results BMI, liver function, and the value of ElastPQ were considerably higher in the patient group than that in the healthy volunteers. The values of liver stiffness obtained by ElastPQ were increased gradually from 3.48(3.14-3.81) kPa in the normal liver to 8.15(6.44-9.88) in the severe fatty liver. The receiver operating characteristic (ROC) for the diagnosis of fatty liver with ElastPQ were 0.85, 0.79, 0.80, and 0.87 for the diagnosis of normal, mild, moderate, and severe steatosis, respectively, with a sensitive/specificity of 79%/76.4%, 85.7%/78.3%, 86.2%/73%, and 81.3%/82.1%, correspondingly. Moreover, ElastPQ in the olanzapine group was higher than those in the risperidone and aripiprazole groups (5.11(3.83-5.61) kPa vs 4.35(3.63-4.98) kPa, P < 0.05; 5.11(3.83-5.61) kPa vs 4.79(4.18-5.24) kPa, P < 0.05). After one-year treatment, the value of ElastPQ was 4.43(3.85-5.22) kPa, but it was 5.81(5.09-7.33) kPa in patients treated for more than three years. This value increased with treatment prolongation (P < 0.05). Conclusion ElastPQ is a real-time, quantitative method for assessing the stiffness of NAFLD. The liver stiffness value could be varied in the different stages of fatty liver. Olanzapine has a considerable influence on liver stiffness. The long-term use of AAPDs can increase the stiffness value of fatty liver.
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Affiliation(s)
- Linlin Sun
- Department of Ultrasound, Peking University Huilonguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People’s Republic of China
| | - Nan Li
- Department of Ultrasound, Peking University Huilonguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People’s Republic of China
| | - Ligang Zhang
- Department of Psychiatry, Peking University Huilonguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People’s Republic of China
| | - Jingxu Chen
- Department of Psychiatry, Peking University Huilonguan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, People’s Republic of China
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Portincasa P. NAFLD, MAFLD, and beyond: one or several acronyms for better comprehension and patient care. Intern Emerg Med 2023; 18:993-1006. [PMID: 36807050 PMCID: PMC10326150 DOI: 10.1007/s11739-023-03203-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/19/2023]
Abstract
The term non-alcoholic fatty liver disease (NAFLD) has rapidly become the most common type of chronic liver disease. NAFLD points to excessive hepatic fat storage and no evidence of secondary hepatic fat accumulation in patients with "no or little alcohol consumption". Both the etiology and pathogenesis of NAFLD are largely unknown, and a definitive therapy is lacking. Since NAFLD is very often and closely associated with metabolic dysfunctions, a consensus process is ongoing to shift the acronym NAFLD to MAFLD, i.e., metabolic-associated fatty liver disease. The change in terminology is likely to improve the classification of affected individuals, the disease awareness, the comprehension of the terminology and pathophysiological aspects involved, and the choice of more personalized therapeutic approaches while avoiding the intrinsic stigmatization due to the term "non-alcoholic". Even more recently, other sub-classifications have been proposed to concentrate the heterogeneous causes of fatty liver disease under one umbrella. While awaiting additional validation studies in this field, we discuss the main reasons underlying this important shift of paradigm.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Lee SJ, Kim YR, Lee YH, Yoon KH. US Attenuation Imaging for the Evaluation and Diagnosis of Fatty Liver Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:666-675. [PMID: 37324990 PMCID: PMC10265227 DOI: 10.3348/jksr.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/30/2022] [Accepted: 10/14/2022] [Indexed: 06/17/2023]
Abstract
Purpose This study aimed to determine whether the attenuation coefficient (AC) from attenuation imaging (ATI) was correlated with visual US assessment in patients with hepatic steatosis. Moreover, it aimed to assess whether the patient's blood chemistry results and CT attenuation were correlated with AC. Materials and Methods Patients who underwent abdominal US with ATI between April 2018 and December 2018 were included in this study. Patients with chronic liver disease or cirrhosis were excluded. The correlation between AC and other parameters, such as visual US assessment, blood chemistry results, liver attenuation, and liver-to-spleen (L/S) ratio, were analyzed. AC values according to visual US assessment grades were compared using analysis of variance. Results A total of 161 patients were included in this study. The correlation coefficient between US assessment and AC was 0.814 (p < 0.001). The mean AC values for the normal, mild, moderate, and severe grades were 0.56, 0.66, 0.74, and 0.85, respectively (p < 0.001). Alanine aminotransferase levels were significantly correlated with AC (r = 0.317, p < 0.001). The correlation coefficients between liver attenuation and AC and between L/S ratio and AC were -0.702 and -0.626, respectively (p < 0.001). Conclusion Visual US assessment and AC showed a strong positive correlation with the discriminative value between the groups. Computed tomography attenuation and AC showed a strong negative correlation.
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Zhao Y, Qiu C, Dong Y, Wang X, Chen J, Yao J, Jiang Y, Zhang C, Weng H, Liu Y, Wong YN, Huang P. Technical Acoustic Measurements Combined with Clinical Parameters for the Differential Diagnosis of Nonalcoholic Steatohepatitis. Diagnostics (Basel) 2023; 13:diagnostics13091547. [PMID: 37174939 PMCID: PMC10177914 DOI: 10.3390/diagnostics13091547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Background and aim: Diagnosing nonalcoholic steatohepatitis (NASH) is challenging. This study intended to explore the diagnostic value of multiple technical acoustic measurements in the diagnosis of NASH, and to establish a diagnostic model combining technical acoustic measurements with clinical parameters to improve the diagnostic efficacy of NASH. Methods: We consecutively enrolled 75 patients with clinically suspected nonalcoholic fatty liver disease (NAFLD) who underwent percutaneous liver biopsy in our hospital from June 2020 to December 2021. All cases underwent multiple advanced acoustic measurements for liver such as shear wave dispersion (SWD), shear wave speed (SWS), attenuation imaging (ATI), normalized local variance (NLV), and liver-kidney intensity ratio (Ratio) examination before liver biopsies. A nomogram prediction model combining the technical acoustic measurements and clinical parameters was established and the model is proposed to improve the diagnostic performance of NASH. Results: A total of 75 cases were included in this study. The classification of pathological grade for NASH was as follows: normal liver, (n = 15, 20%), nonalcoholic fatty liver (NAFL), (n = 44, 58.7%), and NASH, (n = 16, 21.3%). There were statistically significant differences in SWS (p = 0.002), acoustic coefficient (AC) (p = 0.018), NLV (p = 0.033), age (p = 0.013) and fasting blood glucose (Glu) (p = 0.049) between NASH and non-NASH. A nomogram model which includes SWS, AC, NLV, age and Glu was built to predict NASH, and the calibration curves showed good calibrations in both training and validation sets. The AUCs of the combined nomogram model for the training set and validation set were 0.8597 and 0.7794, respectively. Conclusion: There were statistically significant differences in SWS, AC, NLV, age and Glu between NASH and non-NASH. A nomogram model which includes SWS, AC, NLV, age and Glu was built to predict NASH. The predictive model has a higher diagnostic performance than a single factor model in the diagnosis of NASH and has good clinical application prospects.
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Affiliation(s)
- Yanan Zhao
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chen Qiu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yiping Dong
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xuchu Wang
- Department of Laboratory, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jifan Chen
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jianting Yao
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yifan Jiang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chao Zhang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Huifang Weng
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yajing Liu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | | | - Pintong Huang
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
- Binjiang Institute of Zhejiang University, Hangzhou 310053, China
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Wang K, Zhang S, Zhou W, Wen L, Zhang S, Yu D. Clinical Application of Shear Wave Elastography With Shear Wave Dispersion Imaging in the Preoperative Evaluation of Hepatic Parenchyma in Patients With Liver Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:797-807. [PMID: 35730210 DOI: 10.1002/jum.16029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection. METHODS A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD. RESULTS Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P < .05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P < .05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P > .05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P < .001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6 kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. CONCLUSIONS SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).
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Affiliation(s)
- Kun Wang
- Department of Ultrasound, The Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Shuchen Zhang
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Wenyan Zhou
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Li Wen
- Function, The Special Care Hospital of Hebei Province, Shijiazhuang, China
| | - Shanshan Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Yu
- Department of Ultrasound, North China Medical Treatment Health Group, Fengfeng General Hospital, Handan, China
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Villani R, Lupo P, Sangineto M, Romano AD, Serviddio G. Liver Ultrasound Elastography in Non-Alcoholic Fatty Liver Disease: A State-of-the-Art Summary. Diagnostics (Basel) 2023; 13:diagnostics13071236. [PMID: 37046454 PMCID: PMC10093430 DOI: 10.3390/diagnostics13071236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a chronic disease which is currently the most common hepatic disorder affecting up to 38% of the general population with differences according to age, country, ethnicity and sex. Both genetic and acquired risk factors such as a high-calorie diet or high intake of saturated fats have been associated with obesity, diabetes and, finally, NAFLD. A liver biopsy has always been considered essential for the diagnosis of NAFLD; however, due to several limitations such as the potential occurrence of major complications, sampling variability and the poor repeatability in clinical practice, it is considered an imperfect option for the evaluation of liver fibrosis over time. For these reasons, a non-invasive assessment by serum biomarkers and the quantification of liver stiffness is becoming the new frontier in the management of patients with NAFLD and liver fibrosis. We present a state-of-the-art summary addressing the methods for the non-invasive evaluation of liver fibrosis in NAFLD patients, particularly the ultrasound-based techniques (transient elastography, ARFI techniques and strain elastography) and their optimal cut-off values for the staging of liver fibrosis.
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23
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Platz Batista da Silva N, Scharf G, Lürken L, Verloh N, Schleder S, Stroszczynski C, Jung EM, Haimerl M. Different Ultrasound Shear Wave Elastography Techniques as Novel Imaging-Based Approaches for Quantitative Evaluation of Hepatic Steatosis-Preliminary Findings. Tomography 2023; 9:681-692. [PMID: 36961013 PMCID: PMC10037607 DOI: 10.3390/tomography9020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Modern ultrasound (US) shear-wave dispersion (SWD) and attenuation imaging (ATI) can be used to quantify changes in the viscosity and signal attenuation of the liver parenchyma, which are altered in hepatic steatosis. We aimed to evaluate modern shear-wave elastography (SWE), SWD and ATI for the assessment of hepatic steatosis. METHODS We retrospectively analyzed the US data of 15 patients who underwent liver USs and MRIs for the evaluation of parenchymal disease/liver lesions. The USs were performed using a multifrequency convex probe (1-8 MHz). The quantitative US measurements for the SWE (m/s/kPa), the SWD (kPa-m/s/kHz) and the ATI (dB/cm/MHz) were acquired after the mean value of five regions of interest (ROIs) was calculated. The liver MRI (3T) quantification of hepatic steatosis was performed by acquiring proton density fat fraction (PDFF) mapping sequences and placing five ROIs in artifact-free areas of the PDFF scan, measuring the fat-signal fraction. We correlated the SWE, SWD and ATI measurements to the PDFF results. RESULTS Three patients showed mild steatosis, one showed moderate steatosis and eleven showed no steatosis in the PDFF sequences. The calculated SWE cut-off (2.5 m/s, 20.4 kPa) value identified 3/4 of patients correctly (AUC = 0.73, p > 0.05). The SWD cut-off of 18.5 m/s/kHz, which had a significant correlation (r = 0.55, p = 0.034) with the PDFF results (AUC = 0.73), identified four patients correctly (p < 0.001). The ideal ATI (AUC = 0.53 (p < 0.05)) cut-off was 0.59 dB/cm/MHz, which showed a significantly good correlation with the PDFF results (p = 0.024). CONCLUSION Hepatic steatosis can be accurately detected using all the US-elastography techniques applied in this study, although the SWD and the SWE showed to be more sensitive than the PDFF.
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Affiliation(s)
| | - Gregor Scharf
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Department of Diagnostic and Interventional Radiology, Hospital Wuerzburg Mitte, 97074 Wuerzburg, Germany
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Sugimoto K, Yano H, Itoi T. US Dispersion Slope in Patients with Varying Liver Pathology. Radiology 2023; 307:e222251. [PMID: 36853180 DOI: 10.1148/radiol.222251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Taru MG, Neamti L, Taru V, Procopciuc LM, Procopet B, Lupsor-Platon M. How to Identify Advanced Fibrosis in Adult Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) Using Ultrasound Elastography-A Review of the Literature and Proposed Multistep Approach. Diagnostics (Basel) 2023; 13:diagnostics13040788. [PMID: 36832276 PMCID: PMC9955630 DOI: 10.3390/diagnostics13040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), and its progressive form, non-alcoholic steatohepatitis (NASH), represent, nowadays, real challenges for the healthcare system. Liver fibrosis is the most important prognostic factor for NAFLD, and advanced fibrosis is associated with higher liver-related mortality rates. Therefore, the key issues in NAFLD are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. We critically reviewed the ultrasound (US) elastography techniques for the quantitative characterization of fibrosis, steatosis, and inflammation in NAFLD and NASH, with a specific focus on how to differentiate advanced fibrosis in adult patients. Vibration-controlled transient elastography (VCTE) is still the most utilized and validated elastography method for liver fibrosis assessment. The recently developed point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) techniques that use multiparametric approaches could bring essential improvements to diagnosis and risk stratification.
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Affiliation(s)
- Madalina-Gabriela Taru
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Lidia Neamti
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vlad Taru
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
- Christian Doppler Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, 1090 Vienna, Austria
| | - Lucia Maria Procopciuc
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Bogdan Procopet
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Monica Lupsor-Platon
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Medical Imaging Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Correspondence:
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Sugimoto R, Iwasa M, Eguchi A, Tamai Y, Shigefuku R, Fujiwara N, Tanaka H, Kobayashi Y, Ikoma J, Kaito M, Nakagawa H. Effect of pemafibrate on liver enzymes and shear wave velocity in non-alcoholic fatty liver disease patients. Front Med (Lausanne) 2023; 10:1073025. [PMID: 36824614 PMCID: PMC9941328 DOI: 10.3389/fmed.2023.1073025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background/Aims Pemafibrate is a selective peroxisome proliferator-activated receptor α modulator that improves serum alanine aminotransferase (ALT) in dyslipidemia patients. Pemafibrate was reported to reduce ALT in non-alcoholic fatty liver disease (NAFLD) patients, but efficacy was not clearly elucidated due to the small size of previous study populations. Therefore, we explored pemafibrate efficacy in NAFLD patients. Methods We retrospectively evaluated pemafibrate efficacy on liver enzymes (n = 132) and liver shear wave velocity (SWV, n = 51) in NAFLD patients who had taken pemafibrate for at least 24 weeks. Results Patient ALT levels were decreased from 81.0 IU/L at baseline to 48.0 IU/L at week 24 (P < 0.0001). Serum levels of aspartate aminotransferase (AST), γ-glutamyl transpeptidase (γ-GTP) and triglyceride (TG) were significantly decreased, and high-density lipoprotein cholesterol and platelet count were significantly increased, with no change in body weight being observed. Study participant SWV values decreased from 1.45 m/s at baseline to 1.32 m/s at week 48 (P < 0.001). Older age (P = 0.035) and serum TG levels (P = 0.048) were significantly associated with normalized ALT. Changes in AST, ALT, γ-GTP and body weight were significantly correlated with change in SWV. Conclusion Pemafibrate significantly improves liver function, serum TG and liver stiffness in NAFLD patients. Pemafibrate is a promising therapeutic agent for NAFLD and may be a candidate for NAFLD patients with elevated TG.
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Affiliation(s)
- Ryosuke Sugimoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Akiko Eguchi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan,*Correspondence: Akiko Eguchi,
| | - Yasuyuki Tamai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Ryuta Shigefuku
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hideaki Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshinao Kobayashi
- Center for Physical and Mental Health, Graduate School of Medicine, Mie University, Tsu, Japan
| | | | | | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Mie University, Tsu, Japan
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Nogami A, Iwaki M, Kobayashi T, Honda Y, Ogawa Y, Imajo K, Higurashi T, Hosono K, Kirikoshi H, Saito S, Nakajima A, Yoneda M. Real-world assessment of SmartExam, a novel FibroScan computational method: A retrospective single-center cohort study. J Gastroenterol Hepatol 2023; 38:321-329. [PMID: 36436879 DOI: 10.1111/jgh.16076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/23/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM SmartExam is a novel computational method compatible with FibroScan that uses a software called SmartDepth and continuous controlled attenuation parameter measurements to evaluate liver fibrosis and steatosis. This retrospective study compared the diagnostic accuracy of conventional and SmartExam-equipped FibroScan for liver stiffness measurement (LSM). METHODS The liver stiffness and the associated controlled attenuation parameters of 167 patients were measured using conventional and SmartExam-Equipped FibroScan as well as reference methods like magnetic resonance elastography (MRE) and magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) measurements to assess its diagnostic performance. M or XL probes were selected based on the probe-to-liver capsule distance for all FibroScan examinations. RESULTS The liver stiffness and controlled attenuation parameter (CAP) correlation coefficients calculated from conventional and SmartExam-equipped FibroScan were 0.97 and 0.82, respectively. Using MRE/MRI-PDFF as a reference and the DeLong test for analysis, LSM and the area under the receiver operating characteristic curve for CAP measured by conventional and SmartExam-equipped FibroScan showed no significant difference. However, the SmartExam-equipped FibroScan measurement (33.6 s) took 1.4 times longer than conventional FibroScan (23.2 s). CONCLUSIONS SmartExam has a high diagnostic performance comparable with that of conventional FibroScan. Because the results of the conventional and SmartExam-equipped FibroScan were strongly correlated, it can be considered useful for assessing the fibrosis stage and steatosis grade of the liver in clinical practice, with less variability but little longer measurement time compared with the conventional FibroScan.
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Affiliation(s)
- Asako Nogami
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Michihiro Iwaki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Kobayashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Gastroenterology and Endoscopy, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroyuki Kirikoshi
- Department of Clinical Laboratory, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Nogami A, Yoneda M, Iwaki M, Kobayashi T, Honda Y, Ogawa Y, Imajo K, Saito S, Nakajima A. Non-invasive imaging biomarkers for liver steatosis in non-alcoholic fatty liver disease: present and future. Clin Mol Hepatol 2023; 29:S123-S135. [PMID: 36503207 PMCID: PMC10029939 DOI: 10.3350/cmh.2022.0357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Non-alcoholic fatty liver disease is currently the most common chronic liver disease, affecting up to 25% of the global population. Simple fatty liver, in which fat is deposited in the liver without fibrosis, has been regarded as a benign disease in the past, but it is now known to be prognostic. In the future, more emphasis should be placed on the quantification of liver fat. Traditionally, fatty liver has been assessed by histological evaluation, which requires an invasive examination; however, technological innovations have made it possible to evaluate fatty liver by non-invasive imaging methods, such as ultrasonography, computed tomography, and magnetic resonance imaging. In addition, quantitative as well as qualitative measurements for the detection of fatty liver have become available. In this review, we summarize the currently used qualitative evaluations of fatty liver and discuss quantitative evaluations that are expected to further develop in the future.
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Affiliation(s)
- Asako Nogami
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Michihiro Iwaki
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Takashi Kobayashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
- Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
- Department of Gastroenterology and Endoscopy, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate school of Medicine, Yokohama, Japan
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29
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Rojano A, Sena E, Manzano-Nuñez R, Pericàs JM, Ciudin A. NAFLD as the metabolic hallmark of obesity. Intern Emerg Med 2023; 18:31-41. [PMID: 36357606 DOI: 10.1007/s11739-022-03139-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/17/2022] [Indexed: 11/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide, associated with a high risk of progression to NASH, liver cirrhosis and hepatocarcinoma. Its prevalence is closely related to obesity (understood as adipose-based disease and insulin resistance), which makes that at present NAFLD can be considered a metabolic dysfunction hallmark, regardless of the body mass index. Despite being such a prevalent condition, with such severe consequences, at present there are no reliable biomarkers for its diagnosis or specific treatment. Significant and sustained weight loss, as well as some antidiabetic treatments, has shown promising results for NAFLD but data needs confirmation in larger clinical trials and longer follow-up. Efforts should be made for a better and more accurate baseline diagnosis (including large-scale genetics), identification of patients at higher risk for progression to NASH as well as adequate treatment, to allow us to offer a personalized approach in NAFLD in the context of precision medicine.
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Affiliation(s)
- Alba Rojano
- Endocrinology and Nutrition Department, Vall d'HebronInstitut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Elena Sena
- Liver Unit, Internal Medicine Department, Vall d'HebronInstitut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Ramiro Manzano-Nuñez
- Liver Unit, Internal Medicine Department, Vall d'HebronInstitut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Juan M Pericàs
- Liver Unit, Internal Medicine Department, Vall d'HebronInstitut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Digestivas Y Hepáticas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'HebronInstitut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain.
- CIBER de Diabetes Y Enfermedades Metabólicas Asociadas (CIBERDem), Instituto de Salud Carlos III, Madrid, Spain.
- Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain.
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30
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Cetiner M, Schiepek F, Finkelberg I, Hirtz R, Büscher AK. Validation of attenuation imaging coefficient, shear wave elastography, and dispersion as emerging tools for non-invasive evaluation of liver tissue in children. Front Pediatr 2023; 11:1020690. [PMID: 37138563 PMCID: PMC10150017 DOI: 10.3389/fped.2023.1020690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The number of children with acute and chronic liver disease is rising. Moreover, liver involvement may be limited to subtle changes in organ texture especially in early childhood and some syndromic conditions, such as ciliopathies. Attenuation imaging coefficient (ATI), shear wave elastography (SWE), and dispersion (SWD) are emerging ultrasound technologies providing data about attenuation, elasticity, and viscosity of liver tissue. This additional and qualitative information has been correlated with certain liver pathologies. However, limited data are available for healthy controls and have mainly been raised in adults. Methods This prospective monocentric study was conducted at a university hospital with a specialization in pediatric liver disease and transplantation. Between February and July 2021, 129 children aged 0-17.92 years were recruited. Study participants attended outpatient clinics due to minor illnesses excluding liver or cardiac diseases, acute (febrile) infections or other conditions affecting liver tissue and function. ATI, SWE, and SWD measurements were performed on an Aplio i800 (Canon Medical Systems) with an i8CX1 curved transducer by two different investigators with long-standing experience in pediatric ultrasound according to a standardized protocol. Results Considering multiple potential covariates, we derived percentile charts for all 3 devices relying on the Lambda-Mu-Sigma (LMS) approach. 112 children were considered for further analysis, excluding those with abnormal liver function and under-/overweight (BMI SDS<-1.96/> 1.96, respectively). Age range was 0-17.92 years (mean 6.89±0.50SD), 58% were male. The mean duration of the ultrasound examination (basic ultrasound plus SWE, SWD, and ATI) was 6.67±0.22 minutes and it was well tolerated in 83% (n=92) of cases. While ATI was related to age, SWD was found to depend on BMI SDS, and SWE on abdominal wall thickness and sex. ATI correlated with neither SWE nor SWD, but SWE was correlated with SWD. Conclusions Our study provides norm values and reference charts for ATI, SWE, and SWD considering important covariates including age, sex and, BMI. This may help to implement these promising tools into imaging diagnostics of liver disease and to improve the diagnostic relevance of liver ultrasound. In addition, these noninvasive techniques proved to be time-effective and highly reliable, which make them ideal for application in children.
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31
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Kim JH, Yoon JH, Joo I, Lee JM. Intra-individual comparison of twodimensional shear wave elastography techniques using plane wave imaging and the multi-beam technique: are they interchangeable in measuring liver fibrosis? Ultrasonography 2022; 42:265-274. [PMID: 36935597 PMCID: PMC10071060 DOI: 10.14366/usg.22135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study compared two different two-dimensional shear wave elastography techniques-plane wave imaging (PWI) and multi-beam (MB) imaging-from the same vendor to evaluate liver fibrosis. METHODS In this prospective study, 42 patients with chronic liver disease who had recently undergone magnetic resonance elastography (<3 months) were enrolled, and their liver stiffness (LS) values were measured using PWI or MB. The LS values (kPa) were compared using the Wilcoxon rank-sum test. Inter-technique reproducibility and intra-observer repeatability were assessed using Bland-Altman analysis with 95% limits of agreement (LOA) and coefficients of variation (CVs). The cutoff values for predicting severe fibrosis (≥F3) were estimated using receiver operating characteristic curve (ROC) analysis, with magnetic resonance elastography as the reference standard. RESULTS PWI exhibited technical failure in four patients. Therefore, 38 patients underwent both examinations. The LS values showed moderate agreement between PWI and MB (CV, 22.5%) and 95% LOA of -3.71 to 7.44 kPa. The MB technique showed good intra-observer agreement (CV, 8.1%), while PWI showed moderate agreement (CV, 11.0%). The cutoff values of PWI and MB for diagnosing ≥F3 were 12.3 kPa and 13.8 kPa, respectively, with areas under the ROC curve of 0.89 and 0.95 (sensitivity, 100% and 100%; specificity, 65.6% and 85.7%). CONCLUSION The LS values significantly differed between PWI and MB, hindering their interchangeable use in longitudinal follow-up. Considering its low technical failure rate and better repeatability, the MB technique may be preferable for evaluating liver fibrosis in chronic liver disease patients.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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32
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Jesper D, Fiedler S, Klett D, Waldner MJ, Schellhaas B, Zundler S, Neurath MF, Pfeifer L. Shear Wave Dispersion Imaging for the Characterization of Focal Liver Lesions - A Pilot study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:507-513. [PMID: 34614516 DOI: 10.1055/a-1610-9171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Shear wave dispersion imaging is a novel ultrasound-based technique, which analyzes the speed of different shear wave components depending on their frequency. The dispersion of shear wave speed correlates with the viscosity of the liver parenchyma. The aim of this prospective study was to evaluate the use of shear wave dispersion imaging in focal liver lesions in the non-cirrhotic liver. METHODS Patients with unclear focal liver lesions in B-mode ultrasound were prospectively assigned to shear wave dispersion imaging (m/s/kHz). Measurements were conducted within the lesion and in the liver parenchyma of the right liver lobe using an intercostal window. Histology and contrast-enhanced ultrasound served as the reference for the characterization of the lesions. RESULTS Out of 46 patients included in this study, 24 had liver metastases and 22 had benign liver lesions. Benign lesions consisted mostly of hemangiomas (n=12) and focal nodular hyperplasia (n=8). Malignant lesions showed significantly lower shear wave dispersion (13.0±2.45 m/s/kHz) compared to benign tumors (15.2±2.74 m/s/kHz, p<0.01). In further subgroup analysis, the difference was significant for hemangiomas (15.32±2.42 m/s/kHz, p=0.04) but not for FNHs (14.98±3.36 m/s/kHz, p=0.38). The dispersion of reference liver parenchyma did not differ significantly between the groups (p=0.54). CONCLUSION The quantification of viscosity by shear wave dispersion is a new parameter for the characterization of focal liver lesions with higher dispersion values in hemangiomas and lower dispersion values in metastases. However, it cannot differentiate reliably between benign and malignant lesions.
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Affiliation(s)
- Daniel Jesper
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Steffen Fiedler
- Department of Anaesthesiology, Erlangen University Hospital Department of Anaesthesiology, Erlangen, Germany
| | - Daniel Klett
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Maximilian J Waldner
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Barbara Schellhaas
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Sebastian Zundler
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
| | - Lukas Pfeifer
- Department of Internal Medicine 1, Erlangen University Hospital Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen, Germany
- Department of Gastroenterology and Interventional Endoscopy, Barmherzige Bruder gemeinnutzige Krankenhaus GmbH, Regensburg, Germany
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33
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Sanabria SJ, Pirmoazen AM, Dahl J, Kamaya A, El Kaffas A. Comparative Study of Raw Ultrasound Data Representations in Deep Learning to Classify Hepatic Steatosis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2060-2078. [PMID: 35914993 DOI: 10.1016/j.ultrasmedbio.2022.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Adiposity accumulation in the liver is an early-stage indicator of non-alcoholic fatty liver disease. Analysis of ultrasound (US) backscatter echoes from liver parenchyma with deep learning (DL) may offer an affordable alternative for hepatic steatosis staging. The aim of this work was to compare DL classification scores for liver steatosis using different data representations constructed from raw US data. Steatosis in N = 31 patients with confirmed or suspected non-alcoholic fatty liver disease was stratified based on fat-fraction cutoff values using magnetic resonance imaging as a reference standard. US radiofrequency (RF) frames (raw data) and clinical B-mode images were acquired. Intermediate image formation stages were modeled from RF data. Power spectrum representations and phase representations were also calculated. Co-registered patches were used to independently train 1-, 2- and 3-D convolutional neural networks (CNNs), and classifications scores were compared with cross-validation. There were 67,800 patches available for 2-D/3-D classification and 1,830,600 patches for 1-D classification. The results were also compared with radiologist B-mode annotations and quantitative ultrasound (QUS) metrics. Patch classification scores (area under the receiver operating characteristic curve [AUROC]) revealed significant reductions along successive stages of the image formation process (p < 0.001). Patient AUROCs were 0.994 for RF data and 0.938 for clinical B-mode images. For all image formation stages, 2-D CNNs revealed higher patch and patient AUROCs than 1-D CNNs. CNNs trained with power spectrum representations converged faster than those trained with RF data. Phase information, which is usually discarded in the image formation process, provided a patient AUROC of 0.988. DL models trained with RF and power spectrum data (AUROC = 0.998) provided higher scores than conventional QUS metrics and multiparametric combinations thereof (AUROC = 0.986). Radiologist annotations indicated lower hepatic steatosis classification accuracies (Acc = 0.914) with respect to magnetic resonance imaging proton density fat fraction that DL models (Acc = 0.989). Access to raw ultrasound data combined with artificial intelligence techniques may offer superior opportunities for quantitative tissue diagnostics than conventional sonographic images.
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Affiliation(s)
- Sergio J Sanabria
- Department of Radiology, Stanford University, Stanford, California, USA; Deusto Institute of Technology, University of Deusto/Ikerbasque, Basque Foundation for Science, Bilbao, Spain.
| | - Amir M Pirmoazen
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeremy Dahl
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University, Stanford, California, USA
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Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal. Diagnostics (Basel) 2022; 12:2287. [PMID: 36291976 PMCID: PMC9600709 DOI: 10.3390/diagnostics12102287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 08/10/2023] Open
Abstract
The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology and Hepatology, University Hospital Center Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Kristian Podrug
- Department of Gastroenterology and Hepatology, University Hospital Center Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Ivana Mikolasevic
- Department of Gastroenterology and Hepatology, University Hospital Center Rijeka, Krešimirova 42, 51 000 Rijeka, Croatia
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 2, 10 000 Zagreb, Croatia
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Şendur HN, Özdemir Kalkan D, Cerit MN, Kalkan G, Şendur AB, Özhan Oktar S. Hepatic Fat Quantification With Novel Ultrasound Based Techniques: A Diagnostic Performance Study Using Magnetic Resonance Imaging Proton Density Fat Fraction as Reference Standard. Can Assoc Radiol J 2022; 74:362-369. [PMID: 36113064 DOI: 10.1177/08465371221123696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To assess the diagnostic performances of novel Tissue attenuation imaging (TAI) and Tissue scatter distribution imaging (TSI) tools in quantification of liver fat content using magnetic resonance imaging proton density fat fraction (MRI PDFF) as reference standard. Methods: Eighty consecutive patients with known or suspected non-alcoholic fatty liver disease (NAFLD) who volunteered to participate in the study comprised the study cohort. All patients underwent MRI PDFF scan and quantitative ultrasound (QUS) imaging using TAI and TSI tools. The cutoff values of ≥5%, ≥16.3% and ≥21.7% on MRI PDFF were used for mild, moderate and severe steatosis, respectively. Area under the Receiver operating characteristic (AUROC) curves were used to assess the diagnostic performance of TAI and TSI in detecting different grades of hepatic steatosis. Results: The AUROCs of TAI and TSI tools in detecting hepatosteatosis (MRI PDFF ≥5%), were 0.95 [95% Confidence Interval (CI): 0.91–0.99] ( P < 0.001) and 0.96 (95% CI: 0.93–0.99) ( P < 0.001), respectively. In distinguishing between different grades of steatosis, the values of 0.75, 0.86 and 0.96 dB/cm/MHz have 88%, 88% and 100% sensitivity, respectively, for TAI tool; and the values of 92.44, 96.64 and 99.45 have 90%, 92% and 91.7% sensitivity, respectively, for TSI tool. Conclusion: TAI and TSI tools accurately quantify liver fat content and can be used for the assessment and grading of hepatosteatosis in patients with known or suspected NAFLD.
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Affiliation(s)
- Halit Nahit Şendur
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | | | - Mahi Nur Cerit
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | - Gökalp Kalkan
- Medicana International Ankara Hospital, Radiology Unit, Ankara, Turkey
| | | | - Suna Özhan Oktar
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
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Updated S2k Clinical Practice Guideline on Non-alcoholic Fatty Liver Disease (NAFLD) issued by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) - April 2022 - AWMF Registration No.: 021-025. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:e733-e801. [PMID: 36100201 DOI: 10.1055/a-1880-2388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Roeb E, Canbay A, Bantel H, Bojunga J, de Laffolie J, Demir M, Denzer UW, Geier A, Hofmann WP, Hudert C, Karlas T, Krawczyk M, Longerich T, Luedde T, Roden M, Schattenberg J, Sterneck M, Tannapfel A, Lorenz P, Tacke F. Aktualisierte S2k-Leitlinie nicht-alkoholische Fettlebererkrankung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – April 2022 – AWMF-Registernummer: 021–025. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1346-1421. [PMID: 36100202 DOI: 10.1055/a-1880-2283] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- E Roeb
- Gastroenterologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
| | - A Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - H Bantel
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - J Bojunga
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin., Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - J de Laffolie
- Allgemeinpädiatrie und Neonatologie, Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland
| | - M Demir
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Berlin, Deutschland
| | - U W Denzer
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Marburg, Deutschland
| | - A Geier
- Medizinische Klinik und Poliklinik II, Schwerpunkt Hepatologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W P Hofmann
- Gastroenterologie am Bayerischen Platz - Medizinisches Versorgungszentrum, Berlin, Deutschland
| | - C Hudert
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Karlas
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Krawczyk
- Klinik für Innere Medizin II, Gastroent., Hepat., Endokrin., Diabet., Ern.med., Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Longerich
- Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Luedde
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Roden
- Klinik für Endokrinologie und Diabetologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J Schattenberg
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland
| | - M Sterneck
- Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - P Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - F Tacke
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Berlin, Deutschland
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Comparison of the diagnostic performance of shear wave elastography with shear wave dispersion for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. Eur J Radiol 2022; 154:110459. [DOI: 10.1016/j.ejrad.2022.110459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 11/22/2022]
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Guan X, Chen YC, Xu HX. New horizon of ultrasound for screening and surveillance of non-alcoholic fatty liver disease spectrum. Eur J Radiol 2022; 154:110450. [PMID: 35917757 DOI: 10.1016/j.ejrad.2022.110450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 12/07/2022]
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The effects of vitamin B12 supplementation on metabolic profile of patients with non-alcoholic fatty liver disease: a randomized controlled trial. Sci Rep 2022; 12:14047. [PMID: 35982162 PMCID: PMC9388548 DOI: 10.1038/s41598-022-18195-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
The present study is the first effort to evaluate the effects of vitamin B12 supplementation on the serum level of liver enzymes, homocysteine, grade of hepatic steatosis, and metabolic profiles in patients with non-alcoholic fatty liver disease (NAFLD). Forty patients with NAFLD were enrolled in a double-blind placebo-controlled trial to receive either one oral tablet of vitamin B12 (1000 µg cyanocobalamin) or a placebo per day for 12 weeks. We investigated serum levels of homocysteine, aminotransferases, fasting blood glucose (FBG), lipids, malondialdehyde (MDA), and homeostasis model assessment of insulin resistance (HOMA-IR). The grade of liver steatosis and fibrosis was measured by real-time 2-dimensional shear wave elastography. Vitamin B12 supplementation significantly decreased serum levels of homocysteine compared to placebo (medians: - 2.1 vs. - 0.003 µmol/l; P = 0.038). Although serum alanine transaminase (ALT) in the vitamin B12 group decreased significantly, this change did not reach a significant level compared to the placebo group (medians: - 7.0 vs. 0.0 IU/l; P > 0.05). Despite the significant within-group decrease in FBG, MDA, and liver steatosis in the vitamin B12 group, between-group comparisons did not reveal any significant difference. Vitamin B12 supplementation might decrease serum levels of homocysteine in patients with NAFLD. The fasting blood glucose and serum levels of MDA were significantly improved in the trial group who received vitamin B12. However, these changes did not reach a significant level compared to the placebo group. In this respect, further studies with larger sample sizes, different doses, and types of vitamin B12 will reveal additional evidence.Trial Registration: At http://irct.ir/ as IRCT20120718010333N5 on December 25, 2019.
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Zhang XQ, Zheng RQ, Jin JY, Wang JF, Zhang T, Zeng J. US Shear-Wave Elastography Dispersion for Characterization of Chronic Liver Disease. Radiology 2022; 305:597-605. [PMID: 35916675 DOI: 10.1148/radiol.212609] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background Little is known about the benefits of the use of dispersion slope (DS) as a viscosity-related parameter derived from two-dimensional (2D) shear-wave elastography (SWE) in the stratification of hepatic pathologic stages. Purpose To evaluate whether DS as an additional parameter can improve the diagnostic performance in detecting liver necroinflammation, fibrosis, and steatosis. Materials and Methods In this prospective study, consecutive participants with chronic liver disease who underwent liver biopsy and 2D SWE were recruited between July 2019 and September 2020. DS and liver stiffness (LS) measurements were obtained with use of a 2D SWE system immediately before biopsy. The biopsy specimens were assessed to obtain the scores of fibrosis, necroinflammation, and steatosis. Differences in the area under the receiver operating characteristic curve (AUC) were used to compare the diagnostic performance of DS, LS, and a combination of DS and LS. Results There were 159 participants evaluated (among them, 79 participants with chronic hepatitis B and 11 participants with nonalcoholic fatty liver disease). The distributions of DS values among various necroinflammatory activities (P = .02) and fibrosis stages (P < .001) were different. Moreover, DS was only associated with fibrosis after subgroup analysis based on the fibrosis stages and necroinflammatory activities (P < .001). The AUCs of DS in detecting clinically significant fibrosis (fibrosis stage ≥F2), cirrhosis (fibrosis stage of F4), and moderate to severe necroinflammatory activity (necroinflammatory activity ≥A2) were 0.72 (95% CI: 0.64, 0.79), 0.71 (95% CI: 0.63, 0.78), and 0.64 (95% CI: 0.55, 0.71), respectively. The differences of AUCs were not apparent for the DS and LS combination model after excluding DS (fibrosis stage ≥F2: 0.00 [95% CI: 0.00, 0.01], fibrosis stage of F4: -0.01 [95% CI: -0.02, 0.00], and necroinflammatory activity ≥A2: 0.00 [95% CI: 0.00, 0.01]). Conclusion The addition of dispersion slope derived from two-dimensional shear-wave elastography did not improve the diagnostic performance in detecting liver fibrosis, necroinflammation, or steatosis in patients with primarily viral hepatitis. ClinicalTrials.gov registration no.: NCT03777293 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Xiao-Qing Zhang
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
| | - Rong-Qin Zheng
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
| | - Jie-Yang Jin
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
| | - Jin-Fen Wang
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
| | - Ting Zhang
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
| | - Jie Zeng
- From the Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou 510630, China
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Cassinotto C, Jacq T, Anselme S, Ursic-Bedoya J, Blanc P, Faure S, Belgour A, Guiu B. Diagnostic Performance of Attenuation to Stage Liver Steatosis with MRI Proton Density Fat Fraction as Reference: A Prospective Comparison of Three US Machines. Radiology 2022; 305:353-361. [PMID: 35819322 DOI: 10.1148/radiol.212846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background US tools to quantify liver fat content have recently been made clinically available by different vendors, but comparative data on their accuracy are lacking. Purpose To compare the diagnostic performances of the attenuation parameters of US machines from three different manufacturers (vendors 1, 2, and 3) in participants who underwent liver fat quantification with the MRI-derived proton density fat fraction (PDFF). Materials and Methods From July 2020 to June 2021, consecutive participants with chronic liver disease were enrolled in this prospective single-center study and underwent MRI PDFF quantification (reference standard) and US on the same day. US was performed with two different machines from among three vendors assessed. Areas under the receiver operating characteristic curve (AUCs) for the staging of liver steatosis (MRI PDFF: ≥5.5% for grade ≥S1 and ≥15.5% for grade ≥S2) were calculated in test and validation samples and then compared between vendors in the study sample. Results A total of 534 participants (mean age, 60 years ± 13 [SD]; 320 men) were evaluated. Failure of measurements occurred in less than 1% of participants for all vendors. Correlation coefficients with the MRI PDFF were 0.71, 0.73, and 0.54 for the attenuation coefficients of vendors 1, 2, and 3, respectively. In the test sample, AUCs for diagnosis of steatosis grade S1 and higher and grade S2 and higher were 0.89 and 0.93 for vendor 1 attenuation, 0.88 and 0.92 for vendor 2 attenuation, and 0.79 and 0.79 for vendor 3 attenuation, respectively. In the validation sample, a threshold value of 0.65 for vendor 1 and 0.66 for vendor 2 yielded sensitivity of 77% and 84% and specificity of 78% and 85%, respectively, for diagnosis of grade S1 and higher. Vendor 2 attenuation had greater AUCs than vendor 3 attenuation (P = .001 and P = .003) for diagnosis of grade S1 and higher and grade S2 and higher, respectively, and vender 2 had greater AUCs for attenuation than vendor 1 for diagnosis of grade S2 and higher (P = .04). For all vendors, attenuation was not associated with liver stiffness (correlation coefficients <0.05). Conclusion To stage liver steatosis, attenuation coefficient accuracy varied among US devices across vendors when using MRI proton density fat fraction quantification as the reference standard, with some demonstrating excellent diagnostic performance and similar cutoff values. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Dubinsky in this issue.
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Affiliation(s)
- Christophe Cassinotto
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Tony Jacq
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Sophie Anselme
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - José Ursic-Bedoya
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Pierre Blanc
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Stéphanie Faure
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Ali Belgour
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
| | - Boris Guiu
- From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.)
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Wu T, Ye J, Shao C, Lin Y, Wang W, Feng S, Zhong B. The Ability of Lipoprotein (a) Level to Predict Early Carotid Atherosclerosis Is Impaired in Patients With Advanced Liver Fibrosis Related to Metabolic-Associated Fatty Liver Disease. Clin Transl Gastroenterol 2022; 13:e00504. [PMID: 35608296 PMCID: PMC10476839 DOI: 10.14309/ctg.0000000000000504] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hepatic fibrosis reduces the serum level of lipoprotein (a) (Lp(a)) and may affect its accuracy in cardiovascular disease prediction of metabolic-associated fatty liver disease (MAFLD). We aimed to estimate the association between Lp(a) levels and the risk of carotid atherosclerosis in MAFLD patients with advanced fibrosis. METHODS This was a cross-sectional study enrolling 4,348 consecutive individuals (1,346 patients with MAFLD and 3,002 non-MAFLD patients) who were admitted to the First Affiliated Hospital, Sun Yat-sen University, and underwent abdominal and carotid ultrasonography from 2015 to 2021. Lp(a) levels, liver biochemical markers, metabolic indices, and anthropometric parameters were measured. Liver fat content and fibrosis severity were assessed by MRI-PDFF, using the NAFLD fibrosis score (NFS) and liver stiffness measurement (LSM) of two-dimensional shear wave elastography, respectively. RESULTS There was an L-shaped relationship between Lp(a) levels and LSMs in patients with MAFLD, and Lp(a) levels had a different relationship with liver fat content in MAFLD patients with F1-2 versus those with F3-4. Non-MAFLD patients had higher levels of Lp(a) than MAFLD patients with or without advanced fibrosis (both P < 0.05). Lp(a) levels and degree of liver fibrosis were both positively correlated with carotid atherosclerosis in patients with MAFLD. Lp(a) levels performed well on carotid atherosclerosis risk prediction for non-MAFLD patients with an area under the curve (AUC) of 0.819, which was significantly better than the carotid atherosclerosis risk prediction for MAFLD patients with NFS ≤ -1.836 (AUC: 0.781), NFS > -1.836 (AUC: 0.692), and LSM ≥ 9.0 kPa (AUC: 0.635) (all P < 0.05). DISCUSSION Advanced liver fibrosis significantly reduces the predictive value of Lp(a) levels for the risk of carotid atherosclerosis in patients with MAFLD.
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Affiliation(s)
- Tingfeng Wu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
| | - Junzhao Ye
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
| | - Congxiang Shao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
| | - Yansong Lin
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
| | - Wei Wang
- Department of Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
| | - Shiting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Bihui Zhong
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China;
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Jang JK, Lee ES, Seo JW, Kim YR, Kim SY, Cho YY, Lee DH. Two-dimensional Shear-Wave Elastography and US Attenuation Imaging for Nonalcoholic Steatohepatitis Diagnosis: A Cross-sectional, Multicenter Study. Radiology 2022; 305:118-126. [PMID: 35727151 DOI: 10.1148/radiol.220220] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Multiparametric US examination may have potential in the comprehensive evaluation of nonalcoholic fatty liver disease (NAFLD), but multicenter studies are lacking. Purpose To evaluate the diagnostic performance of multiparametric US with the attenuation coefficient (AC) from attenuation imaging (ATI) and liver stiffness (LS) and dispersion slope (DS) from two-dimensional (2D) shear-wave elastography (SWE) in a multicenter study of patients with NAFLD. Materials and Methods This prospective study enrolled consecutive participants between December 2019 and June 2021 with suspected nonalcoholic steatohepatitis (NASH) who were scheduled to undergo liver biopsy in five tertiary hospitals. Before the procedure, all participants underwent US with ATI and 2D SWE according to the study protocol. Multivariable linear regression analyses were performed to determine the significant determinant factors for AC, LS, and DS. Diagnostic performance was decided based on the areas under the receiver operating characteristic curve (AUCs). Results A total of 132 participants (median age, 38 years; IQR, 27-54 years; 69 women) were evaluated. Among the participant characteristics, including pathologic findings, demographic characteristics, body mass index, and serum markers, hepatic steatosis for AC (P < .001), lobular inflammatory activity for DS (P = .007), and both fibrosis (P = .01) and lobular inflammatory activity (P = .04) for LS were significant determinant factors. At histopathologic examination, 53 of the 132 participants (40.2%) had NASH. The risk score system obtained using unweighted sum of scores from AC and DS showed the best diagnostic performance in the detection of NASH (AUC = 0.94; 95% CI: 0.89, 0.98; P < .05 for all), as compared with serum markers or other US parameters alone (AUC ≤ 0.88). Conclusion US attenuation imaging and two-dimensional shear-wave elastography were useful for assessing hepatic steatosis, lobular inflammation, and fibrosis. The risk score system obtained using the attenuation coefficient and dispersion slope showed the best diagnostic performance fo r nonalcoholic steatohepatitis. cris.nih.go.kr no. KCT0004326 © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Jong Keon Jang
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Eun Sun Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Jung Wook Seo
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Youe Ree Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - So Yeon Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Young Youn Cho
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
| | - Dong Ho Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.K.J., S.Y.K.); Departments of Radiology (E.S.L.) and Internal Medicine (Y.Y.C.), Chung-Ang University Hospital, Seoul, Korea; Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi, Korea (J.W.S.); Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea (Y.R.K.); and Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (D.H.L.)
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Amioka N, Takaya Y, Nakamura K, Kondo M, Akazawa K, Ohno Y, Ichikawa K, Nakayama R, Saito Y, Akagi S, Miyoshi T, Yoshida M, Morita H, Ito H. Impact of shear wave dispersion slope analysis for assessing the severity of myocarditis. Sci Rep 2022; 12:8776. [PMID: 35610503 PMCID: PMC9130270 DOI: 10.1038/s41598-022-12935-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/17/2022] [Indexed: 12/19/2022] Open
Abstract
This study aimed to elucidate the utility of a novel ultrasound-based technique, shear wave dispersion slope (SWDS) analysis, which estimates tissue viscosity, for evaluating the severity of myocardial inflammation. Experimental autoimmune myocarditis (EAM) at different disease phases [3-week (acute phase): n = 10, 5-week (subacute phase): n = 9, and 7-week (late phase): n = 11] were developed in male Lewis rats. SWDS was measured in the right and the left ventricular free walls (RVFW and LVFW) under a retrograde perfusion condition. Histological myocardial inflammation was evaluated by CD68 staining. The accumulation of CD68-positive cells was severe in the myocardium of the EAM 3-week group. The median (interquartile range) SWDS of RVFW was significantly higher in the EAM 3-week group [9.9 (6.5-11.0) m/s/kHz] than in the control group [5.4 (4.5-6.8) m/s/kHz] (P = 0.034). The median SWDS of LVFW was also significantly higher in the EAM 3-week group [8.1 (6.4-11.0) m/s/kHz] than in the control group [4.4 (4.2-4.8) m/s/kHz] (P = 0.003). SWDS and the percentage of CD68-positive area showed a significant correlation in RVFW (R2 = 0.64, P < 0.001) and LVFW (R2 = 0.73, P < 0.001). This study showed that SWDS was elevated in ventricular walls with acute inflammation and also significantly correlated with the degree of myocardial inflammation. These results suggest the potential of SWDS in estimating the histological severity of acute myocarditis.
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Affiliation(s)
- Naofumi Amioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Kondo
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kaoru Akazawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yuko Ohno
- Kawasaki University of Medical Welfare, Okayama, Japan
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yukihiro Saito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masashi Yoshida
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Alves VPV, Dillman JR, Tkach JA, Bennett PS, Xanthakos SA, Trout AT. Comparison of Quantitative Liver US and MRI in Patients with Liver Disease. Radiology 2022; 304:660-669. [PMID: 35608446 DOI: 10.1148/radiol.212995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Quantitative US techniques can be used to identify changes of liver disease, but data regarding their diagnostic performance and relationship to MRI measures are sparse. Purpose To define associations between quantitative US and MRI measures of the liver in children, adolescents, and young adults with liver disease and to define the predictive ability of quantitative US measures to detect abnormal liver stiffening and steatosis defined with MRI. Materials and Methods In this prospective study, consecutive patients aged 8-21 years and known to have or suspected of having liver disease and body mass index less than 35 kg/m2 underwent 1.5-T MRI and quantitative liver US during the same visit at a pediatric academic medical center between April 2018 and December 2020. Acquired US parameters included shear-wave speed (SWS) and attenuation coefficient, among others. US parameters were compared with liver MR elastography and liver MRI proton density fat fraction (PDFF). Pearson correlation, multiple logistic regression, and receiver operating characteristic curve analyses were performed to assess associations and determine the performance of US relative to that of MRI. Results A total of 44 study participants (mean age, 16 years ± 4 [SD]; age range, 8-21 years; 23 male participants) were evaluated. There was a positive correlation between US SWS and MR elastography stiffness (r = 0.73, P < .001). US attenuation was positively correlated with MRI PDFF (r = 0.45, P = .001). For the prediction of abnormal (>2.8 kPa) liver shear stiffness, SWS (1.56 m/sec [7.3 kPa] cutoff) had an area under the receiver operating characteristic curve (AUC) of 0.95 with 91% sensitivity (95% CI: 71, 99) (20 of 22 participants) and 95% specificity (95% CI: 76, 99) (20 of 21 participants). For the prediction of abnormal (>5%) liver PDFF, US attenuation (0.55 dB/cm/MHz cutoff) had an AUC of 0.75 with a sensitivity of 73% (95% CI: 39, 94) (eight of 11 participants) and a specificity of 73% (95% CI: 55, 86) (24 of 33 participants). Conclusion In children, adolescents, and young adults with known or suspected liver disease, there was moderate to high correlation between US shear-wave speed (SWS) and MR elastography-derived stiffness. US SWS predicted an abnormal liver shear stiffness with high performance. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Khanna and Alazraki in this issue.
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Affiliation(s)
- Vinicius P V Alves
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan R Dillman
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jean A Tkach
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paula S Bennett
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stavra A Xanthakos
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew T Trout
- From the Department of Radiology (V.P.V.A, J.R.D., J.A.T., P.S.B., A.T.T.) and Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH 45226; and Departments of Radiology (J.R.D., A.T.T.) and Pediatrics (S.A.X., A.T.T.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Cetinic I, de Lange C, Simrén Y, Ekvall N, Östling M, Stén L, Boström H, Lagerstrand K, Hebelka H. Ultrasound Shear Wave Elastography, Shear Wave Dispersion and Attenuation Imaging of Pediatric Liver Disease with Histological Correlation. CHILDREN (BASEL, SWITZERLAND) 2022; 9:692. [PMID: 35626865 PMCID: PMC9139364 DOI: 10.3390/children9050692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
Aim: To evaluate the feasibility of multiple ultrasound markers for the non-invasive characterization of fibrosis, inflammation and steatosis in the liver in pediatric patients. Materials and methods: The quantitative ultrasound measures shear wave elastography (SWE), shear wave dispersion (SWD) and attenuation imaging (ATI) were compared and correlated with percutaneous liver biopsies and corresponding measures in a control cohort. Results: The median age of the 32 patients was 12.1 years (range 0.1−17.9), and that of the 15 controls was 11.8 years (range: 2.6−16.6). Results: There was a significant difference in SWE values between histologic grades of fibrosis (p = 0.003), with a positive correlation according to the grade (r = 0.7; p < 0.0001). Overall, a difference in SWD values between grades of inflammation was found (p = 0.009) but with a lack of correlation (r = 0.1; p = 0.67). Comparing inflammation grades 0−1 (median:13.6 m/s kHz [min; max; 8.4; 17.5]) versus grades 2−3 (16.3 m/s kHz [14.6; 24.2]) showed significant differences between the groups (p = 0.003). In the 30 individuals with a steatosis score of 0, ATI was measured in 23 cases with a median value of 0.56 dB/cm/MHz. Conclusion: Comprehensive ultrasound analysis was feasible to apply in children and has the potential to reflect the various components of liver affection non-invasively. Larger studies are necessary to conclude to what extent these image-based markers can classify the grade of fibrosis, inflammation and steatosis.
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Affiliation(s)
- Ivan Cetinic
- Department of Radiology & Pediatric Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (C.d.L.); (Y.S.); (H.B.); (H.H.)
| | - Charlotte de Lange
- Department of Radiology & Pediatric Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (C.d.L.); (Y.S.); (H.B.); (H.H.)
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Yvonne Simrén
- Department of Radiology & Pediatric Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (C.d.L.); (Y.S.); (H.B.); (H.H.)
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Nils Ekvall
- Department of Pediatric Medicine, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden;
| | - Maja Östling
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.Ö.); (L.S.)
| | - Liselotte Stén
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.Ö.); (L.S.)
| | - Håkan Boström
- Department of Radiology & Pediatric Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (C.d.L.); (Y.S.); (H.B.); (H.H.)
| | - Kerstin Lagerstrand
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden;
| | - Hanna Hebelka
- Department of Radiology & Pediatric Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (C.d.L.); (Y.S.); (H.B.); (H.H.)
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
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The effect of the skin-liver capsule distance on the accuracy of ultrasound diagnosis for liver steatosis and fibrosis. J Med Ultrason (2001) 2022; 49:443-450. [PMID: 35524897 DOI: 10.1007/s10396-022-01210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Transient elastography (TE) and the controlled attenuation parameter (CAP) have been used for diagnosis of liver fibrosis and steatosis. Obesity is a limiting factor to the accuracy of elastography; however, an XL probe was validated for use in obese patients. Two-dimensional shear wave elastography (2D-SWE) and attenuation imaging (ATI) have also been developed. It is unknown if obesity affects 2D-SWE/ATI values for evaluation of liver fibrosis and steatosis. We assessed the reliability of the measurement rate and the diagnostic performance of TE/CAP versus SWE/ATI. METHODS The patients (n = 85) underwent TE/CAP, 2D-SWE/ATI, and liver biopsy on the same day. They were diagnosed with chronic hepatitis based on liver biopsy. The patients were divided into three groups by skin-liver capsule distance (SCD). RESULTS The reliability of the measurement rate for the M probe was lower than that for the XL probe in the group with SCD over 22.5 mm. The rate achieved with 2D-SWE was high in all groups regardless of the SCD. In the assessment of the diagnostic performance, there was no difference between the area under the receiver-operating curve (AUROC) of TE compared to 2D-SWE to stratify the fibrosis stage. There was no difference in the AUROC for the stratification of the steatosis grades between CAP and ATI. The diagnostic accuracy of TE for F ≥ 3 fibrosis evaluated with the M probe and 2D-SWE was lower than that of TE evaluated with the XL probe in the group with SCD over 22.5 mm. CONCLUSION The ability of 2D-SWE to stratify fibrosis stage and steatosis grade was as good as FibroScan. However, 2D-SWE had a high reliability in the measurement rate regardless of the SCD with one probe. And the XL probe showed high diagnostic accuracy for severe fibrosis in the group with SCD over 22.5 mm.
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Ito K. US-derived Fat Fraction Screening of Hepatic Steatosis. Radiology 2022; 304:83-84. [PMID: 35348384 DOI: 10.1148/radiol.213052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katsuyoshi Ito
- From the Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-8505, Japan
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Rehman A, Darira J, Hamid K, Ahmed MS, Shazlee MK, Amirali A. Relationship Between Greyscale Ultrasound Grading of Hepatic Steatosis and Attenuation Imaging. Cureus 2022; 14:e23435. [PMID: 35494925 PMCID: PMC9038208 DOI: 10.7759/cureus.23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed. Method A total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI’s diagnostic capability and cutoff values. Result The correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p < 0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively. Conclusions Attenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.
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