1
|
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:S0301-5629(24)00143-1. [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] [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.
Collapse
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
| |
Collapse
|
2
|
Kang CC, Wang TE, Liu CY, Chen MJ, Wang HY, Chang CW, Chang CW. Update on Imaging-based Noninvasive Methods for Assessing Hepatic Steatosis in Nonalcoholic Fatty Liver Disease. J Med Ultrasound 2024; 32:116-120. [PMID: 38882614 PMCID: PMC11175382 DOI: 10.4103/jmu.jmu_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/03/2023] [Accepted: 10/07/2023] [Indexed: 06/18/2024] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), among the most common chronic liver diseases worldwide, affects approximately 25% of the global population. Its incidence is increasing owing to various risk factors, including genetic variation, metabolic health, dietary habits, and microbiota. Hepatic steatosis is a critical histological characteristic of NAFLD. Evaluating liver fat content is vital for identifying and following up with patients at risk of developing NAFLD. NAFLD includes simple liver steatosis and more severe forms such as inflammation, nonalcoholic steatohepatitis, fibrosis, and cirrhosis. The early assessment of fatty liver is important for reversing liver disease progression. Metabolic (dysfunction)-associated fatty liver disease recently replaced NAFLD as the most common hepatic disease worldwide. This article reviews the current state of noninvasive imaging, especially ultrasound, for liver fat quantification.
Collapse
Affiliation(s)
- Chia-Chien Kang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Tsang-En Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Chia-Yuan Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Chen-Wang Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Ching-Wei Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
3
|
Rocca A, Komici K, Brunese MC, Pacella G, Avella P, Di Benedetto C, Caiazzo C, Zappia M, Brunese L, Vallone G. Quantitative ultrasound (QUS) in the evaluation of liver steatosis: data reliability in different respiratory phases and body positions. LA RADIOLOGIA MEDICA 2024; 129:549-557. [PMID: 38512608 PMCID: PMC11021279 DOI: 10.1007/s11547-024-01786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Liver steatosis is the most common chronic liver disease and affects 10-24% of the general population. As the grade of disease can range from fat infiltration to steatohepatitis and cirrhosis, an early diagnosis is needed to set the most appropriate therapy. Innovative noninvasive radiological techniques have been developed through MRI and US. MRI-PDFF is the reference standard, but it is not so widely diffused due to its cost. For this reason, ultrasound tools have been validated to study liver parenchyma. The qualitative assessment of the brightness of liver parenchyma has now been supported by quantitative values of attenuation and scattering to make the analysis objective and reproducible. We aim to demonstrate the reliability of quantitative ultrasound in assessing liver fat and to confirm the inter-operator reliability in different respiratory phases. We enrolled 45 patients examined during normal breathing at rest, peak inspiration, peak expiration, and semi-sitting position. The highest inter-operator agreement in both attenuation and scattering parameters was achieved at peak inspiration and peak expiration, followed by semi-sitting position. In conclusion, this technology also allows to monitor uncompliant patients, as it grants high reliability and reproducibility in different body position and respiratory phases.
Collapse
Affiliation(s)
- Aldo Rocca
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy.
| | - Giulia Pacella
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Pasquale Avella
- Department of General Surgery, Center for Hepatobiliary and Pancreatic Surgery, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Chiara Di Benedetto
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100, Campobasso, Italy
| |
Collapse
|
4
|
Byenfeldt M, Kihlberg J, Nasr P, Grönlund C, Lindam A, Bartholomä WC, Lundberg P, Ekstedt M. Altered probe pressure and body position increase diagnostic accuracy for men and women in detecting hepatic steatosis using quantitative ultrasound. Eur Radiol 2024:10.1007/s00330-024-10655-1. [PMID: 38459346 DOI: 10.1007/s00330-024-10655-1] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To evaluate the diagnostic performance of ultrasound guided attenuation parameter (UGAP) for evaluating liver fat content with different probe forces and body positions, in relation to sex, and compared with proton density fat fraction (PDFF). METHODS We prospectively enrolled a metabolic dysfunction-associated steatotic liver disease (MASLD) cohort that underwent UGAP and PDFF in the autumn of 2022. Mean UGAP values were obtained in supine and 30° left decubitus body position with normal 4 N and increased 30 N probe force. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS Among 60 individuals (mean age 52.9 years, SD 12.9; 30 men), we found the best diagnostic performance with increased probe force in 30° left decubitus position (AUC 0.90; 95% CI 0.82-0.98) with a cut-off of 0.58 dB/cm/MHz. For men, the best performance was in supine (AUC 0.91; 95% CI 0.81-1.00) with a cut-off of 0.60 dB/cm/MHz, and for women, 30° left decubitus position (AUC 0.93; 95% CI 0.83-1.00), with a cut-off 0.56 dB/cm/MHz, and increased 30 N probe force for both genders. No difference was in the mean UGAP value when altering body position. UGAP showed good to excellent intra-reproducibility (Intra-class correlation 0.872; 95% CI 0.794-0.921). CONCLUSION UGAP provides excellent diagnostic performance to detect liver fat content in metabolic dysfunction-associated steatotic liver diseases, with good to excellent intra-reproducibility. Regardless of sex, the highest diagnostic accuracy is achieved with increased probe force with men in supine and women in 30° left decubitus position, yielding different cut-offs. CLINICAL RELEVANCE STATEMENT The ultrasound method ultrasound-guided attenuation parameter shows excellent diagnostic accuracy and performs with good to excellent reproducibility. There is a possibility to alter body position and increase probe pressure, and different performances for men and women should be considered for the highest accuracy. KEY POINTS • There is a possibility to alter body position when performing the ultrasound method ultrasound-guided attenuation parameter. • Increase probe pressure for the highest accuracy. • Different performances for men and women should be considered.
Collapse
Affiliation(s)
- Marie Byenfeldt
- Department of Radiology in Östersund, Östersund, Sweden.
- Department of Radiation Science, Umeå University, Umeå, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Johan Kihlberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Radiology in Linköping, Linköping, Sweden
| | - Patrik Nasr
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Anna Lindam
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Wolf C Bartholomä
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Radiology in Linköping, Linköping, Sweden
| | - Peter Lundberg
- Department of Radiation Physics, Linköping University, Linköping, Sweden
- Department of Medical and Health Science in Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Zhang X, Luo L, Liu H, Liang S, Xu E. Reliability and stability of ultrasound-guided attenuation parameter in evaluating hepatic steatosis. J Ultrasound 2024; 27:145-152. [PMID: 38281291 PMCID: PMC10908761 DOI: 10.1007/s40477-023-00856-7] [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: 08/14/2023] [Accepted: 12/03/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE This study aimed to explore the reliability and stability of ultrasound-guided attenuation parameter (UGAP) values obtained by two measuring methods and different measuring times. METHODS Patients who underwent liver UGAP examinations in our hospital from September 2022 to December 2022 were retrospectively analyzed. The clinical data and UGAP measurements results were collected. Two different measuring methods: static single-frame multi-point measuring and dynamic multi-frame single-point measuring, were performed for each patient, and 10 UGAP values of each measuring method were recorded. The medians of the UGAP values of the 1st-3rd, 1st-5th, 1st-7th and 1st-10th by each measuring method were taken as the final UGAP values of measuring 3, 5, 7 and 10 times. The UGAP values obtained by the two different measuring methods and different measuring times (3, 5, 7 or 10 times) were compared. RESULTS 206 patients were included in this study. There was no statistical difference between UGAP values measured by static single-frame multi-point measuring and dynamic multi-frame single-point measuring (P = 0.689, P = 0.270, P = 0.298, P = 0.091), regardless of measuring times (3, 5, 7, 10 times). No significant difference between the UGAP values obtained by 3, 5, 7 and 10 measurements was found (P = 0.554, P = 0.916). CONCLUSION The UGAP values obtained by the two different measuring methods and different measuring times (3, 5, 7 and 10 times) are stable and reliable. Additionally, 3 times of UGAP measurements might be enough for each patient in clinical practice.
Collapse
Affiliation(s)
- Xiaodan Zhang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, China
| | - Liping Luo
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025, Shennanzhong Road, Shenzhen, 518033, China.
| |
Collapse
|
6
|
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%.
Collapse
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.)
| |
Collapse
|
7
|
Ujihara Y, Tamura K, Mori S, Tai DI, Tsui PH, Hirata S, Yoshida K, Maruyama H, Yamaguchi T. Modified multi-Rayleigh model-based statistical analysis of ultrasound envelope for quantification of liver steatosis and fibrosis. J Med Ultrason (2001) 2024; 51:5-16. [PMID: 37796397 PMCID: PMC10991033 DOI: 10.1007/s10396-023-01354-3] [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: 03/29/2023] [Accepted: 07/26/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Quantitative diagnosis of the degree of fibrosis progression is currently a focus of attention for fatty liver in nonalcoholic steatohepatitis (NASH). However, previous studies have focused on either lipid droplets or fibrotic tissue, and few have reported the evaluation of both in patients whose livers contain adipose and fibrous features. Our aim was to evaluate fibrosis tissue and lipid droplets in the liver. METHODS We used an analytical method combining the multi-Rayleigh (MRA) model and a healthy liver structure filter (HLSF) as a technique for statistical analysis of the amplitude envelope to estimate fat and fibrotic volumes in clinical datasets with different degrees of fat and fibrosis progression. RESULTS Fat mass was estimated based on the non-MRA fraction corresponding to the signal characteristics of aggregated lipid droplets. Non-MRA fraction has a positive correlation with fat mass and is effective for detecting moderate and severe fatty livers. Progression of fibrosis was estimated using MRA parameters in combination with the HLSF. The proposed method was used to extract non-healthy areas with characteristics of fibrotic tissue. Fibrosis in early fatty liver suggested the possibility of evaluation. On the other hand, fat was identified as a factor that reduced the accuracy of estimating fibrosis progression in moderate and severe fatty livers. CONCLUSION The proposed method was used to simultaneously evaluate fat mass and fibrosis progression in early fatty liver, suggesting the possibility of quantitative evaluation for discriminating between lipid droplets and fibrous tissue in the early fatty liver.
Collapse
Affiliation(s)
- Yuki Ujihara
- Graduate School of Science and Engineering, Chiba University, 1-33 Yayoicho, Inage, Chiba, 2638522, Japan
| | - Kazuki Tamura
- Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, 4313192, Japan
| | - Shohei Mori
- Graduate School of Engineering, Tohoku University, Sendai, Miyagi, 9808579, Japan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 33305, Taiwan
| | - Po-Hsiang Tsui
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, 33305, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, 33305, Taiwan
| | - Shinnosuke Hirata
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage, Chiba, 2638522, Japan
| | - Kenji Yoshida
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage, Chiba, 2638522, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Bunkyo, Tokyo, 1138421, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage, Chiba, 2638522, Japan.
| |
Collapse
|
8
|
Hwang SM, Cho KY. Noninvasive assessment of paediatric hepatic steatosis by using attenuation imaging. Eur Radiol 2023; 33:8353-8365. [PMID: 37195431 PMCID: PMC10189215 DOI: 10.1007/s00330-023-09731-9] [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: 11/12/2022] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of attenuation imaging (ATI) with an ultrasound scanner (US) in the detection of paediatric hepatic steatosis. METHODS Ninety-four prospectively enrolled children were classified into normal weight and overweight/obese (OW/OB) groups according to body mass index (BMI). US findings, including hepatic steatosis grade and ATI value, were examined by two radiologists. Anthropometric and biochemical parameters were obtained, and nonalcoholic fatty liver disease (NAFLD) scores, including the Framingham steatosis index (FSI) and hepatic steatosis index (HSI), were calculated. RESULTS After screening, 49 OW/OB and 40 normal weight children aged 10-18 years old (55 males and 34 females) participated in this study. The ATI value was significantly higher in the OW/OB group than in the normal weight group and showed a significant positive correlation with BMI, serum alanine transferase (ALT), uric acid, and NAFLD scores (p < 0.05). In the multiple linear regression adjusted for age, sex, BMI, ALT, uric acid, and HSI, ATI showed a significant positive association with BMI and ALT (p < 0.05). The receiver operating characteristic analysis showed a very good ability of ATI to predict hepatic steatosis. The intraclass correlation coefficient (ICC) of interobserver variability was 0.92, and the ICCs of intraobserver variability were 0.96 and 0.93 (p < 0.05). According to the two-level Bayesian latent class model analysis, the diagnostic performance of ATI showed the best performance for predicting hepatic steatosis among other known noninvasive NAFLD predictors. CONCLUSIONS This study suggests that ATI is an objective and possible surrogate screening test for detecting hepatic steatosis in paediatric patients with obesity. CLINICAL RELEVANCE STATEMENT Using ATI as a quantitative tool in hepatic steatosis allows clinicians to estimate the extent of the condition and track changes over time. This is helpful for monitoring disease progression and guiding treatment decisions, especially in paediatric practice. KEY POINTS • Attenuation imaging is a noninvasive US-based method for the quantification of hepatic steatosis. • Attenuation imaging values were significantly higher in the OW/OB and steatosis groups than in the normal weight and no steatosis groups, respectively, with a meaningful correlation with known clinical indicators of nonalcoholic fatty liver disease. • Attenuation imaging performs better than other noninvasive predictive models used to diagnose hepatic steatosis.
Collapse
Affiliation(s)
- Sook Min Hwang
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, 07441, Korea
| | - Ky Young Cho
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Korea.
| |
Collapse
|
9
|
Kuroda H, Oguri T, Kamiyama N, Toyoda H, Yasuda S, Imajo K, Suzuki Y, Sugimoto K, Akita T, Tanaka J, Yasui Y, Kurosaki M, Izumi N, Nakajima A, Fujiwara Y, Abe T, Kakisaka K, Matsumoto T, Kumada T. Multivariable Quantitative US Parameters for Assessing Hepatic Steatosis. Radiology 2023; 309:e230341. [PMID: 37787670 DOI: 10.1148/radiol.230341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Because of the global increase in the incidence of nonalcoholic fatty liver disease, the development of noninvasive, widely available, and highly accurate methods for assessing hepatic steatosis is necessary. Purpose To evaluate the performance of models with different combinations of quantitative US parameters for their ability to predict at least 5% steatosis in patients with chronic liver disease (CLD) as defined using MRI proton density fat fraction (PDFF). Materials and Methods Patients with CLD were enrolled in this prospective multicenter study between February 2020 and April 2021. Integrated backscatter coefficient (IBSC), signal-to-noise ratio (SNR), and US-guided attenuation parameter (UGAP) were measured in all participants. Participant MRI PDFF value was used to define at least 5% steatosis. Four models based on different combinations of US parameters were created: model 1 (UGAP alone), model 2 (UGAP with IBSC), model 3 (UGAP with SNR), and model 4 (UGAP with IBSC and SNR). Diagnostic performance of all models was assessed using area under the receiver operating characteristic curve (AUC). The model was internally validated using 1000 bootstrap samples. Results A total of 582 participants were included in this study (median age, 64 years; IQR, 52-72 years; 274 female participants). There were 364 participants in the steatosis group and 218 in the nonsteatosis group. The AUC values for steatosis diagnosis in models 1-4 were 0.92, 0.93, 0.95, and 0.96, respectively. The C-indexes of models adjusted by the bootstrap method were 0.92, 0.93, 0.95, and 0.96, respectively. Compared with other models, models 3 and 4 demonstrated improved discrimination of at least 5% steatosis (P < .01). Conclusion A model built using the quantitative US parameters UGAP, IBSC, and SNR could accurately discriminate at least 5% steatosis in patients with CLD. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Han in this issue.
Collapse
Affiliation(s)
- Hidekatsu Kuroda
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Takuma Oguri
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Naohisa Kamiyama
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Hidenori Toyoda
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Satoshi Yasuda
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Kento Imajo
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Yasuaki Suzuki
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Katsutoshi Sugimoto
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Tomoyuki Akita
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Junko Tanaka
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Yutaka Yasui
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Masayuki Kurosaki
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Namiki Izumi
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Atsushi Nakajima
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Yudai Fujiwara
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Tamami Abe
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Keisuke Kakisaka
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Takayuki Matsumoto
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| | - Takashi Kumada
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-cho, Shiwa-gun, Iwate 028-3694, Japan (H.K., Y.F., T. Abe, K.K., T.M.); Ultrasound General Imaging, GE HealthCare, Hino, Japan (T.O., N.K.); Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan (H.T., S.Y.); Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan (K.I.); Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan (Y.S.); Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan (K.S.); Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan (T. Akita, J.T.); Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan (Y.Y., M.K., N.I.); Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan (A.N.); and Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan (T.K.)
| |
Collapse
|
10
|
Kakisaka K, Kuroda H, Abe T, Nakaya I, Watanabe T, Yusa K, Sato H, Suzuki A, Kooka Y, Endo K, Yoshida Y, Oikawa T, Miyasaka A, Matsumoto T. Coincidental items in the definition of metabolic dysfunction-associated fatty liver are useful in identifying patients having significant fibrosis with fatty liver. Hepatol Res 2023; 53:857-865. [PMID: 37269213 DOI: 10.1111/hepr.13928] [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: 01/10/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
AIM We aimed to establish a method that will identify patients at a high risk for progressive phenotype of fatty liver. METHODS Patients with fatty liver who underwent liver biopsy between July 2008 and November 2019 were included as cohort 1, and those who underwent abdominal ultrasound screening examination by general physicians between August 2020 and May 2022 served as cohort 2. According to the definition of metabolic dysfunction-associated fatty liver (MAFLD), the subjects were classified by body mass index of ≥23, diabetes mellitus, and coexistence of two or more metabolic risk items. The progressive phenotype of MAFLD is defined by significant fibrosis complicated with either nonalcoholic fatty liver disease activity score ≥4 (BpMAFLD) or steatosis grade ≥2 by ultrasound examination (UpMAFLD). RESULTS One hundred sixty-eight patients and 233 patients were enrolled in cohorts 1 and 2, respectively. In cohort 1, the prevalence of BpMAFLD was 0% in patients without a complicating factor (n = 10), 13% in those with one complicating factor (n = 67), 32% in those with two (n = 73), and 44% in those with all three complicating factors (n = 36). A logistic regression analysis revealed that factors in the MAFLD definition were significantly associated with BpMAFLD. In cohort 2, a criterion of two or more positive MAFLD definitions was found to have a 97.4% negative predictive value for the diagnosis of UpMAFLD. CONCLUSION Patients with two or more complicating factors in the MAFLD definition should have further evaluation for liver fibrosis.
Collapse
Affiliation(s)
- Keisuke Kakisaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Ippeki Nakaya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Takuya Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Kenji Yusa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Akiko Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yohei Kooka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Kei Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yuichi Yoshida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Takayoshi Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Akio Miyasaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Şendur HN, Cerit MN, Fatullayeva T, Erdal ZS, Karabörk Kılıç AC, Özhan Oktar S. Do Ultrasound Based Quantitative Hepatic Fat Content Measurements Have Differences Between Respiratory Phases? Acad Radiol 2023; 30:1832-1837. [PMID: 36628802 DOI: 10.1016/j.acra.2022.12.021] [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: 11/07/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES The recently developed ultrasound based tools using attenuation coefficient (AC) and scatter distribution coefficient (SDC) values can be used to quantify hepatic fat content in patients with non-alcoholic fatty liver disease (NAFLD). However, currently the impact of respiratory phase on these measurements is not known. The purpose of this study is to compare AC and SDC measurements acquired at peak inspiration and end expiration phases. MATERIALS AND METHODS AC and SDC measurements were obtained in 50 patients with NAFLD. Tissue Attenuation Imaging (TAI) and Tissue Scatter Distribution Imaging (TSI) tools were utilized to measure AC and SDC values, respectively. Five measurements were performed at respiratory phases using TAI and TSI tools and the median values were noted. Subgroup analyses were performed and Wilcoxon signed rank test was used for comparison of the measurements. RESULTS The median values of the AC measurements at peak inspiration and end expiration phases were 0.87 dB/cm/MHz and 0.89 dB/cm/MHz, respectively. The median values of the SDC measurements at peak inspiration and end expiration phases were 97.91 and 96.62, respectively. There were no statistically significant differences in AC and SDC measurements between the respiratory phases except for AC measurements in BMI <30 kg/m2 subgroup. CONCLUSION Our results revealed that respiratory phases have no impact on SDC measurements. However, while the AC measurements in BMI ≥30 kg/m2 subgroup showed no significant difference, there was a significant difference in AC measurements in BMI <30 kg/m2 subgroup between the respiratory phases.
Collapse
Affiliation(s)
- Halit Nahit Şendur
- Department of Radiology, Gazi University Faculty of Medicine, Yenimahalle, Ankara, Turkey.
| | - Mahi N Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Yenimahalle, Ankara, Turkey
| | - Turkana Fatullayeva
- Department of Radiology, Gazi University Faculty of Medicine, Yenimahalle, Ankara, Turkey
| | - Zeynep S Erdal
- Department of Radiology, Gazi University Faculty of Medicine, Yenimahalle, Ankara, Turkey
| | | | - Suna Özhan Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Yenimahalle, Ankara, Turkey
| |
Collapse
|
13
|
Collin R, Magnin B, Gaillard C, Nicolas C, Abergel A, Buchard B. Prospective study comparing hepatic steatosis assessment by magnetic resonance imaging and four ultrasound methods in 105 successive patients. World J Gastroenterol 2023; 29:3548-3560. [PMID: 37389233 PMCID: PMC10303516 DOI: 10.3748/wjg.v29.i22.3548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/04/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is becoming a major health problem, resulting in hepatic, metabolic and cardio-vascular morbidity.
AIM To evaluate new ultrasonographic tools to detect and measure hepatic steatosis.
METHODS We prospectively included 105 patients referred to our liver unit for NAFLD suspicion or follow-up. They underwent ultrasonographic measurement of liver sound speed estimation (SSE) and attenuation coefficient (AC) using Aixplorer MACH 30 (Supersonic Imagine, France), continuous controlled attenuation parameter (cCAP) using Fibroscan (Echosens, France) and standard liver ultrasound with hepato-renal index (HRI) calculation. Hepatic steatosis was then classified according to magnetic resonance imaging proton density fat fraction (PDFF). Receiver operating curve (ROC) analysis was performed to evaluate the diagnostic performance in the diagnosis of steatosis.
RESULTS Most patients were overweight or obese (90%) and had metabolic syndrome (70%). One third suffered from diabetes. Steatosis was identified in 85 patients (81%) according to PDFF. Twenty-one patients (20%) had advanced liver disease. SSE, AC, cCAP and HRI correlated with PDFF, with respective Spearman correlation coefficient of -0.39, 0.42, 0.54 and 0.59 (P < 0.01). Area under the receiver operating characteristic curve (AUROC) for detection of steatosis with HRI was 0.91 (0.83-0.99), with the best cut-off value being 1.3 (Se = 83%, Sp = 98%). The optimal cCAP threshold of 275 dB/m, corresponding to the recent EASL-suggested threshold, had a sensitivity of 72% and a specificity of 80%. Corresponding AUROC was 0.79 (0.66-0.92). The diagnostic accuracy of cCAP was more reliable when standard deviation was < 15 dB/m with an AUC of 0.91 (0.83-0.98). An AC threshold of 0.42 dB/cm/MHz had an AUROC was 0.82 (0.70-0.93). SSE performed moderately with an AUROC of 0.73 (0.62-0.84).
CONCLUSION Among all ultrasonographic tools evaluated in this study, including new-generation tools such as cCAP and SSE, HRI had the best performance. It is also the simplest and most available method as most ultrasound scans are equipped with this module.
Collapse
Affiliation(s)
- Remi Collin
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges 87000, France
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Benoit Magnin
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Constance Gaillard
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Carine Nicolas
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Armand Abergel
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| | - Benjamin Buchard
- Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
| |
Collapse
|
14
|
Jang W, Song JS. Non-Invasive Imaging Methods to Evaluate Non-Alcoholic Fatty Liver Disease with Fat Quantification: A Review. Diagnostics (Basel) 2023; 13:diagnostics13111852. [PMID: 37296703 DOI: 10.3390/diagnostics13111852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Hepatic steatosis without specific causes (e.g., viral infection, alcohol abuse, etc.) is called non-alcoholic fatty liver disease (NAFLD), which ranges from non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), fibrosis, and NASH-related cirrhosis. Despite the usefulness of the standard grading system, liver biopsy has several limitations. In addition, patient acceptability and intra- and inter-observer reproducibility are also concerns. Due to the prevalence of NAFLD and limitations of liver biopsies, non-invasive imaging methods such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) that can reliably diagnose hepatic steatosis have developed rapidly. US is widely available and radiation-free but cannot examine the entire liver. CT is readily available and helpful for detection and risk classification, significantly when analyzed using artificial intelligence; however, it exposes users to radiation. Although expensive and time-consuming, MRI can measure liver fat percentage with magnetic resonance imaging proton density fat fraction (MRI-PDFF). Specifically, chemical shift-encoded (CSE)-MRI is the best imaging indicator for early liver fat detection. The purpose of this review is to provide an overview of each imaging modality with an emphasis on the recent progress and current status of liver fat quantification.
Collapse
Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Jeonbuk, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, Republic of Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Jeonbuk, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Jeonbuk, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, Republic of Korea
| |
Collapse
|
15
|
Zeng KY, Bao WYG, Wang YH, Liao M, Yang J, Huang JY, Lu Q. Non-invasive evaluation of liver steatosis with imaging modalities: New techniques and applications. World J Gastroenterol 2023; 29:2534-2550. [PMID: 37213404 PMCID: PMC10198053 DOI: 10.3748/wjg.v29.i17.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/26/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the world, nonalcoholic fatty liver disease (NAFLD) accounts for majority of diffuse hepatic diseases. Notably, substantial liver fat accumulation can trigger and accelerate hepatic fibrosis, thus contributing to disease progression. Moreover, the presence of NAFLD not only puts adverse influences for liver but is also associated with an increased risk of type 2 diabetes and cardiovascular diseases. Therefore, early detection and quantified measurement of hepatic fat content are of great importance. Liver biopsy is currently the most accurate method for the evaluation of hepatic steatosis. However, liver biopsy has several limitations, namely, its invasiveness, sampling error, high cost and moderate intraobserver and interobserver reproducibility. Recently, various quantitative imaging techniques have been developed for the diagnosis and quantified measurement of hepatic fat content, including ultrasound- or magnetic resonance-based methods. These quantitative imaging techniques can provide objective continuous metrics associated with liver fat content and be recorded for comparison when patients receive check-ups to evaluate changes in liver fat content, which is useful for longitudinal follow-up. In this review, we introduce several imaging techniques and describe their diagnostic performance for the diagnosis and quantified measurement of hepatic fat content.
Collapse
Affiliation(s)
- Ke-Yu Zeng
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wu-Yong-Ga Bao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yun-Han Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min Liao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
16
|
Weijers G, Munsterman ID, Thijssen JM, Kuppeveld H, Drenth JPH, Tjwa ETTL, de Korte CL. Noninvasive Staging of Hepatic Steatosis Using Calibrated 2D US with Liver Biopsy as the Reference Standard. Radiology 2023; 306:e220104. [PMID: 36255308 DOI: 10.1148/radiol.220104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Accumulation of lipid in the liver (ie, hepatic steatosis) is the basis of nonalcoholic fatty liver disease (NAFLD). Asymptomatic steatosis can lead to nonalcoholic steatohepatitis and downstream complications. Purpose To assess the diagnostic performance of calibrated US (CAUS) as a method for detection and staging of hepatic steatosis in comparison with liver biopsy. Materials and Methods Two-dimensional US images in 223 consecutive patients who underwent US-guided liver biopsy from May 2012 to February 2016 were retrospectively analyzed by two observers using CAUS. CAUS semiautomatically estimates echo-level and texture parameters, with particular interest in the residual attenuation coefficient (RAC), which is the remaining steatosis-driven attenuation obtained after correction of the beam profile. Data were correlated with patient characteristics and histologically determined steatosis grades and fibrosis stages. The data were equally divided into training and test sets to independently train and test logistic regression models for detection (>5% fat) and staging (>33% and >66% fat) of hepatic steatosis by using area under the receiver operating characteristic curve (AUC) analysis. Results A total of 195 patients (mean age, 50 years ± 13 [SD]; 110 men) were included and divided into a training set (n = 97 [50%]) and a test set (n = 98 [50%]). The average CAUS interobserver correlation coefficient was 0.95 (R range, 0.87-0.99). The best correlation with steatosis was found for the RAC parameter (R = 0.78, P < .01), while no correlation was found for fibrosis (R = 0.14, P = .054). Steatosis detection using RAC showed an AUC of 0.97 (95% CI: 0.94, 1.00), and the multivariable AUC was found to be 0.97 (95% CI: 0.95, 1.00). The predictive performance for moderate and severe hepatic steatosis using RAC was 0.93 (95% CI: 0.88, 0.98) and 0.93 (95% CI: 0.87, 0.98), respectively. Conclusion The calibrated US parameter residual attenuation coefficient detects and stages steatosis accurately with limited interobserver variability, and performance is not hampered by the presence of fibrosis. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Grant in this issue.
Collapse
Affiliation(s)
- Gert Weijers
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Isabelle D Munsterman
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Johan M Thijssen
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Hans Kuppeveld
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Joost P H Drenth
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Eric T T L Tjwa
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| | - Chris L de Korte
- From the Medical UltraSound Imaging Center (MUSIC), Department of Medical Imaging, Radboud Institute for Health Sciences (G.W., J.M.T., H.K., C.L.d.K.), and Department of Gastroenterology and Hepatology (I.D.M., J.P.H.D., E.T.T.L.T.), Radboud University Medical Center, Geert Grootepleinzuid 10, Nijmegen 6500 HB, the Netherlands
| |
Collapse
|
17
|
Solberg S, Amini N, Zaza Y, Angelsen BAJ, Hansen R. Estimation of fat content in soft tissues using dual frequency ultrasound-A phantom study. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:1766. [PMID: 37002069 DOI: 10.1121/10.0017601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/25/2023] [Indexed: 05/18/2023]
Abstract
This paper presents an initial investigation into the use of dual frequency pulse-echo ultrasound, second order ultrasound field (SURF) imaging, to measure the fat content of soft tissues. The SURF imaging method was used to measure the non-linear bulk elasticity (NBE) of several fatty phantoms that were created by mixing different mass fractions of soybean oil uniformly into agar phantoms. The median of the measured NBE within the estimation region was found to increase linearly with fat mass fraction (R2 = 0.99), from 1.7 GPa-1 at 9.6% fat to 2.52 GPa-1 at 63.6% fat, thus, showing promise as a sensitive parameter for fat content measurement. Comparisons to mixture laws in earlier literature are made, and the most important error sources that need to be considered for the in vivo applications of the method are discussed.
Collapse
Affiliation(s)
| | | | - Yamen Zaza
- SURF Technology AS, 7491 Trondheim, Norway
| | - Bjørn A J Angelsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Rune Hansen
- Department of Health Research, SINTEF Digital, 7465 Trondheim, Norway
| |
Collapse
|
18
|
Ultrasound-based hepatic fat quantification: current status and future directions. Clin Radiol 2023; 78:187-200. [PMID: 36411088 DOI: 10.1016/j.crad.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/19/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease from fatty accumulation (steatosis), necro-inflammation though to fibrosis. It is of increasing global prevalence as a hepatic manifestation of the metabolic syndrome. Although accurate histopathology and magnetic resonance imaging techniques for hepatic fat quantification exist, these are limited by invasiveness and availability, respectively. Ultrasonography is potentially ideal for assessing and monitoring hepatic steatosis given the examination is rapid and readily available. Traditional ultrasound methods include qualitative B-mode for imaging markers, such as increased hepatic parenchymal echogenicity compared to adjacent renal cortex are commonplace; however, there is acknowledged significant interobserver variability and they are suboptimal for detecting mild steatosis. Recently quantitative ultrasound metrics have been investigated as biomarkers for hepatic steatosis. These methods rely on changes in backscatter, attenuation, and speed of sound differences encountered in a steatotic liver. Prospective studies using quantitative ultrasound parameters show good diagnostic performance even at low steatosis grades and in NAFLD. This review aims to define the clinical need for ultrasound-based assessments of liver steatosis, to describe briefly the physics that underpins the various techniques available, and to assess the evidence base for the effectiveness of the techniques that are available commercially from various ultrasound vendors.
Collapse
|
19
|
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.
Collapse
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:
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Yuri M, Nishimura T, Tada T, Yoshida M, Fujiwara A, Kawata S, Yoshihara K, Yoshioka R, Ota S, Nakano R, Yuri Y, Takashima T, Aizawa N, Ikeda N, Shiomi H, Ide YH, Enomoto H, Yasuhiro F, Yano H, Iijima H. Diagnosis of hepatic steatosis based on ultrasound attenuation imaging is not influenced by liver fibrosis. Hepatol Res 2022; 52:1009-1019. [PMID: 36018852 DOI: 10.1111/hepr.13831] [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: 04/05/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/13/2022]
Abstract
AIM Recently, a new technique using attenuation imaging (ATI) was developed to diagnose hepatic steatosis. The aim of this study was to investigate whether ATI for the evaluation of hepatic steatosis is influenced by liver fibrosis. METHODS A total of 328 patients with chronic liver disease were enrolled to study the associations between histological hepatic steatosis or liver fibrosis and ATI findings. The interaction between liver fibrosis and ATI was also analyzed. RESULTS Median ATI values according to steatosis grade and fibrosis stage increased in line with the progression of liver steatosis (p < 0.001) and fibrosis (p < 0.05). However, in each steatosis grade, ATI values according to fibrosis stage were not significantly increased. In multiple regression analyses for assessment of the effect of their interaction, the p values for fibrosis stage, steatosis grade, and fibrosis stage × steatosis grade were 0.096, <0.001, and 0.077, respectively. Variance inflation factor values for fibrosis stage, steatosis grade, and fibrosis stage × steatosis grade were 1.079, 1.094, and 1.074, respectively. CONCLUSION Attenuation imaging values are not influenced by liver fibrosis.
Collapse
Affiliation(s)
- Minako Yuri
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Takashi Nishimura
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan.,Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Masahiro Yoshida
- Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Japan
| | - Aoi Fujiwara
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Shoki Kawata
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Kohei Yoshihara
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Ryota Yoshioka
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Shogo Ota
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Ryota Nakano
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Yukihisa Yuri
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Tomoyuki Takashima
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuhiro Aizawa
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Naoto Ikeda
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Hideyuki Shiomi
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | - Yoshi-Hiro Ide
- Department of Pathology, Hyogo Medical University, Nishinomiya, Japan
| | - Hirayuki Enomoto
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan
| | | | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroko Iijima
- Department of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan.,Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Japan
| |
Collapse
|
24
|
Quantification of Hepatic Steatosis by Ultrasound: Prospective Comparison With MRI Proton Density Fat Fraction as Reference Standard. AJR Am J Roentgenol 2022; 219:784-791. [PMID: 35674351 DOI: 10.2214/ajr.22.27878] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND. Multiple ultrasound platforms now provide quantitative measures of hepatic steatosis. One such measure is the ultrasound-derived fat fraction (UDFF), which combines attenuation and backscatter quantification. OBJECTIVE. The purpose of this study was to characterize agreement between UDFF and MRI proton-density fat fraction (PDFF) measurements. METHODS. This prospective cross-sectional study enrolled 56 overweight and obese adolescents and adults (age ≥ 16 years) who underwent investigational ultrasound (deep abdominal transducer) and MRI examinations of the liver during a single visit from August 2020 to October 2020. Ultrasound examinations included three UDFF acquisitions of five measurements each (15 measurements total), and an overall median of medians was computed (UDFFoverall). MRI examinations included three PDFF acquisitions with calculation of an overall median PDFF. Spearman rank-order correlation was computed between UDFF and MRI PDFF measurements. Intraclass correlation coefficients and Bland-Altman difference plots were used to assess agreement. ROC curves were used to assess diagnostic performance of UDFF for detecting MRI PDFF of 5.5% or more. RESULTS. Median participant age was 32.5 years (IQR, 24.0-39.0 years); 40 participants were female, and 16 were male. A total of 34 (60.7%) participants had an MRI PDFF of 5.5% or more. UDFFoverall was 10.5% (IQR, 5.0-20.0%); median MRI PDFF was 6.1% (IQR, 3.4-13.7%). UDFFoverall was positively associated with MRI PDFF (ρ, 0.82; p < .001; intraclass correlation coefficient, 0.84 [95% CI, 0.59-0.93]). Mean bias between UDFF and PDFF was 4.0% (95% limits of agreement, -7.9% to 15.9%), with similar bias if summarizing UDFF by the first five measurements (4.4%), first three measurements (4.4%), or first measurement (4.6%). UDFFoverall AUC was 0.90 (95% CI, 0.79-0.96) for MRI PDFF of 5.5% or more; AUC was not significantly different when it was based on the number of UDFF measurements (p = .11-.97 for all pairwise AUC comparisons). UDFFoverall cutoff of more than 5% had sensitivity of 94.1% and specificity of 63.6% for diagnosing MRI PDFF of 5.5% or more. CONCLUSION. Measurements of hepatic steatosis using UDFF show strong agreement with measurements by MRI PDFF. A UDFFoverall cutoff of more than 5% provides high AUC and sensitivity, albeit low specificity, for detection of MRI PDFF of 5.5% or more. CLINICAL IMPACT. UDFF may have a clinical role in detection of hepatic steatosis. A reduced number of individual measurements is likely sufficient for determining an overall UDFF value. TRIAL REGISTRATION. ClinicalTrials.gov: NCT04523584.
Collapse
|
25
|
Imajo K, Toyoda H, Yasuda S, Suzuki Y, Sugimoto K, Kuroda H, Akita T, Tanaka J, Yasui Y, Tamaki N, Kurosaki M, Izumi N, Nakajima A, Kumada T. Utility of Ultrasound-Guided Attenuation Parameter for Grading Steatosis With Reference to MRI-PDFF in a Large Cohort. Clin Gastroenterol Hepatol 2022; 20:2533-2541.e7. [PMID: 34768008 DOI: 10.1016/j.cgh.2021.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Ultrasound-guided attenuation parameter (UGAP) is recently developed for noninvasive evaluation of steatosis. However, reports on its usefulness in clinical practice are limited. This prospective multicenter study analyzed the diagnostic accuracy of grading steatosis with reference to magnetic resonance imaging-based proton density fat fraction (MRI-PDFF), a noninvasive method with high accuracy, in a large cohort. METHODS Altogether, 1010 patients with chronic liver disease who underwent MRI-PDFF and UGAP were recruited and prospectively enrolled from 6 Japanese liver centers. Linearity was evaluated using intraclass correlation coefficients between MRI-PDFF and UGAP values. Bias, defined as the mean difference between MRI-PDFF and UGAP values, was assessed by Bland-Altman analysis. UGAP cutoffs for pairwise MRI-PDFF-based steatosis grade were determined using area under the receiver-operating characteristic curve (AUROC) analyses. RESULTS UGAP values were shown to be normally distributed. However, because PDFF values were not normally distributed, they were log-transformed (MRI-logPDFF). UGAP values significantly correlated with MRI-logPDFF (intraclass correlation coefficient = 0.768). Additionally, Bland-Altman analysis showed good agreement between MRI-logPDFF and UGAP with a mean bias of 0.0002% and a narrow range of agreement (95% confidence interval [CI], -0.015 to 0.015). The AUROCs for distinguishing steatosis grade ≥1 (MRI-PDFF ≥5.2%), ≥2 (MRI-PDFF ≥11.3%), and 3 (MRI-PDFF ≥17.1%) were 0.910 (95% CI, 0.891-0.928), 0.912 (95% CI, 0.894-0.929), and 0.894 (95% CI, 0.873-0.916), respectively. CONCLUSIONS UGAP has excellent diagnostic accuracy for grading steatosis with reference to MRI-PDFF. Additionally, UGAP has good linearity and negligible bias, suggesting that UGAP has excellent technical performance characteristics that can be widely used in clinical trials and patient care. (UMIN Clinical Trials Registry, Number: UMIN000041196).
Collapse
Affiliation(s)
- Kento Imajo
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki, Japan.
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuaki Suzuki
- Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hidekatsu Kuroda
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Kumada
- Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan
| |
Collapse
|
26
|
Moret A, Boursier J, Houssel Debry P, Riou J, Crouan A, Dubois M, Michalak Provost S, Aubé C, Paisant A. Evaluation of the Hepatorenal B-Mode Ratio and the "Controlled Attenuation Parameter" for the Detection and Grading of Steatosis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:479-487. [PMID: 32992377 DOI: 10.1055/a-1233-2290] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE The aim of this study was to evaluate the hepatorenal index ratio of Supersonic Imagine (B-mode ratio) and the controlled attenuation parameter (CAP) of FibroScan for the noninvasive diagnosis and grading of steatosis. MATERIALS AND METHODS Two centers prospectively included patients who underwent liver biopsy, B-mode ratio and CAP evaluation all on the same day between June 2017 and July 2019. MRI and histological morphometry were also performed in center 1. Histology (classic semiquantitative score and morphometry) was used as the reference. RESULTS Concerning the B-mode ratio, the AUROCs for ≥ S1, ≥ S2 and ≥ S3 were respectively 0.896 ± 0.20, 0.775 ± 0.30 and 0.729 ± 0.39 with the best cut-off values being 1.22 for ≥ S1 (Se = 76.4 %, Sp = 93.2 %), 1.42 for ≥ S2 (Se = 70.2 %, Sp = 71.2 %) and 1.54 for ≥ S3 (Se = 68.4 %, Sp = 69.8 %). The correlation between the B-mode ratio and morphometry was moderate (Rs = 0.575, p < 0.001) and the correlation between the B-mode ratio and MRI was good (Rs = 0.613, p < 0.001). Concerning the CAP, the AUROCs for ≥ S1, ≥ S2 and ≥ S3 were 0.926 ± 0.18, 0.760 ± 0.30 and 0.701 ± 0.40, respectively, with the best cut-off values being 271 dB/m for ≥ S1 (Se = 84 %, Sp = 88.2 %), 331 dB/m for ≥ S2 (Se = 64.5 %, Sp = 74.7 %) and 355 dB/m for ≥ S3 (Se = 55.3 %, Sp = 75.1 %). The correlation between the CAP and morphometry and between the CAP and MRI was moderate in both cases (Rs = 0.526, p < 0.001 and Rs = 0.397, p < 0.001, respectively). The B-mode ratio was better at ruling in and the CAP was better at ruling out the disease. CONCLUSION B-mode ratio and CAP show similar and good performance for the diagnosis of steatosis (≥ S1). However, both techniques are limited with respect to differentiating mild to moderate (≥ S2) or severe (≥ S3) steatosis.
Collapse
Affiliation(s)
- Antoine Moret
- Department of Radiology, University Hospital Centre Angers, France
| | - Jérome Boursier
- Department of Hepatology, University Hospital Centre Angers, France
- HIFIH Laboratory, EA 3859, University of Angers, France
| | | | - Jérémie Riou
- UFR Santé, 49000 Angers, France; MINT UMR INSERM 1066, CNRS 6021, University of Angers, France
| | - Anne Crouan
- Department of Radiology, University Hospital Centre Angers, France
| | - Marine Dubois
- Department of Radiology, University Hospital Centre Rennes, France
| | | | - Christophe Aubé
- Department of Radiology, University Hospital Centre Angers, France
- HIFIH Laboratory, EA 3859, University of Angers, France
| | - Anita Paisant
- Department of Radiology, University Hospital Centre Angers, France
- HIFIH Laboratory, EA 3859, University of Angers, France
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Kechagias S, Ekstedt M, Simonsson C, Nasr P. Non-invasive diagnosis and staging of non-alcoholic fatty liver disease. Hormones (Athens) 2022; 21:349-368. [PMID: 35661987 PMCID: PMC9464753 DOI: 10.1007/s42000-022-00377-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 02/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of the metabolic syndrome and is characterized by ectopic accumulation of triglycerides in the cytoplasm of hepatocytes, i.e., steatosis. NAFLD has become the most common chronic liver disease, with an estimated global prevalence of 25%. Although the majority of NAFLD patients will never experience liver-related complications, the progressive potential of NAFLD is indisputable, with 5-10% of subjects progressing to cirrhosis, end-stage liver disease, or hepatocellular carcinoma. NAFLD patients with advanced fibrosis are at the highest risk of developing cardiovascular and cirrhosis-related complications. Liver biopsy has hitherto been considered the reference method for evaluation of hepatic steatosis and fibrosis stage. Given the limitations of biopsy for widescale screening, non-invasive tests (NITs) for assessment of steatosis and fibrosis stage, including serum-based algorithms and ultrasound- and magnetic resonance-based methods, will play an increasing role in the management of NAFLD patients. This comprehensive review presents the advantages and limitations of NITs for identification of steatosis and advanced fibrosis in NAFLD. The clinical implications of using NITs to identify and manage NAFLD patients are also discussed.
Collapse
Affiliation(s)
- Stergios Kechagias
- Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden.
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Mattias Ekstedt
- Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christian Simonsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Patrik Nasr
- Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
30
|
Srigandan S, Zelesco M, Abbott S, Welman CJ. Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis. Australas J Ultrasound Med 2022; 25:107-115. [PMID: 35978731 PMCID: PMC9351430 DOI: 10.1002/ajum.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/26/2022] [Accepted: 04/05/2022] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Hepatic steatosis screening is required to assess high-risk populations, identify those for intervention, monitor response and prevent disease progression and complications. Liver biopsy and magnetic resonance imaging proton density fat fraction are current gold standards, but are limited by biopsy risk factors, patient tolerance and cost. Non-invasive, cost-effective, semi-quantitative and quantitative ultrasound assessment exists. The aim of this study was to assess the correlation between the semi-quantitative hepatorenal index (HRI) to assess hepatic steatosis using the quantitative attenuation imaging (ATI) as a reference standard, in adults with varied suspected liver pathologies. METHODS Data were collected prospectively between April 2019 and March 2020 at a tertiary institution on any patient >18 years referred to US assessment of suspected liver pathology. The only exclusion criteria were absent or invalid HRI or ATI measurements. Three hundred fifty eight patients were included. RESULTS There was a significant weak positive correlation between HRI and ATI (r = 0.351, P < 0.001) and between HRI steatosis grade (SG) and ATI SG (r = 0.329, P < 0.001), using previously established cut-off values. With ATI as the reference standard, there was no significant correlation between HRI and hepatic steatosis within steatosis grades, nor for no (SG = 0) or any (SG > 0) hepatic steatosis. CONCLUSIONS Our study in a typical heterogeneous clinical population suggests the semi-quantitative HRI is of limited use in hepatic steatosis imaging. As HRI is the objective measure of the subjective brightness (B)-mode assessment, this imaging feature may not be as reliable as previously thought. Quantitative ATI may be the preferred non-invasive technique for hepatic steatosis assessment.
Collapse
Affiliation(s)
- Shrivuthsun Srigandan
- Department of Medical ImagingFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Marilyn Zelesco
- Department of Medical ImagingFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Steven Abbott
- Department of Medical ImagingFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Christopher J Welman
- Department of Medical ImagingFiona Stanley HospitalMurdochWestern AustraliaAustralia
| |
Collapse
|
31
|
Nakatsuka T, Tateishi R, Koike K. Changing clinical management of NAFLD in Asia. Liver Int 2022; 42:1955-1968. [PMID: 34459096 DOI: 10.1111/liv.15046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, affecting approximately 25% of the world's population. Recently, because of the sedentary lifestyle and overnutrition resulting from urbanisation, the burden of NAFLD has rapidly increased in many Asian countries. Currently, the prevalence of NAFLD in Asia is approximately 30%, as is the case in many Western countries. In Asia, the prevalence and presentation of NAFLD vary widely across regions because of the substantial diversity in race, socioeconomic status and living environment. Furthermore, the dual aetiology of fatty liver, particularly with viral hepatitis in Asia, makes it complex and challenging to manage. Because Asians are likely to have central adiposity and insulin resistance, approximately 7%-20% of non-obese Asians with body mass indexes of less than 25 kg/m2 are estimated to have NAFLD. Accumulating evidence indicates that NAFLD is associated with various extrahepatic comorbidities such as cardiovascular disease, chronic kidney disease, malignancy, in addition to liver-specific complications. Therefore, NAFLD should be managed as a multisystem disease in conjunction with metabolic syndrome. Lifestyle modification remains the basis of NAFLD management, but few patients can achieve adequate weight loss and maintain it long term. While various pharmacological agents are in phase 3 trials for steatohepatitis, Asian patients are underrepresented in most trials. This article reviews the epidemiological trends, clinical features, optimal assessment and current management practices for NAFLD in Asia.
Collapse
Affiliation(s)
- Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| |
Collapse
|
32
|
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.
Collapse
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.)
| |
Collapse
|
33
|
Iwashita H, Shakado S, Yoshimaru N, Tanaka H, Koto F, Tanaka T, Takata K, Yokoyama K, Yamaguchi M, Irie M, Hirai F. Clinical Utility of Ultrasound-Guided Attenuation Parameter for the Detection and Quantification of Hepatic Steatosis in Patients with Fatty Liver Diagnosed by Computed Tomography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1282-1289. [PMID: 35397929 DOI: 10.1016/j.ultrasmedbio.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
This retrospective study was aimed (i) at elucidating the correlation between fatty liver diagnoses based on the plain computed tomography (CT) value and those based on the attenuation coefficient (AC) value determined with the ultrasound-guided attenuation parameter (UGAP) and (ii) at evaluating the diagnostic power of AC values. We included 125 patients who underwent blood tests, abdominal ultrasonography and abdominal CT at our department between April 2020 and March 2021. Hepatic fat infiltration was categorized as S0 (<5%), S1 (≥5 and 30<%), S2 (≥30 and <50%) or S3 (≥50%). The diagnostic ability of UGAP-determined AC was evaluated using receiver operating characteristic (ROC) curve analysis, and the correlation between AC value and fatty liver grade by CT value. The coefficient of correlation (r) between the AC value and plain CT value was -0.6188, indicating a moderate relationship. For diagnosing grade ≥S1 (n = 44), the area under the ROC curve (AUROC) was 0.8541, sensitivity 84.1%, specificity 81.5% and cutoff value 0.676 dB/cm/MHz. In diagnosing grade ≥S2 (n = 35), the AUROC was 0.8603, sensitivity 88.6%, specificity 81.1% and cutoff value 0.694 dB/cm/MHz. In diagnosing grade = S3 (n = 18), the AUROC was 0.9016, sensitivity 94.5%, specificity 81.9% and cutoff value, 0.704 dB/cm/MHz. The AC value is useful in diagnosing fatty liver.
Collapse
Affiliation(s)
- Hideyuki Iwashita
- Department of Gastroenterology and Medicine, Fukuoka University Nishijin Hospital, Fukuoka, Japan.
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Namiko Yoshimaru
- Medical Technology Center, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Hitomi Tanaka
- Medical Technology Center, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Fumika Koto
- Medical Technology Center, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Masashi Yamaguchi
- Department of Gastroenterology and Medicine, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Makoto Irie
- Department of Gastroenterology and Medicine, Fukuoka University Nishijin Hospital, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| |
Collapse
|
34
|
Yoon H, Kim J, Lim HJ, Kamiyama N, Oguri T, Koh H, Lee MJ. Attenuation Coefficient Measurement Using a High-Frequency (2-9 MHz) Convex Transducer for Children Including Fatty Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1070-1077. [PMID: 35296397 DOI: 10.1016/j.ultrasmedbio.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
We evaluated the measurement feasibility and diagnostic ability of an ultrasound-guided attenuation parameter (UGAP) using a high-frequency convex transducer in children. This retrospective study included all consecutive children who underwent abdomen ultrasonography from July to December 2020. Attenuation coefficients (ACs) of the liver were measured using both 1- to 6-MHz (AC1-6) and 2- to 9-MHz (AC2-9) probes of the LOGIQ E10 system (GE Healthcare). t-Tests and Pearson's or partial correlation analyses were performed, and AC cutoff values for diagnosing fatty liver were obtained from receiver operating characteristic curve analyses. Finally, 118 patients (M:F = 83:35, mean age: 10.2 ± 4.1 y) were evaluated, and the measurement success rate was 98.3% (116/118) for AC2-9. AC1-6 was available in children with a liver depth greater than 9 cm. The ratio of interquartile range to median of the AC2-9 was lower than that of the AC1-6 (4.3 vs. 8.5, p < 0.001). In the normal group (n = 41), the AC2-9 values were not associated with age, sex or body mass index. For the evaluation of steatosis, the AC2-9 values exhibited a positive correlation with the MR fat fraction (coefficient = 0.498, p < 0.001). The cutoff value of 0.699 dB/cm/MHz had 90.2% sensitivity and 100% specificity for diagnosing fatty liver. In conclusion, measurements of ACs using a high-frequency convex transducer are feasible even in small children, with lower measurement variability. The AC2-9 values also had good diagnostic performance for pediatric fatty liver.
Collapse
Affiliation(s)
- Haesung Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jisoo Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ji Lim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Takuma Oguri
- Ultrasound General Imaging, GE Healthcare, Hino, Tokyo, Japan
| | - Hong Koh
- Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
35
|
Gatos I, Drazinos P, Yarmenitis S, Theotokas I, Koskinas J, Koullias E, Mitranou A, Manesis E, Zoumpoulis PS. Liver Ultrasound Attenuation: An Ultrasound Attenuation Index for Liver Steatosis Assessment. Ultrasound Q 2022; 38:124-132. [PMID: 35353797 DOI: 10.1097/ruq.0000000000000605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the most widespread chronic liver disease type in the Western countries. Ultrasound (US) is used for NAFLD and hepatic steatosis (HS) grading. The most popular US method for NAFLD assessment is the hepatorenal index (HRI), but because of its limitations, other noninvasive methods have been developed. The Resona 7 US system has recently incorporated an US attenuation-related quantitative feature, liver ultrasound attenuation (LiSA), for HS estimation. The purpose of this study is to compare LiSA's and HRI's performance on NAFLD assessment. METHODS A total of 159 NAFLD patients having a magnetic resonance imaging-proton density fat fraction (MRI-PDFF) examination were examined by 2 radiologists, who performed LiSA and HRI measurements in the liver. Correlation of LiSA's and HRI's measurements with MRI-PDFF values was calculated through Pearson correlation coefficient (PCC). To further investigate the performance of LiSA and HRI, optimum cutoffs, provided by the literature, were used to correspond HS grades to MRI-PDFF results. Moreover, a receiver operating characteristic (ROC) analysis on LiSA measurements and steatosis grades was performed. RESULTS Magnetic resonance imaging-PDFF was better correlated with LiSA (PCC = 0.80) than HRI (PCC = 0.67). Receiver operating characteristic analysis showed better performance range for LiSA (77.8%-91.8%) than for HRI (72.8%-85.4%) on all HS grades for all studies used for corresponding MRI-PDFF values to HS grades. CONCLUSIONS The results indicate that LiSA is more accurate than HRI in HS differentiation and can lead to more accurate grading of HS on NAFLD patients.
Collapse
|
36
|
Ormachea J, Parker KJ. A Preliminary Study of Liver Fat Quantification Using Reported Ultrasound Speed of Sound and Attenuation Parameters. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:675-684. [PMID: 35039191 DOI: 10.1016/j.ultrasmedbio.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
The quantification of liver fat as a diagnostic assessment of steatosis remains an important priority for non-invasive imaging systems. We derive a framework in which the unknown fat volume percentage can be estimated from a pair of ultrasound measurements. The precise estimation of ultrasound speed of sound and attenuation within the liver is found to be sufficient for estimating fat volume assuming a classic model of the properties of a composite elastic material. In this model, steatosis is represented as a random dispersion of spherical fat vacuoles with acoustic properties similar to those of edible oils. Using values of speed of sound and attenuation from the literature in which normal and steatotic livers were studied near 3.5 MHz, we describe agreement of the new estimation method with independent measures of fat. This framework holds the potential for translation to clinical scanners with which the two ultrasound measurements can be made and used for improved quantitative assessment of steatosis.
Collapse
Affiliation(s)
- Juvenal Ormachea
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
| | - Kevin J Parker
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA.
| |
Collapse
|
37
|
Jung J, Han A, Madamba E, Bettencourt R, Loomba RR, Boehringer AS, Andre MP, Erdman JW, O'Brien WD, Fowler KJ, Sirlin CB, Loomba R. Direct Comparison of Quantitative US versus Controlled Attenuation Parameter for Liver Fat Assessment Using MRI Proton Density Fat Fraction as the Reference Standard in Patients Suspected of Having NAFLD. Radiology 2022; 304:75-82. [PMID: 35348378 DOI: 10.1148/radiol.211131] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background MRI-derived proton density fat fraction (PDFF) is an accurate, reliable, and safe biologic marker for use in the noninvasive diagnosis of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). Because of the cost and limited availability of MRI, it is necessary to develop an accurate method to diagnose NAFLD with potential point-of-care access. Purpose To compare the diagnostic accuracy of the quantitative US (QUS) fat fraction (FF) estimator with that of the controlled attenuation parameter (CAP) in the diagnosis of NAFLD using contemporaneous MRI-derived PDFF as the reference standard. Materials and Methods Participants with or suspected of having NAFLD were prospectively recruited at the NAFLD Research Center between July 2015 and July 2019. All participants underwent MRI-derived PDFF measurement, transient elastography with CAP measurement, and QUS. QUS FF was derived using computed QUS parameters from the acquired radiofrequency US data using a calibrated reference phantom. The area under the receiver operating characteristic curve (AUC) was calculated to assess the accuracy of QUS FF and CAP in the diagnosis of hepatic steatosis (defined as MRI-derived PDFF ≥ 5%). AUCs were compared using the DeLong test. Results A total of 123 participants were included (mean age, 52 years ± 13 [SD]; 67 [54%] women). Of these participants, 100 (81%) had MRI-derived PDFF of 5% or more. QUS FF had a significantly higher AUC for diagnosis of NAFLD than did CAP (0.92 [95% CI: 0.87, 0.98] vs 0.79 [95% CI: 0.67, 0.90], P = .03). QUS FF had a sensitivity of 98% (98 of 100) and a specificity of 48% (11 of 23). CAP had a sensitivity of 87% (87 of 100) and a specificity of 57% (13 of 23). Conclusion The quantitative US fat fraction estimator is more accurate than the controlled attenuation parameter in the diagnosis of hepatic steatosis in patients with or suspected of having nonalcoholic fatty liver disease. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Ito in this issue.
Collapse
Affiliation(s)
- Jinho Jung
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Aiguo Han
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Egbert Madamba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Ricki Bettencourt
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Rohan R Loomba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Andrew S Boehringer
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Michael P Andre
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - John W Erdman
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - William D O'Brien
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Kathryn J Fowler
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Claude B Sirlin
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| | - Rohit Loomba
- From the NAFLD Research Center, Department of Medicine (J.J., E.M., R.B., R.R.L., R.L.), Liver Imaging Group, Department of Radiology (A.S.B., K.J.F., C.B.S.), Department of Radiology (M.P.A.), and Division of Epidemiology, Department of Family and Preventive Medicine (R.L.), University of California at San Diego, ACTRI Building, 1W202, 9452 Medical Center Dr, La Jolla, CA 92037; Bioacoustics Research Laboratory, Department of Electrical and Computer Engineering (A.H., W.D.O.), and Department of Food Science and Human Nutrition (J.W.E.), University of Illinois at Urbana-Champaign, Urbana, Ill
| |
Collapse
|
38
|
Tao X, Chen L, Zhao Y, Liu Y, Shi R, Jiang B, Mi Y, Xu L. A Novel Noninvasive Diagnostic Model of HBV-Related Inflammation in Chronic Hepatitis B Virus Infection Patients With Concurrent Nonalcoholic Fatty Liver Disease. Front Med (Lausanne) 2022; 9:862879. [PMID: 35402467 PMCID: PMC8984271 DOI: 10.3389/fmed.2022.862879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsPatients with chronic hepatitis B virus infection (CBI) with concurrent nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common in clinical practice, and it is quite important to identify the etiology when hepatitis occurs. A noninvasive diagnostic model was constructed to identify patients who need antihepatitis B virus (HBV) therapies [histologic activity index (HAI) ≥ 4] in patients with CBI with concurrent NAFLD by analyzing clinical routine parameters.Approach and ResultsIn total, 303 out of 502 patients with CBI with concurrent NAFLD proven by liver biopsy from January 2017 to December 2020 in the Tianjin Second People's Hospital were enrolled and they were divided into the HBV-related inflammation (HBV-I) group (HAI ≥ 4,176 cases) and the non-HBV-I group (HAI < 4,127 cases) according to hepatic pathology. The univariate analysis and multivariate logistic regression analysis were performed on the two groups of patients, and then the HBV-I model of patients with CBI with concurrent NAFLD was constructed. The areas under receiver operating characteristic curves (AUROCs) were used to evaluate the parameters of the regression formula. Another 115 patients with CBI with concurrent NAFLD proven by liver biopsy from January 2021 to January 2022 were enrolled as the validation group. There were some statistical differences in demographic data, biochemical indicators, immune function, thyroid function, virology indicator, and blood routine indicators between the two groups (P < 0.05) and liver stiffness measurement (LSM) in the HBV-I group was significantly higher than those in the non-HBV-I group (P < 0.05). While controlled attenuation parameters (CAP) in the HBV-I group were lower than those in the non-HBV-I group (P < 0.05); (2) We developed a novel model by logistic regression analysis: HBV-I = −0.020 × CAP + 0.424 × LSM + 0.376 × lg (HBV DNA) + 0.049 × aspartate aminotransferase (AST) and the accuracy rate was 82.5%. The area under the receiver operating characteristic (AUROC) is 0.907, the cutoff value is 0.671, the sensitivity is 89.30%, the specificity is 77.80%, the positive predictive value is 90.34%, and the negative predictive value is 81.89%; (3) The AUROC of HBV-I in the validation group was 0.871 and the overall accuracy rate is 86.96%.ConclusionOur novel model HBV-I [combining CAP, LSM, lg (HBV DNA), and AST] shows promising utility for predicting HBV-I in patients with CBI with concurrent NAFLD with high sensitivity, accuracy, and repeatability, which may contribute to clinical application.
Collapse
Affiliation(s)
- Xuemei Tao
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Lin Chen
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Youfei Zhao
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
| | - Yonggang Liu
- Tianjin Research Institute of Liver Diseases, Tianjin, China
| | - Ruifang Shi
- Tianjin Research Institute of Liver Diseases, Tianjin, China
| | - Bei Jiang
- Tianjin Research Institute of Liver Diseases, Tianjin, China
| | - Yuqiang Mi
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
- *Correspondence: Yuqiang Mi
| | - Liang Xu
- Clinical School of the Second People's Hospital, Tianjin Medical University, Tianjin, China
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, China
- Liang Xu
| |
Collapse
|
39
|
Hirooka M, Koizumi Y, Sunago K, Nakamura Y, Hirooka K, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y. Efficacy of B-mode ultrasound-based attenuation for the diagnosis of hepatic steatosis: a systematic review/meta-analysis. J Med Ultrason (2001) 2022; 49:199-210. [PMID: 35239088 DOI: 10.1007/s10396-022-01196-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/26/2022] [Indexed: 10/25/2022]
Abstract
The accuracy of attenuation coefficients and B-mode ultrasound for distinguishing between S0 (healthy, < 5% fat) and S1-3 (steatosis ≥ 5%) livers compared to a controlled attenuation parameter is unclear. This meta-analysis aimed to comprehensively assess the diagnostic performance of B-mode ultrasound imaging for evaluating steatosis of ≥ 5%. We searched the PubMed, Embase, and Web of Science databases for studies on the accuracy of B-mode ultrasound for differentiating S0 from S1-3 in adults with chronic liver disease. A bivariate random-effects model was performed to estimate the pooled sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and diagnostic odds ratios (DORs). Subgroup analyses by attenuation coefficient, conventional B-mode ultrasound findings, and B-mode ultrasound findings without semi-quantification methods were performed. Liver steatosis was scored as follows: S0, < 5%; S1, 5-33%; S2, 33-66%; and S3, > 66%. Nineteen studies involving 3240 patients were analyzed. The pooled sensitivity and specificity of B-mode ultrasound for detecting S1 were 0.70 (95% confidence interval [CI], 0.63-0.77) and 0.86 (95% CI 0.82-0.89), respectively. The pooled PLR, NLR, and DOR were 4.90 (95% CI 3.69-6.51), 0.35 (95% CI 0.27- 0.44), and 14.1 (95% CI 8.7-23.0), respectively. The diagnostic accuracy was better in patients with attenuation coefficients (area under the curve [AUC], 0.89; sensitivity, 0.75; specificity, 0.86) than in those with conventional B-mode findings (AUC, 0.80; sensitivity, 0.59; specificity, 0.83). In particular, the diagnostic value was better when the attenuation coefficient guided by B-mode ultrasound was utilized. To screen patients with steatosis of ≥ 5%, attenuation coefficient should be used.
Collapse
Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan.
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Kotarou Sunago
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Yoshiko Nakamura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Kana Hirooka
- Department of Gastroenterology and Metabology, National Hospital Organization Ehime Medical Center, Tōon, Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan
| |
Collapse
|
40
|
Kim JW, Lee CH, Kim BH, Lee YS, Hwang SY, Park BN, Park YS. Ultrasonographic index for the diagnosis of non-alcoholic steatohepatitis in patients with non-alcoholic fatty liver disease. Quant Imaging Med Surg 2022; 12:1815-1829. [PMID: 35284276 PMCID: PMC8899945 DOI: 10.21037/qims-21-895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/06/2021] [Indexed: 08/03/2023]
Abstract
BACKGROUND Liver biopsy is a gold standard for the diagnosis of non-alcoholic steatohepatitis (NASH), but has several disadvantages including invasiveness, high cost, and sampling error. Ultrasonography (US) is a noninvasive imaging modality widely used in non-alcoholic fatty liver disease (NAFLD) patients. This study aimed: (I) to assess the feasibility of US in the prediction of NASH and (II) to develop various US indices combining US parameters and laboratory data for the detection of NASH in NAFLD patients and to compare the diagnostic performance of them. METHODS Sixty patients who underwent liver biopsy, gray-scale US [hepatorenal index (HRI) and shear-wave elastography (SWE)], and Fibroscan [controlled attenuation parameter (CAP) and transient elastography (TE)] for the evaluation of NASH were included. Patients were classified according to the NAFLD Activity Score (NAS) into the NASH (NAS ≥5) and non-NASH (NAS <5) groups. The diagnostic performance of HRI, CAP, SWE, TE, and laboratory data for grading steatosis, lobular inflammation, ballooning degeneration, and fibrosis was evaluated. After the identification of laboratory data that were independently associated with NASH through univariable and multivariable logistic regression analyses, various US indices were developed by combining US parameters with or without these laboratory data. The diagnostic performance of the US indices was assessed with obtaining area under the curve (AUC) and compared using DeLong test. RESULTS Twenty-five NASH and 35 non-NASH patients were included. The mean AUCs for grading steatosis were 0.871 using HRI and 0.583 using CAP. The mean AUCs for grading fibrosis and ballooning degeneration were 0.777 and 0.729 using SWE and 0.830 and 0.708 using TE, respectively. Aspartate aminotransferase (AST) was the only significant laboratory data associated with NASH (OR, 1.019; P=0.032). Using AST, the mean AUCs for grading lobular inflammation and ballooning degeneration were 0.712 and 0.775, respectively. Among various US indices, the index consisting of gray-scale US parameters (SWE and HRI) and AST showed the best diagnostic performance for the detection of NASH in NAFLD patients (AUC =0.806). CONCLUSIONS The index combining gray-scale US parameters and AST is useful for the detection of NASH and may be used to exclude the need for liver biopsy in NAFLD patients.
Collapse
Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young-Sun Lee
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- Department of Biostatistics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bit Na Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
41
|
Reproducibility of ultrasound-guided attenuation parameter (UGAP) to the noninvasive evaluation of hepatic steatosis. Sci Rep 2022; 12:2876. [PMID: 35190618 PMCID: PMC8861045 DOI: 10.1038/s41598-022-06879-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to identify the applicability of an ultrasound-guided attenuation parameter (UGAP) for the noninvasive assessment of hepatic steatosis in clinical practice and to compare its correlation with B-mode ultrasound (US). From May to July 2021, 63 subjects with different body mass index (BMI) grades were included in the prospective study. All of them performed UGAP measurements, under different breathing manipulations, positions, diet statuses, and operators. After that, the UGAP values were compared with the visual grades of hepatic steatosis on B-mode US using a 4-point scale method. The intraclass correlation (ICC) of the UGAP values between the two radiologists was 0.862 (p < 0.001), and the ICCs of the UGAP values on the same day and different days by radiologist A were 0.899 (p < 0.001) and 0.910 (p < 0.001), respectively. There were no significant differences in UGAP values under different breathing manipulations (p > 0.05), positions (p > 0.05), or diet statuses (p = 0.300). The UGAP values in the fasting (supine position, segment V, 1) condition among the lean (BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2) and obese groups (BMI ≥ 28 kg/m2) were 0.60 ± 0.12, 0.66 ± 0.14, and 0.71 ± 0.11 dB/cm/MHz, respectively, with a significant difference (p = 0.006). The correlation coefficients (Rho) between the UGAP values and the visual grades of hepatic steatosis by the two reviewers were 0.845 (p < 0.001) and 0.850 (p < 0.001), corresponding to a strong relationship. Steatosis grades by reviewer 1 (p = 0.036) and reviewer 2 (p = 0.003) were significant factors determining the UGAP values according to the multivariate linear regression analysis. UGAP demonstrated excellent intraobserver and interobserver reproducibility in the assessment of hepatic steatosis. UGAP may be a promising tool in clinical practice to predict hepatic steatosis.
Collapse
|
42
|
Ferraioli G, Kumar V, Ozturk A, Nam K, de Korte CL, Barr RG. US Attenuation for Liver Fat Quantification: An AIUM-RSNA QIBA Pulse-Echo Quantitative Ultrasound Initiative. Radiology 2022; 302:495-506. [PMID: 35076304 DOI: 10.1148/radiol.210736] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, with an estimated prevalence of up to 30% in the general population and higher in people with type 2 diabetes. The assessment of liver fat content is essential to help identify patients with or who are at risk for NAFLD and to follow their disease over time. The American Institute of Ultrasound in Medicine-RSNA Quantitative Imaging Biomarkers Alliance Pulse-Echo Quantitative Ultrasound Initiative was formed to help develop and standardize acquisition protocols and to better understand confounding factors of US-based fat quantification. The three quantitative US parameters explored by the initiative are attenuation, backscatter coefficient, and speed of sound. The purpose of this review is to present the current state of attenuation imaging for fat quantification and to provide expert opinion on examination performance and interpretation. US attenuation methods that need further study are outlined.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| | - Viksit Kumar
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| | - Arinc Ozturk
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| | - Kibo Nam
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| | - Chris L de Korte
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| | - Richard G Barr
- From the Medical School University of Pavia, Viale Brambilla, Pavia, Italy (G.F.); Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.K., A.O.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (K.N.); Medical UltraSound Imaging Center, Radboud University Medical Center, Nijmegen, the Netherlands (C.L.d.K.); Technical Medical (TechMed) Center, University of Twente, Enschede, the Netherlands (C.L.d.K.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); and Southwoods Imaging, 7623 Market St, Youngstown, OH 44512 (R.G.B.)
| |
Collapse
|
43
|
Park J, Lee JM, Lee G, Jeon SK, Joo I. Quantitative Evaluation of Hepatic Steatosis Using Advanced Imaging Techniques: Focusing on New Quantitative Ultrasound Techniques. Korean J Radiol 2022; 23:13-29. [PMID: 34983091 PMCID: PMC8743150 DOI: 10.3348/kjr.2021.0112] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease, characterized by excessive accumulation of fat in the liver, is the most common chronic liver disease worldwide. The current standard for the detection of hepatic steatosis is liver biopsy; however, it is limited by invasiveness and sampling errors. Accordingly, MR spectroscopy and proton density fat fraction obtained with MRI have been accepted as non-invasive modalities for quantifying hepatic steatosis. Recently, various quantitative ultrasonography techniques have been developed and validated for the quantification of hepatic steatosis. These techniques measure various acoustic parameters, including attenuation coefficient, backscatter coefficient and speckle statistics, speed of sound, and shear wave elastography metrics. In this article, we introduce several representative quantitative ultrasonography techniques and their diagnostic value for the detection of hepatic steatosis.
Collapse
Affiliation(s)
- Junghoan Park
- Department of Radiology, Seoul National University Hospital, 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.
| | - Gunwoo Lee
- Ultrasound R&D 2 Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Sun Kyung Jeon
- 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
| |
Collapse
|
44
|
Tamaki N, Ajmera V, Loomba R. Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD. Nat Rev Endocrinol 2022; 18:55-66. [PMID: 34815553 PMCID: PMC9012520 DOI: 10.1038/s41574-021-00584-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 01/27/2023]
Abstract
Hepatic steatosis is a key histological feature of nonalcoholic fatty liver disease (NAFLD). The non-invasive quantification of liver fat is now possible due to advances in imaging modalities. Emerging data suggest that high levels of liver fat and its temporal change, as measured by quantitative non-invasive methods, might be associated with NAFLD progression. Ultrasound-based modalities have moderate diagnostic accuracy for liver fat content and are suitable for screening. However, of the non-invasive imaging modalities, MRI-derived proton density fat fraction (MRI-PDFF) has the highest diagnostic accuracy and is used for trial enrolment and to evaluate therapeutic effects in early-phase clinical trials in nonalcoholic steatohepatitis (NASH). In patients with NAFLD without advanced fibrosis, high levels of liver fat are associated with rapid disease progression. Furthermore, changes on MRI-PDFF (≥30% decline relative to baseline) are associated with NAFLD activity score improvement and fibrosis regression. However, an inverse association exists between liver fat and complications of cirrhosis. Liver fat decreases as liver fibrosis progresses towards cirrhosis, and the clinical importance of quantitative measurements of liver fat differs by NAFLD status. As such, patients with NAFLD should be stratified by fibrosis severity to investigate the utility of quantitative measurements of liver fat for assessing NAFLD progression and prognosis.
Collapse
Affiliation(s)
- Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
45
|
A method for eliminating the disturbance of pseudo-textural-direction in ultrasound image feature extraction. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
46
|
Audière S, Labourdette A, Miette V, Fournier C, Ternifi R, Boussida S, Pouletaut P, Charleux F, Bensamoun SF, Harrison SA, Sandrin L. Improved Ultrasound Attenuation Measurement Method for the Non-invasive Evaluation of Hepatic Steatosis Using FibroScan. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3181-3195. [PMID: 34373137 DOI: 10.1016/j.ultrasmedbio.2021.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/24/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Controlled attenuation parameter (CAP) is a measurement of ultrasound attenuation used to assess liver steatosis non-invasively. However, the standard method has some limitations. This study assessed the performance of a new CAP method by ex vivo and in vivo assessments. The major difference with the new method is that it uses ultrasound data continuously acquired during the imaging phase of the FibroScan examination. Seven reference tissue-mimicking phantoms were used to test the performance. In vivo performance was assessed in two cohorts (in total 195 patients) of patients using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as a reference. The precision of CAP was improved by more than 50% on tissue-mimicking phantoms and 22%-41% in the in vivo cohort studies. The agreement between both methods was excellent, and the correlation between CAP and MRI-PDFF improved in both studies (0.71 to 0.74; 0.70 to 0.76). Using MRI-PDFF as a reference, the diagnostic performance of the new method was at least equal or superior (area under the receiver operating curve 0.889-0.900, 0.835-0.873). This study suggests that the new continuous CAP method can significantly improve the precision of CAP measurements ex vivo and in vivo.
Collapse
Affiliation(s)
| | | | | | | | - Redouane Ternifi
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de recherche Royallieu, Compiègne, France
| | - Salem Boussida
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de recherche Royallieu, Compiègne, France
| | - Philippe Pouletaut
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de recherche Royallieu, Compiègne, France
| | - Fabrice Charleux
- ACRIM-Polyclinique Saint Côme, Medical Radiology, Compiègne, France
| | - Sabine F Bensamoun
- Université de technologie de Compiègne, CNRS, Biomechanics and Bioengineering, Centre de recherche Royallieu, Compiègne, France
| | | | | |
Collapse
|
47
|
Jeon SK, Lee JM, Joo I, Yoon JH. Assessment of the inter-platform reproducibility of ultrasound attenuation examination in nonalcoholic fatty liver disease. Ultrasonography 2021; 41:355-364. [PMID: 34933319 PMCID: PMC8942738 DOI: 10.14366/usg.21167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/31/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to assess the inter-platform reproducibility of ultrasound attenuation examination in patients with nonalcoholic fatty liver disease (NAFLD). Methods Between March 2021 and April 2021, patients with clinically suspected or known NAFLD were prospectively enrolled; each patient underwent ultrasound attenuation examinations with three different platforms (Attenuation Imaging [ATI], Canon Medical System; Tissue Attenuation Imaging [TAI], Samsung Medison; and Ultrasound-Guided Attenuation Parameter [UGAP], GE Healthcare) on the same day. The mean attenuation coefficient (AC) values of the three platforms were compared using repeated-measures analysis of variance with the Bonferroni correction. To evaluate inter-platform reproducibility, the AC values obtained for each platform were compared using Bland-Altman analysis with the calculation of 95% limits of agreement (LOA), intraclass correlation coefficients (ICCs), and coefficients of variation (CVs). Results Forty-six patients (23 men; mean age±standard deviation, 52.3±12.4 years) were enrolled. The mean AC values showed significant differences among the three platforms (0.75±0.12, 0.80±0.11, and 0.74±0.09 dB/cm/MHz for ATI, TAI, and UGAP, respectively; P<0.001). For inter-platform reproducibility, the 95% LOAs were -0.22 to 0.11 dB/cm/MHz between ATI and TAI, -0.17 to 0.18 dB/cm/MHz between ATI and UGAP, and -0.08 to 0.20 dB/cm/MHz between TAI and UGAP, respectively. The pairwise ICCs were 0.790-0.797 in terms of absolute agreement among the three platforms; the CVs were 8.23%-9.47%. Conclusion The AC values obtained from different ultrasound attenuation examination platforms showed significant differences, with significant inter-platform variability. Therefore, the AC values measured using different ultrasound attenuation examination techniques should not be used interchangeably for longitudinal follow-up of patients with NAFLD.
Collapse
Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, 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
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
48
|
Deeba F, Schneider C, Mohammed S, Honarvar M, Lobo J, Tam E, Salcudean S, Rohling R. A multiparametric volumetric quantitative ultrasound imaging technique for soft tissue characterization. Med Image Anal 2021; 74:102245. [PMID: 34614475 DOI: 10.1016/j.media.2021.102245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/21/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
Quantitative ultrasound (QUS) offers a non-invasive and objective way to quantify tissue health. We recently presented a spatially adaptive regularization method for reconstruction of a single QUS parameter, limited to a two dimensional region. That proof-of-concept study showed that regularization using homogeneity prior improves the fundamental precision-resolution trade-off in QUS estimation. Based on the weighted regularization scheme, we now present a multiparametric 3D weighted QUS (3D QUS) method, involving the reconstruction of three QUS parameters: attenuation coefficient estimate (ACE), integrated backscatter coefficient (IBC) and effective scatterer diameter (ESD). With the phantom studies, we demonstrate that our proposed method accurately reconstructs QUS parameters, resulting in high reconstruction contrast and therefore improved diagnostic utility. Additionally, the proposed method offers the ability to analyze the spatial distribution of QUS parameters in 3D, which allows for superior tissue characterization. We apply a three-dimensional total variation regularization method for the volumetric QUS reconstruction. The 3D regularization involving N planes results in a high QUS estimation precision, with an improvement of standard deviation over the theoretical 1/N rate achievable by compounding N independent realizations. In the in vivo liver study, we demonstrate the advantage of adopting a multiparametric approach over the single parametric counterpart, where a simple quadratic discriminant classifier using feature combination of three QUS parameters was able to attain a perfect classification performance to distinguish between normal and fatty liver cases.
Collapse
Affiliation(s)
- Farah Deeba
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada.
| | - Caitlin Schneider
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada
| | - Shahed Mohammed
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada
| | | | | | | | - Septimiu Salcudean
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada
| | - Robert Rohling
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, Canada; Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada
| |
Collapse
|
49
|
Ferraioli G, Berzigotti A, Barr RG, Choi BI, Cui XW, Dong Y, Gilja OH, Lee JY, Lee DH, Moriyasu F, Piscaglia F, Sugimoto K, Wong GLH, Wong VWS, Dietrich CF. Quantification of Liver Fat Content with Ultrasound: A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2803-2820. [PMID: 34284932 DOI: 10.1016/j.ultrasmedbio.2021.06.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
New ultrasound methods that can be used to quantitatively assess liver fat content have recently been developed. These quantitative ultrasound (QUS) methods are based on the analysis of radiofrequency echoes detected by the transducer, allowing calculation of parameters for quantifying the fat in the liver. In this position paper, after a section dedicated to the importance of quantifying liver steatosis in patients with non-alcoholic fatty liver disease and another section dedicated to the assessment of liver fat with magnetic resonance, the current clinical studies performed using QUS are summarized. These new methods include spectral-based techniques and techniques based on envelope statistics. The spectral-based techniques that have been used in clinical studies are those estimating the attenuation coefficient and those estimating the backscatter coefficient. Clinical studies that have used tools based on the envelope statistics of the backscattered ultrasound are those performed by using the acoustic structure quantification or other parameters derived from it, such as the normalized local variance, and that performed by estimating the speed of sound. Experts' opinions are reported.
Collapse
Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Medical School University of Pavia, Pavia, Italy
| | - Annalisa Berzigotti
- Hepatology Dept., University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Switzerland
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | - Byung I Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Jae Young Lee
- Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
| | - Fabio Piscaglia
- Unit of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Grace Lai-Hung Wong
- Medical Data Analytic Centre and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
| |
Collapse
|
50
|
Cloutier G, Destrempes F, Yu F, Tang A. Quantitative ultrasound imaging of soft biological tissues: a primer for radiologists and medical physicists. Insights Imaging 2021; 12:127. [PMID: 34499249 PMCID: PMC8429541 DOI: 10.1186/s13244-021-01071-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/07/2021] [Indexed: 12/26/2022] Open
Abstract
Quantitative ultrasound (QUS) aims at quantifying interactions between ultrasound and biological tissues. QUS techniques extract fundamental physical properties of tissues based on interactions between ultrasound waves and tissue microstructure. These techniques provide quantitative information on sub-resolution properties that are not visible on grayscale (B-mode) imaging. Quantitative data may be represented either as a global measurement or as parametric maps overlaid on B-mode images. Recently, major ultrasound manufacturers have released speed of sound, attenuation, and backscatter packages for tissue characterization and imaging. Established and emerging clinical applications are currently limited and include liver fibrosis staging, liver steatosis grading, and breast cancer characterization. On the other hand, most biological tissues have been studied using experimental QUS methods, and quantitative datasets are available in the literature. This educational review addresses the general topic of biological soft tissue characterization using QUS, with a focus on disseminating technical concepts for clinicians and specialized QUS materials for medical physicists. Advanced but simplified technical descriptions are also provided in separate subsections identified as such. To understand QUS methods, this article reviews types of ultrasound waves, basic concepts of ultrasound wave propagation, ultrasound image formation, point spread function, constructive and destructive wave interferences, radiofrequency data processing, and a summary of different imaging modes. For each major QUS technique, topics include: concept, illustrations, clinical examples, pitfalls, and future directions.
Collapse
Affiliation(s)
- Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, Québec, H2X 0A9, Canada.
- Department of Radiology, Radio-oncology, and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada.
- Institute of Biomedical Engineering, Université de Montréal, Montréal, Québec, Canada.
| | - François Destrempes
- Laboratory of Biorheology and Medical Ultrasonics, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - François Yu
- Department of Radiology, Radio-oncology, and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
- Institute of Biomedical Engineering, Université de Montréal, Montréal, Québec, Canada
- Microbubble Theranostics Laboratory, CRCHUM, Montréal, Québec, Canada
| | - An Tang
- Department of Radiology, Radio-oncology, and Nuclear Medicine, Université de Montréal, Montréal, Québec, Canada
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Laboratory of Medical Image Analysis, Montréal, CRCHUM, Canada
| |
Collapse
|