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Overview of the Pathogenesis, Genetic, and Non-Invasive Clinical, Biochemical, and Scoring Methods in the Assessment of NAFLD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193570. [PMID: 31554274 PMCID: PMC6801903 DOI: 10.3390/ijerph16193570] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. It represents a range of disorders, including simple steatosis, nonalcoholic steatohepatitis (NASH), and liver cirrhosis, and its prevalence continues to rise. In some cases, hepatocellular carcinoma (HCC) may develop. The develop;ment of non-invasive diagnostic and screening tools is needed, in order to reduce the frequency of liver biopsies. The most promising methods are those able to exclude advanced fibrosis and quantify steatosis. In this study, new perspective markers for inflammation, oxidative stress, apoptosis, and fibrogenesis; emerging scoring models for detecting hepatic steatosis and fibrosis; and new genetic, epigenetic, and multiomic studies are discussed. As isolated biochemical parameters are not specific or sensitive enough to predict the presence of NASH and fibrosis, there is a tendency to use various markers and combine them into mathematical algorithms. Several predictive models and scoring systems have been developed. Current data suggests that panels of markers (NAFLD fibrosis score, Fib-4 score, BARD score, and others) are useful diagnostic modalities to minimize the number of liver biopsies. The review unveils pathophysiological aspects related to new trends in current non-invasive biochemical, genetic, and scoring methods, and provides insight into their diagnostic accuracies and suitability in clinical practice.
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Lefebvre T, Wartelle-Bladou C, Wong P, Sebastiani G, Giard JM, Castel H, Murphy-Lavallée J, Olivié D, Ilinca A, Sylvestre MP, Gilbert G, Gao ZH, Nguyen BN, Cloutier G, Tang A. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol 2019; 29:6477-6488. [PMID: 31278577 DOI: 10.1007/s00330-019-06331-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). METHODS This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method. RESULTS TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96). CONCLUSION MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis. TRIAL REGISTRATION NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.
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Affiliation(s)
- Thierry Lefebvre
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Medical Physics Unit, McGill University, Montreal, Canada
| | - Claire Wartelle-Bladou
- Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Philip Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Giada Sebastiani
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Jeanne-Marie Giard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Hélène Castel
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Jessica Murphy-Lavallée
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - Damien Olivié
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - André Ilinca
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada
| | - Guillaume Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,MR Clinical Science, Philips Healthcare Canada, Markham, Canada
| | - Zu-Hua Gao
- Department of Pathology, McGill University, Montreal, Canada
| | - Bich N Nguyen
- Service of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.,Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada. .,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. .,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.
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Carbonell G, Berná-Serna JDD, Oltra L, Martínez CM, Garcia-Carrillo N, Guzmán-Aroca F, Salazar FJ, Tudela J, Berná-Mestre JDD. Evaluation of rat liver with ARFI elastography: In vivo and ex vivo study. PLoS One 2019; 14:e0217297. [PMID: 31120974 PMCID: PMC6532896 DOI: 10.1371/journal.pone.0217297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare in vivo vs ex vivo liver stiffness in rats with acoustic radiation force impulse (ARFI) elastography using the histological findings as the gold standard. METHODS Eighteen male Wistar rats aged 16-18 months were divided into a control group (n = 6) and obese group (n = 12). Liver stiffness was measured with shear wave velocity (SWV) using the ARFI technique both in vivo and ex vivo. The degree of fibrosis, steatosis and liver inflammation was evaluated in the histological findings. Pearson's correlation coefficient was applied to relate the SWV values to the histological parameters. RESULTS The SWV values acquired in the ex vivo study were significantly lower than those obtained in vivo (P < 0.004). A significantly higher correlation value between the degree of liver fibrosis and the ARFI elastography assessment was observed in the ex vivo study (r = 0.706, P < 0.002), than the in vivo study (r = 0.623, P < 0.05). CONCLUSION Assessment of liver stiffness using ARFI elastography yielded a significant correlation between SWV and liver fibrosis in both the in vivo and ex vivo experiments. We consider that by minimising the influence of possible sources of artefact we could improve the accuracy of the measurements acquired with ARFI.
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Affiliation(s)
- Guillermo Carbonell
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- * E-mail:
| | - Juan de Dios Berná-Serna
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Lidia Oltra
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Department of Physiology, School of Medicine, University of Murcia, Murcia, Spain
| | - Carlos M. Martínez
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Nuria Garcia-Carrillo
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Preclinical Imaging Unit, Laboratory Animal Service, University of Murcia, Murcia, Spain
| | - Florentina Guzmán-Aroca
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Francisco Javier Salazar
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Department of Physiology, School of Medicine, University of Murcia, Murcia, Spain
| | - José Tudela
- GENZ-Group of Research on Enzymology, Department of Biochemistry and Molecular Biology-A, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
| | - Juan de Dios Berná-Mestre
- Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
- Institute of Biomedical Research (IMIB), Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
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Zhou JH, Cai JJ, She ZG, Li HL. Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice. World J Gastroenterol 2019; 25:1307-1326. [PMID: 30918425 PMCID: PMC6429343 DOI: 10.3748/wjg.v25.i11.1307] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
With the increasing number of individuals with diabetes and obesity, nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent, affecting one-quarter of adults worldwide. The spectrum of NAFLD ranges from simple steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). NAFLD, especially NASH, may progress to fibrosis, leading to cirrhosis and hepatocellular carcinoma. NAFLD can impose a severe economic burden, and patients with NAFLD-related terminal or deteriorative liver diseases have become one of the main groups receiving liver transplantation. The increasing prevalence of NAFLD and the severe outcomes of NASH make it necessary to use effective methods to identify NAFLD. Although recognized as the gold standard, biopsy is limited by its sampling bias, poor acceptability, and severe complications, such as mortality, bleeding, and pain. Therefore, noninvasive methods are urgently needed to avoid biopsy for diagnosing NAFLD. This review discusses the current noninvasive methods for assessing NAFLD, including steatosis, NASH, and NAFLD-related fibrosis, and explores the advantages and disadvantages of measurement tools. In addition, we analyze potential noninvasive biomarkers for tracking disease processes and monitoring treatment effects, and explore effective algorithms consisting of imaging and nonimaging biomarkers for diagnosing advanced fibrosis and reducing unnecessary biopsies in clinical practice.
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Affiliation(s)
- Jiang-Hua Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Jing-Jing Cai
- Department of Cardiology, The 3rd Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Hong-Liang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Model Animal of Wuhan University, Wuhan 430071, Hubei Province, China
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