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Ozturk A, Kumar V, Pierce TT, Li Q, Baikpour M, Rosado-Mendez I, Wang M, Guo P, Schoen S, Gu Y, Dayavansha S, Grajo JR, Samir AE. The Future Is Beyond Bright: The Evolving Role of Quantitative US for Fatty Liver Disease. Radiology 2023; 309:e223146. [PMID: 37934095 PMCID: PMC10695672 DOI: 10.1148/radiol.223146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common cause of morbidity and mortality. Nonfocal liver biopsy is the historical reference standard for evaluating NAFLD, but it is limited by invasiveness, high cost, and sampling error. Imaging methods are ideally situated to provide quantifiable results and rule out other anatomic diseases of the liver. MRI and US have shown great promise for the noninvasive evaluation of NAFLD. US is particularly well suited to address the population-level problem of NAFLD because it is lower-cost, more available, and more tolerable to a broader range of patients than MRI. Noninvasive US methods to evaluate liver fibrosis are widely available, and US-based tools to evaluate steatosis and inflammation are gaining traction. US techniques including shear-wave elastography, Doppler spectral imaging, attenuation coefficient, hepatorenal index, speed of sound, and backscatter-based estimation have regulatory clearance and are in clinical use. New methods based on channel and radiofrequency data analysis approaches have shown promise but are mostly experimental. This review discusses the advantages and limitations of clinically available and experimental approaches to sonographic liver tissue characterization for NAFLD diagnosis as well as future applications and strategies to overcome current limitations.
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Affiliation(s)
- Arinc Ozturk
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Viksit Kumar
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Theodore T Pierce
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Qian Li
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Masoud Baikpour
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Ivan Rosado-Mendez
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Michael Wang
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Peng Guo
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Scott Schoen
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Yuyang Gu
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Sunethra Dayavansha
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Joseph R Grajo
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
| | - Anthony E Samir
- From the Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 3rd Floor, 323G, Boston, MA 02114 (A.O., V.K., T.T.P., Q.L., M.B., P.G., S.S., Y.G., S.D., A.E.S.); Harvard Medical School, Boston, Mass (A.O., V.K., T.T.P, Q.L., A.E.S.); Departments of Medical Physics and Radiology, University of Wisconsin, Madison, Wis (I.R.M.); GE HealthCare, Milwaukee, Wis (M.W.); and Department of Radiology, University of Florida, Gainesville, Fla (J.R.G.)
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Zhou Z, Tai DI, Wan YL, Tseng JH, Lin YR, Wu S, Yang KC, Liao YY, Yeh CK, Tsui PH. Hepatic Steatosis Assessment with Ultrasound Small-Window Entropy Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1327-1340. [PMID: 29622501 DOI: 10.1016/j.ultrasmedbio.2018.03.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/21/2018] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease is a type of hepatic steatosis that is not only associated with critical metabolic risk factors but can also result in advanced liver diseases. Ultrasound parametric imaging, which is based on statistical models, assesses fatty liver changes, using quantitative visualization of hepatic-steatosis-caused variations in the statistical properties of backscattered signals. One constraint with using statistical models in ultrasound imaging is that ultrasound data must conform to the distribution employed. Small-window entropy imaging was recently proposed as a non-model-based parametric imaging technique with physical meanings of backscattered statistics. In this study, we explored the feasibility of using small-window entropy imaging in the assessment of fatty liver disease and evaluated its performance through comparisons with parametric imaging based on the Nakagami distribution model (currently the most frequently used statistical model). Liver donors (n = 53) and patients (n = 142) were recruited to evaluate hepatic fat fractions (HFFs), using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate and severe), using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct B-mode, small-window entropy and Nakagami images to correlate with HFF analyses and fatty liver stages. The diagnostic values of the imaging methods were evaluated using receiver operating characteristic curves. The results demonstrated that the entropy value obtained using small-window entropy imaging correlated well with log10(HFF), with a correlation coefficient r = 0.74, which was higher than those obtained for the B-scan and Nakagami images. Moreover, small-window entropy imaging also resulted in the highest area under the receiver operating characteristic curve (0.80 for stages equal to or more severe than mild; 0.90 for equal to or more severe than moderate; 0.89 for severe), which indicated that non-model-based entropy imaging-using the small-window technique-performs more favorably than other techniques in fatty liver assessment.
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Affiliation(s)
- Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China; Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ru Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan
| | - Yin-Yin Liao
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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