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Zhang LX, Burgio MD, Vilgrain V, Fang C, Sidhu PS, Cloutier G, Tang A. Quantitative Ultrasound and Ultrasound-Based Elastography for Chronic Liver Disease: Practical Guidance, From the AJR Special Series on Quantitative Imaging. AJR Am J Roentgenol 2024. [PMID: 39259009 DOI: 10.2214/ajr.24.31709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Quantitative ultrasound (QUS) and ultrasound-based elastography techniques are emerging as non-invasive effective methods for assessing chronic liver disease. They are more accurate than B-mode imaging alone and more accessible than MRI as alternatives to liver biopsy. Early detection and monitoring of diffuse liver processes such as steatosis, inflammation, and fibrosis play an important role in guiding patient management. The most widely available and validated techniques are attenuation-based QUS techniques and shear-wave elastography techniques that measure shear-wave speed. Other techniques are supported by a growing body of evidence and are increasingly commercialized. This review explains general physical concepts of QUS and ultrasound-based elastography techniques for evaluating chronic liver disease. The first section describes QUS techniques relying on attenuation, backscatter, and speed of sound. The second section discusses ultrasound-based elastography techniques analyzing shear-wave speed, shear-wave dispersion, and shear-wave attenuation. With an emphasis on clinical implementation, each technique's diagnostic performance along with thresholds for various clinical applications are summarized, to provide guidance on analysis and reporting for radiologists. Measurement methods, advantages, and limitations are also discussed. The third section explores developments in quantitative contrast-enhanced and vascular ultrasound that are relevant to chronic liver disease evaluation.
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Affiliation(s)
- Li Xin Zhang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Canada
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
- Research Center on Inflammation, Université Paris Cité, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - Cheng Fang
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE17EH UK
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE17EH UK
| | - Guy Cloutier
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Canada
- Institute of Biomedical Engineering, Université de Montréal, Montréal, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Canada
- Institute of Biomedical Engineering, Université de Montréal, Montréal, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
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Jiang Y, Liu X, Jiang Z. From Morphology to Therapeutic Strategies: Exploring New Applications of Ultrasound for Diabetic Peripheral Neuropathy Diagnosis and Management. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39239831 DOI: 10.1002/jum.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/24/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that can result in severe lower limb pain and amputation. Early detection and treatment of DPN are vital, but this condition is often missed due to a lack of symptoms and the insensitivity of testing methods. This article reviews various ultrasound imaging modalities in the direct and indirect evaluation of peripheral neuropathy. Moreover, how ultrasound-related therapeutic strategies are playing a role in clinical treatment is discussed. Finally, the application of innovative methodologies in the diagnosis of DPN, including ultrasound attenuation, photoacoustic imaging, and artificial intelligence, is described.
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Affiliation(s)
- Yanfeng Jiang
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Xiatian Liu
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Zhenzhen Jiang
- Department of Ultrasound, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
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Yamaguchi R, Oda T, Nagashima K. Comparison of the diagnostic accuracy of shear wave elastography with transient elastography in adult nonalcoholic fatty liver disease: a systematic review and network meta-analysis of diagnostic test accuracy. Abdom Radiol (NY) 2024:10.1007/s00261-024-04546-8. [PMID: 39240377 DOI: 10.1007/s00261-024-04546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/17/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE To compare the diagnostic test accuracy (DTA) of shear wave elastography (SWE) to that of transient elastography (TE) for liver fibrosis grade assessment in nonalcoholic fatty liver disease adults. METHODS MEDLINE, The Cochrane Library, and Web of Science were searched. Inclusion criteria were primary studies examining DTA of TE, point SWE (pSWE), two-dimensional SWE (2D-SWE), or magnetic resonance elastography (MRE) with liver biopsy. Network meta-analysis was conducted using a Bayesian bivariate mixed-effects model. RESULTS For fibrosis grade 2 or higher, 15 studies with 25 observations (16 observations for TE, 1 for MRE, 4 for pSWE and 2D-SWE; 2,066 patients) were included; the pooled sensitivity and specificity were 0.79 (95% credible interval (CrI) 0.70-0.86; 95% prediction interval (PI) 0.36-0.96) and 0.73 (95% CrI 0.62-0.82; 95% PI 0.23-0.96) for TE, 0.68 (95% CrI 0.48-0.83; 95% PI 0.23-0.94) and 0.75 (95% CrI 0.53-0.88; 95% PI 0.24-0.97) for pSWE, 0.85 (95% CrI 0.70-0.93; 95% PI 0.40-0.98) and 0.72 (95% CrI 0.49-0.86; 95% PI 0.20-0.96) for 2D-SWE, respectively. The proportion of studies classified as unclear in QUADAS-2 was high, and the results were heterogeneous. CONCLUSION 2D-SWE could be recommended as TE is for liver fibrosis assessment. The protocol of this systematic review and network meta-analysis has been registered in PROSPERO (CRD42022327249). All included primary papers have already been published and the information and data can be used freely.
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Affiliation(s)
- Ruri Yamaguchi
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aobaku, Sendai, 980-8575, Japan.
| | - Tetsuro Oda
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, 160-8582, Japan
- Department of Bioregulation, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8602, Japan
- Division of Cancer Therapeutics, National Cancer Center Research Institute, Tokyo, 104-0045, Japan
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Trelsgård AM, Mulabecirovic A, Leiva RA, Nordaas IK, Mjelle AB, Gilja OH, Havre RF. Multiparametric liver assessment in patients successfully treated for hepatitis C: a 4-year follow-up. Scand J Gastroenterol 2024:1-8. [PMID: 39219192 DOI: 10.1080/00365521.2024.2388691] [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: 04/26/2024] [Revised: 06/29/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major cause of chronic liver disease, in which liver stiffness increases. Liver stiffness measurements (LSM) are therefore essential in diagnosing liver diseases and predicting disease development. The study objective was to perform a comprehensive prospective assessment of the liver before, after and 4 years after treatment for HCV, including an assessment of the long-term outcome of fibrosis, steatosis and inflammation. METHODS AND FINDINGS Patients eligible for HCV treatment were included prospectively in 2018 (n = 47). Liver stiffness was measured using transient elastography and 2D shear-wave elastography (SWE). Blood tests, B-mode ultrasound (US) and SWE, were performed before, after (end of treatment [EOT]), 3 months after (EOT3) and 4 years after treatment (4Y). At the final visit, we added attenuation imaging and shear-wave dispersion slope (SWDS) measurements to assess steatosis and inflammation. Three months after treatment, the sustained virologic response rate was 93%. The median liver stiffness for baseline, EOT, EOT3 and 4Y was 8.1, 5.9, 5.6 and 6.3 kPa, respectively. There was a significant reduction in liver stiffness from baseline to EOT, and from EOT to EOT3. After 4 years, the mean attenuation coefficient (AC) was 0.58 dB/cm/MHz, and the mean SWDS value was 14.3 (m/s)/kHz. CONCLUSION The treatment for HCV was highly effective. Measurements of liver stiffness decreased significantly after treatment and remained low after 4 years. AC measurements indicated low levels of liver steatosis. Shear-wave dispersion values indicated inflammation of the liver, but the clinical implication is undetermined and should be explored in larger studies.Clinicaltrials.gov: NCT03434470. ABBREVIATIONS AC: attenuation coefficient; APRI: aspartate aminotransferase to platelet ratio index; ATI: attenuation imaging; cACLD: compensated advanced chronic liver disease; CAP: controlled attenuation parameter; FIB-4: Fibrosis-4 Index for liver fibrosis; HCC: hepatocellular carcinoma; LSM: liver stiffness measurement; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; SWDS: shear-wave dispersion slope; SWE: shear-wave elastography; US: ultrasound.
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Affiliation(s)
- Audun M Trelsgård
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anesa Mulabecirovic
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | - Ingrid K Nordaas
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anders B Mjelle
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Anaesthesia, Stavanger University Hospital, Stavanger, Norway
| | - Odd Helge Gilja
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roald F Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Zhou Y, Nie M, Mao F, Zhou H, Zhao L, Ding J, Kan Y, Jing X. Associations Between Multiparametric US-Based Indicators and Pathological Status in Patients with Metabolic Associated Fatty Liver Disease. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1395-1402. [PMID: 38871490 DOI: 10.1016/j.ultrasmedbio.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/05/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Noninvasive evaluation of metabolic dysfunction-associated fatty liver disease (MAFLD) using ultrasonography holds significant clinical value. The associations between ultrasound (US)-based parameters and the pathological spectra remain unclear and controversial. This study aims to investigate the associations thoroughly. METHODS The participants with MAFLD undergoing liver biopsy and multiparametric ultrasonography were prospectively recruited from December 2020 to September 2022. Three US-based parameters, namely attenuation coefficient (AC), liver stiffness (LS) and dispersion slope (DS) were obtained. The relationship between these parameters and steatosis grades, inflammation grades and fibrosis stages was examined. RESULTS In this study with 116 participants, AC values significantly differed across distinct steatosis grades (p < 0.001), while DS and LS values varied among inflammation grades (p < 0.001) and fibrosis stages (p < 0.001). The area under the receiver operating characteristic curves (AUCs) of AC ranged from 0.82 to 0.84 for differentiating steatosis grades, while AUCs of LS ranged from 0.62 to 0.76 for distinguishing inflammation grades and 0.83-0.95 for discerning fibrosis stages. AUCs for DS ranged from 0.79 to 0.81 in discriminating inflammation grades and 0.80-0.88 for differentiating fibrosis stages. Subgroup analysis revealed that LS demonstrated different trends in inflammation grade but consistent trends in fibrosis stage across subgroups, whereas DS showed consistent trends for both inflammation grade and fibrosis stage across all subgroups. CONCLUSION AC values indicate the degree of hepatic steatosis but not inflammation or fibrosis. LS values are determined only by fibrosis stage and are not associated with inflammation grades. DS values are associated with both fibrosis and inflammation grades.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Mengjin Nie
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Yanmin Kan
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China; Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal, Life Support for Critical Diseases, Artificial Cell Engineering Technology Research, Center, Tianjin Third Central Hospital, Tianjin, China.
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Song SJ, Kim YR, Lee YH, Cho EY. Potential role of two-dimensional shear wave elastography, including liver stiffness measurement and dispersion slope, for management of chronic hepatitis B. Ultrasonography 2024; 43:384-392. [PMID: 39175218 PMCID: PMC11374586 DOI: 10.14366/usg.24091] [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: 05/20/2024] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE This study assessed the use of liver stiffness (LS) and dispersion slope (DS) in classifying patients with chronic hepatitis B (CHB) by the necessity of antiviral treatment. METHODS A retrospective review examined 249 patients with CHB (male:female, 107:142; mean age, 53±14 years) between April 2018 and March 2022. Patients for whom treatment was indicated, termed group 1, exhibited either serum alanine transaminase (ALT) and aspartate aminotransferase levels not exceeding five times the upper limit of normal and LS >13 kPa, or hepatitis B virus DNA >2,000 IU/mL and ALT >40 IU/L. The remaining patients comprised group 2 (treatment not required). In subgroup analysis, patients with LS <13 kPa were further examined. RESULTS Overall, group 1 exhibited significantly higher LS (12.64±6.76 vs. 6.31±1.67 kPa, P<0.001) and DS (15.52±4.95 vs. 11.04±1.93 [m/s]/kHz, P<0.001) than group 2. In subgroup analysis, group 1 also demonstrated significantly higher values (LS: 8.05±2.12 vs 6.31±1.67 kPa, P<0.001, DS: 13.06±2.75 vs. 11.04±1.93 [m/s]/kHz, P<0.001). The areas under the curve (AUCs) for LS and DS in group 1 were 0.855 (95% confidence interval [CI], 0.80 to 0.90; P<0.001) and 0.810 (95% CI, 0.75 to 0.86; P<0.001), respectively. In subgroup analysis, the AUCs for LS and DS in group 1 were 0.751 (95% CI, 0.69 to 0.81; P<0.001) and 0.711 (95% CI, 0.64 to 0.77; P<0.001), respectively. Within group 1, the AUCs for LS and DS did not differ significantly (P>0.05). CONCLUSION LS and DS assist in classifying patients with CHB by their need for antiviral treatment.
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Affiliation(s)
- Seung Ju Song
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Youe Ree Kim
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
| | - Eun Young Cho
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
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Wang K, Zhang J, Wang J, Wang M, Yu Y. Role of multiparametric US in the preoperative assessment of hepatic parenchyma in patients with liver tumors. Abdom Radiol (NY) 2024:10.1007/s00261-024-04386-6. [PMID: 39152231 DOI: 10.1007/s00261-024-04386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic performance of shear wave elastography (SWE), shear wave dispersion (SWD), and attenuation imaging (ATI) in assessment of hepatic parenchyma in patients with liver tumors before resection. METHODS Patients with liver tumors were prospectively enrolled in this study. All participants underwent SWE, SWD, and ATI examinations. Fibrosis stage, necroinflammatory activity and hepatic steatosis grade were determined histopathologically. We evaluated the stability of ATI, SWE and SWD examinations. Multivariable linear regression analyses were conducted to determine the determinant factors for SWE, SWD, attenuation coefficient (AC) values. A receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic performance of multiparametric US (ultrasond). RESULTS A total of 280 participants were enrolled in this study. TG (triglyceride) and steatosis for AC value were significant determinant factors. PLT (platelet), PT (prothrombin time), GGT (glutamyl transpeptidase), and fibrosis stage for SWE value were significant determinant factors. PLT, fibrosis stage and inflammation activity for SWD value were significant determinant factors. AC value was correlated with hepatic steatosis. Both SWE and SWD values were correlated with fibrosis stage, inflammation activity, respectively. The area under the ROC (AUROC) curve of ATI for predicting hepatic steatosis grade were 0.910(≥ S1), 0.927(≥ S2), 0.962(= S3), respectively. The AUROC curve of SWE for predicting fibrosis stage were 0.923(≥ S1), 0.934(≥ S2), 0.930(≥ S3), 0.895(= S4), respectively. The AUROC curve of SWD for predicting fibrosis stage were 0.858(≥ S1), 0.886(≥ S2), 0.866(≥ S1) (≥ S3), 0.825(= S4). The AUROC curve of SWE for predicting inflammation activity were 0.846(≥ G1), 0.724(≥ G2), 0.787 (≥ G3), respectively. The AUROC curve of SWD for predicting inflammation activity were 0.777(≥ G1), 0.727(≥ G2), 0.803 (≥ G3), respectively. CONCLUSIONS For patients with liver tumors, ATI technology showed excellent feasibility and diagnostic performance for detecting and grading hepatic steatosis, SWE was more accurate in detecting fibrosis stage than SWD, SWD was not superior to SWE in detecting inflammation activity.
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Affiliation(s)
- Kun Wang
- Department of Ultrasound, Binzhou Medical University Hospital, 2 Huanghe Road, Shixi District, Binzhou, 256600, China
| | - Jinqiao Zhang
- Department of Ultrasound, Binzhou Medical University Hospital, 2 Huanghe Road, Shixi District, Binzhou, 256600, China
| | - Jing Wang
- Department of Ultrasound, Binzhou Medical University Hospital, 2 Huanghe Road, Shixi District, Binzhou, 256600, China
| | - Min Wang
- Department of Ultrasound, Binzhou Medical University Hospital, 2 Huanghe Road, Shixi District, Binzhou, 256600, China
| | - Yanjie Yu
- Department of Ultrasound, Binzhou Medical University Hospital, 2 Huanghe Road, Shixi District, Binzhou, 256600, China.
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Ferraioli G, Barr RG, Berzigotti A, Sporea I, Wong VWS, Reiberger T, Karlas T, Thiele M, Cardoso AC, Ayonrinde OT, Castera L, Dietrich CF, Iijima H, Lee DH, Kemp W, Oliveira CP, Sarin SK. WFUMB Guidelines/Guidance on Liver Multiparametric Ultrasound. Part 2: Guidance on Liver Fat Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1088-1098. [PMID: 38658207 DOI: 10.1016/j.ultrasmedbio.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has promoted the development of this document on multiparametric ultrasound. Part 2 is a guidance on the use of the available tools for the quantification of liver fat content with ultrasound. These are attenuation coefficient, backscatter coefficient, and speed of sound. All of them use the raw data of the ultrasound beam to estimate liver fat content. This guidance has the aim of helping the reader in understanding how they work and interpret the results. Confounding factors are discussed and a standardized protocol for measurement acquisition is suggested to mitigate them. The recommendations were based on published studies and experts' opinion but were not formally graded because the body of evidence remained low at the time of drafting this document.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Richard Gary Barr
- Department of Radiology, Northeastern Ohio Medical University, Youngstown, OH, USA
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ioan Sporea
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria; Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Thomas Karlas
- Department of Medicine II, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark; Department for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ana Carolina Cardoso
- Hepatology Division, School of Medicine, Federal University of Rio de Janeiro, Clementino, Fraga Filho Hospital, Rio de Janeiro, RJ, Brazil
| | - Oyekoya Taiwo Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia; Medical School, The University of Western Australia, Crawley, WA, Australia; Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Laurent Castera
- Université Paris-Cité, Inserm UMR1149, Centre de Recherche sur l'Inflammation, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Clichy, France
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland
| | - Hiroko Iijima
- Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Disease, Hyogo Medical University, Nishinomiya, Hyogo, Japan; Ultrasound Imaging Center, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Dong Ho Lee
- Department of Radiology, College of Medicine, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Claudia P Oliveira
- Gastroenterology Department, Laboratório de Investigação (LIM07), Hospital das Clínicas de São Paulo, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Yin M. Shear-Wave Dispersion for Detecting Hepatic Inflammation in Metabolic Dysfunction-associated Steatotic Liver Disease. Radiology 2024; 312:e241420. [PMID: 39162631 PMCID: PMC11366665 DOI: 10.1148/radiol.241420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/21/2024]
Affiliation(s)
- Meng Yin
- From the Department of Radiology, Center for Advanced Imaging Research, Opus Building, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Li X, Huang X, Cheng G, Liang J, Qiu L, Zhang J, Yao Q, Ding H. Optimizing the number of valid measurements for the attenuation coefficient to assess hepatic steatosis in MAFLD patients: A study of 139 patients who underwent liver biopsy. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:395-404. [PMID: 38081211 PMCID: PMC11293898 DOI: 10.1055/a-2178-5022] [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: 08/22/2022] [Accepted: 08/17/2023] [Indexed: 08/03/2024]
Abstract
PURPOSE We investigated the optimal number of valid measurements (VMs) for the attenuation coefficient (AC) to assess liver steatosis using attenuation imaging (ATI) and explored factors that may affect AC measurement in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). MATERIALS AND METHODS A total of 139 patients with MAFLD who underwent ATI and liver biopsy were enrolled. Hepatic steatosis was graded as S0-3 according to the SAF scoring system. The AC values from 1, 2, 3, 5, and 7 VMs were compared with the degree of liver steatosis. The correlation between AC values from different VMs was analyzed. The diagnostic performance of AC from different VMs at each steatosis grade was compared. The factors related to AC were identified using linear regression analysis. RESULTS The mean AC values from 1, 2, 3, 5, and 7 VMs were not significantly different between grades S0-3 (p=n.s. for all). Bland-Altman analysis showed the mean difference in AC values of 3 VMs and 7 VMs was 0.003 dB/cm/MHz, which was smaller compared with 2 VMs, and close to 5 VMs. The intraclass correlation coefficients of AC were all > 0.90 among different VM groups. AC values from different VMs all significantly predicted steatosis grade ≥S1, ≥S2, and S3 without significant statistical differences (p=n.s. for all). The multivariate analysis showed that the hepatic steatosis grade and triglyceride level were factors independently associated with AC. CONCLUSION Three valid measurements of AC may be adequate to ensure the accuracy and reproducibility of hepatic steatosis assessment. The degree of liver steatosis and the triglyceride level significantly affected AC values.
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Affiliation(s)
- Xueqi Li
- Department of Ultrasound, Huashan Hospital Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xianjue Huang
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Guangwen Cheng
- Department of Ultrasound, Huashan Hospital Fudan University, Shanghai, China
| | - Jing Liang
- Department of Ultrasound, Huashan Hospital Fudan University, Shanghai, China
| | - Luping Qiu
- Department of Ultrasound, Huashan Hospital Fudan University, Shanghai, China
| | - Jubo Zhang
- Department of Infectious Diseases, Huashan Hospital Fudan University, Shanghai, China
| | - Qiyuan Yao
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Shanghai, China
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Sugimoto K, Moriyasu F, Dioguardi Burgio M, Vilgrain V, Jesper D, Strobel D, Blank V, Karlas T, Grant EG, Kelahan LC, Gabriel H, Choi BI, Nishimura T, Iijima H, Dubinsky TJ, Gao J, Lee DH, Lee JY, Zhao Y, Huang P, Zeng J, Lim A, Xie X, Barr RG, Cantisani V, Ferraioli G, Sakamaki K, Itoi T, Kage M, Yano H. US Markers and Necroinflammation, Steatosis, and Fibrosis in Metabolic Dysfunction-associated Steatotic Liver Disease: The iLEAD Study. Radiology 2024; 312:e233377. [PMID: 39162633 DOI: 10.1148/radiol.233377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopathologic necroinflammation in patients with MASLD. Materials and Methods This international multicenter prospective study enrolled consecutive patients with biopsy-proven MASLD between June 2019 and March 2023. Before biopsy, all participants underwent multiparametric US, and measurements of DS, AC, and SWS were obtained. Multivariable linear regression analyses were performed to assess the association of clinical variables and imaging markers with pathologic findings. The diagnostic performance of imaging markers for determining inflammation grade, steatosis grade, and fibrosis stage was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 124 participants (mean age, 53 years ± 15 [SD]; 62 males) were evaluated. In multivariable regression, lobular inflammation was associated with DS (regression coefficient, 0.06; P = .02), alanine aminotransferase level (regression coefficient, 0.002; P = .002), and Hispanic or Latino ethnicity (regression coefficient, -0.68; P = .047), while steatosis was associated with AC (regression coefficient, 3.66; P < .001) and fibrosis was associated with SWS (regression coefficient, 2.02; P < .001) and body mass index (regression coefficient, 0.05; P = .02). DS achieved an AUC of 0.72 (95% CI: 0.63, 0.82) for identifying participants with inflammation grade A2 or higher (moderate to severe inflammation). AC showed excellent performance for identifying participants with grade S1 (mild) or higher steatosis (AUC, 0.92 [95% CI: 0.87, 0.97]), while SWS showed excellent performance for identifying participants with fibrosis stage F2 or higher (clinically significant fibrosis) (AUC, 0.91 [95% CI: 0.86, 0.96]). Of the three US markers, SWS showed the highest AUC (0.81 [95% CI: 0.74, 0.89]) for the diagnosis of metabolic dysfunction-associated steatohepatitis. Conclusion Of the three US imaging markers (DS, AC, and SWS), DS was most associated with lobular inflammation grade at histologic examination and demonstrated fair diagnostic performance in distinguishing moderate to severe lobular inflammation. ClinicalTrials.gov Identifier: NCT04012242 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Yin in this issue.
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Affiliation(s)
- Katsutoshi Sugimoto
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Fuminori Moriyasu
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Marco Dioguardi Burgio
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Valérie Vilgrain
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Daniel Jesper
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Deike Strobel
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Valentin Blank
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Thomas Karlas
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Edward G Grant
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Linda C Kelahan
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Helena Gabriel
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Byung Ihn Choi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Takashi Nishimura
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Hiroko Iijima
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Theodore J Dubinsky
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Jing Gao
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Dong Ho Lee
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Jae Young Lee
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Yanan Zhao
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Pintong Huang
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Jie Zeng
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Adrian Lim
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Xiaoyan Xie
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Richard G Barr
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Vito Cantisani
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Giovanna Ferraioli
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Kentaro Sakamaki
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Takao Itoi
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Masayoshi Kage
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
| | - Hirohisa Yano
- From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.)
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Zhou Y, Nie M, Zhou H, Mao F, Zhao L, Ding J, Jing X. Head-to-head comparison of three different US-based quantitative parameters for hepatic steatosis assessment: a prospective study. Abdom Radiol (NY) 2024; 49:2262-2271. [PMID: 38740581 DOI: 10.1007/s00261-024-04347-z] [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: 01/31/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To evaluate the diagnostic performance of attenuation coefficient (AC), hepato-renal index (HRI) and controlled attenuation parameter (CAP) in quantitative assessment of hepatic steatosis by employing histopathology as reference standard. METHODS Participants with suspected metabolic-associated fatty liver disease (MAFLD) who underwent US-based parameter examinations and liver biopsy were prospectively recruited. The distributions of US parameters across different grades of steatosis were calculated, and diagnostic performance was determined based on the areas under the receiver operating characteristic curve (AUC). RESULTS A total of 73 participants were included, with hepatic steatosis grades S0, S1, S2, and S3 distributed as follows: 13, 20, 27, and 13 respectively. The correlation coefficients for CAP, AC, and HRI ranged from 0.67 to 0.74. AC and HRI showed a strong correlation with steatosis grade. The AUC for CAP and AC in diagnosing steatosis ≥ S1 were significantly higher at 0.99 and 0.98 compared to HRI's value. For diagnosing steatosis ≥ S2, the AUC of CAP (AUC: 0.85) was lower than that of AC (AUC: 0.94), and HRI (AUC: 0.94). Similarly for diagnosing steatosis S3, the AUC of CAP (AUC: 0.68) was lower than that of AC (AUC: 0.88), and HRI (AUC: 0.88). CONCLUSION The AC and HRI values increased with the progression of hepatic steatosis grade, while CAP increased from S0 to S2 but not from S2 to S3. For mild steatosis diagnosis, CAP and AC showed superior diagnostic performance compared to HRI, while AC and HRI were more advantageous in differentiating moderate and severe steatosis.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
| | - Mengjin Nie
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Department of Ultrasound, The Third Central Clinical College of Tianjin Medical University, Tianjin, 300170, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China.
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Third Central Hospital, Hedong District, No. 83 Jintang Road, Tianjin, 300170, China.
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13
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Kobayashi T, Nakatsuka T, Sato M, Soroida Y, Hikita H, Gotoh H, Iwai T, Tateishi R, Kurano M, Fujishiro M. Diagnostic performance of two-dimensional shear wave elastography and attenuation imaging for fibrosis and steatosis assessment in chronic liver disease. J Med Ultrason (2001) 2024:10.1007/s10396-024-01473-5. [PMID: 38951430 DOI: 10.1007/s10396-024-01473-5] [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: 01/15/2024] [Accepted: 05/14/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE We investigated the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) and attenuation imaging (ATI) in detecting fibrosis and steatosis in patients with chronic liver disease (CLD), comparing them with established methods. METHODS In 190 patients with CLD, 2D-SWE and vibration-controlled transient elastography (VCTE) were used for liver stiffness measurement (LSM), and ATI and controlled attenuation parameter (CAP) were used for steatosis quantification. The correlations between these new and established methods were analyzed. RESULTS Significant correlations were found between 2D-SWE and VCTE (r = 0.78, P < 0.001), and between ATI and CAP (r = 0.70, P < 0.001). Liver stiffness tended to be lower with 2D-SWE compared with that with VCTE, especially in cases with higher LSM, and ATI was less influenced by skin-capsular distance than CAP. Area under the receiver-operating characteristics curves (AUCs) and optimal cut-offs of 2D-SWE for diagnosing liver fibrosis stages F2, F3, and F4 were 0.73 (8.7 kPa), 0.79 (9.1 kPa), and 0.88 (11.6 kPa), respectively. The AUCs and optimal cut-offs of ATI for diagnosing hepatic steatosis grades S1, S2, and S3 were 0.91 (0.66 dB/cm/MHz), 0.80 (0.79 dB/cm/MHz), and 0.88 (0.86 dB/cm/MHz), respectively. A subgroup analysis of 86 patients with metabolic dysfunction-associated steatotic liver disease also demonstrated good performance for 2D-SWE and ATI. CONCLUSION 2D-SWE and ATI performed comparably with conventional VCTE and CAP in evaluating CLD, offering reliable alternatives for diagnosing liver fibrosis and steatosis.
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Affiliation(s)
- Tamaki Kobayashi
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Masaya Sato
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoko Soroida
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Hiromi Hikita
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Hiroaki Gotoh
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Tomomi Iwai
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Makoto Kurano
- Department of Clinical Laboratory Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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14
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Hirooka M, Ogawa S, Koizumi Y, Yoshida Y, Goto T, Yasuda S, Yamahira M, Tamai T, Kuromatsu R, Matsuzaki T, Suehiro T, Kamada Y, Sumida Y, Hiasa Y, Toyoda H, Kumada T. iATT liver fat quantification for steatosis grading by referring to MRI proton density fat fraction: a multicenter study. J Gastroenterol 2024; 59:504-514. [PMID: 38553657 PMCID: PMC11128405 DOI: 10.1007/s00535-024-02096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/03/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Several preliminary reports have suggested the utility of ultrasound attenuation coefficient measurements based on B-mode ultrasound, such as iATT, for diagnosing steatotic liver disease. Nonetheless, evidence supporting such utility is lacking. This prospective study aimed to investigate whether iATT is highly concordant with magnetic resonance imaging (MRI)-based proton density fat fraction (MRI-PDFF) and could well distinguish between steatosis grades. METHODS A cohort of 846 individuals underwent both iATT and MRI-PDFF assessments. Steatosis grade was defined as grade 0 with MRI-PDFF < 5.2%, grade 1 with 5.2% MRI-PDFF < 11.3%, grade 2 with 11.3% MRI-PDFF < 17.1%, and grade 3 with MRI-PDFF of 17.1%. The reproducibility of iATT and MRI-PDFF was evaluated using the Bland-Altman analysis and intraclass correlation coefficients, whereas the diagnostic performance of each steatosis grade was examined using receiver operating characteristic analysis. RESULTS The Bland-Altman analysis indicated excellent reproducibility with minimal fixed bias between iATT and MRI-PDFF. The area under the curve for distinguishing steatosis grades 1, 2, and 3 were 0.887, 0.882, and 0.867, respectively. A skin-to-capsula distance of ≥ 25 mm was identified as the only significant factor causing the discrepancy. No interaction between MRI-logPDFF and MRE-LSM on iATT values was observed. CONCLUSIONS Compared to MRI-PDFF, iATT showed excellent diagnostic accuracy in grading steatosis. iATT could be used as a diagnostic tool instead of MRI in clinical practice and trials. Trial registration This study was registered in the UMIN Clinical Trials Registry (UMIN000047411).
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Affiliation(s)
- Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan.
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Yuichi Yoshida
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Japan
| | - Tatsuya Goto
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Masahiro Yamahira
- Department of Clinical Laboratory Medicine, Suita Municipal Hospital, Suita, Japan
| | - Tsutomu Tamai
- Department of Gastroenterology, Kagoshima City Hospital, Kagoshima, Japan
| | - Ryoko Kuromatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Toshihisa Matsuzaki
- Department of Gastroenterology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Tomoyuki Suehiro
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Yoshihiro Kamada
- Department of Advanced Metabolic Hepatology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshio Sumida
- Graduate School of Healthcare Management, International University of Healthcare and Welfare, Tokyo, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
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15
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Chan WK, Petta S, Noureddin M, Goh GBB, Wong VWS. Diagnosis and non-invasive assessment of MASLD in type 2 diabetes and obesity. Aliment Pharmacol Ther 2024; 59 Suppl 1:S23-S40. [PMID: 38813831 DOI: 10.1111/apt.17866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 12/26/2023] [Indexed: 05/31/2024]
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most common chronic liver disease and an important cause of cirrhosis and hepatocellular carcinoma. It is strongly associated with type 2 diabetes and obesity. Because of the huge number of patients at risk of MASLD, it is imperative to use non-invasive tests appropriately. AIMS To provide a narrative review on the performance and limitations of non-invasive tests, with a special emphasis on the impact of diabetes and obesity. METHODS We searched PubMed and Cochrane databases for articles published from 1990 to August 2023. RESULTS Abdominal ultrasonography remains the primary method to diagnose hepatic steatosis, while magnetic resonance imaging proton density fat fraction is currently the gold standard to quantify steatosis. Simple fibrosis scores such as the Fibrosis-4 index are well suited as initial assessment in primary care and non-hepatology settings to rule out advanced fibrosis and future risk of liver-related complications. However, because of its low positive predictive value, an abnormal test should be followed by specific blood (e.g. Enhanced Liver Fibrosis score) or imaging biomarkers (e.g. vibration-controlled transient elastography and magnetic resonance elastography) of fibrosis. Some non-invasive tests of fibrosis appear to be less accurate in patients with diabetes. Obesity also affects the performance of abdominal ultrasonography and transient elastography, whereas magnetic resonance imaging may not be feasible in some patients with severe obesity. CONCLUSIONS This article highlights issues surrounding the clinical application of non-invasive tests for MASLD in patients with type 2 diabetes and obesity.
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Affiliation(s)
- Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Salvatore Petta
- Sezione di Gastroenterologia, PROMISE, University of Palermo, Palermo, Italy
- Department of Economics and Statistics, University of Palermo, Palermo, Italy
| | - Mazen Noureddin
- Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA
| | - George Boon Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
- Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, Department of Medicine and Therapeutics, 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
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16
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Ueda N, Mokuda S, Kawaoka T, Uchikawa S, Amioka K, Tsuge M, Asada K, Okada Y, Kobayashi Y, Ishikawa M, Arase T, Arihiro K, Oka S. Influence of dispersion slope on the diagnosis of liver fibrosis by the shear wave in metabolic dysfunction-associated steatotic liver disease. Hepatol Res 2024. [PMID: 38806293 DOI: 10.1111/hepr.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
AIM Shear wave (SW) elastography is used to evaluate metabolic dysfunction-associated steatotic liver disease (MASLD) pathophysiology. Increased elasticity due to fibrosis and increased viscosity due to necrosis and inflammation affect SW. Assessing fibrosis, the most prognostically relevant pathology, is critical. Viscosity is evaluated using the dispersion slope (DS); however, cut-off values that affect SW values are unclear. We compared the ultrasound imaging parameters (SW for viscoelasticity; DS for viscosity) with pathological findings. METHODS Patients (n = 159) who underwent liver biopsy and SW and DS assessments at our hospital were included. Fibrosis stage and inflammation grade cut-off values were calculated from SW, DS, and liver biopsy results using receiver operating characteristic curves. Cases in which liver biopsy results were inconsistent with SW results were used to determine the effect of viscosity on SW values. DS was examined in the Correct and Incorrect Diagnosis groups, which were categorized based on the concordance between SW and liver biopsy results. Dispersion slope cut-off values between the two groups were calculated. RESULTS Fibrosis stage cut-off values by SW (m/s) were: ≥F2, 1.62; ≥F3, 1.74; and F4, 1.97. Inflammation grade cut-off values by DS (m/s/kHz) were: ≥A1, 11.6; ≥A2, 14.5; and A3, 16.1. The Correct/Incorrect Diagnosis groups had 25/70 patients. The DS cut-off value for both groups was 13.2 m/s/kHz. CONCLUSIONS Shear wave and DS are useful for evaluating liver fibrosis and inflammation in MASLD. For DS > 13.2 m/s/kHz, SW may be affected by the increased viscosity owing to inflammation. In such patients, caution should be used when determining/interpreting values.
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Affiliation(s)
- Naoyuki Ueda
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Mokuda
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinsuke Uchikawa
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kei Amioka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Masataka Tsuge
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kana Asada
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuri Okada
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yui Kobayashi
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Mai Ishikawa
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Arase
- Division of Laboratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
- Division of Clinical Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
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17
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Jia W, Xia S, Jia X, Tang B, Cheng S, Nie M, Guan L, Duan Y, Zhang M, Chen X, Zhang H, Bai B, Jia H, Li N, Yuan C, Cai E, Dong Y, Zhang J, Jia Y, Liu J, Tang Z, Luo T, Zhang X, Zhan W, Zhu Y, Zhou J. Ultrasound Viscosity Imaging in Breast Lesions: A Multicenter Prospective Study. Acad Radiol 2024:S1076-6332(24)00159-4. [PMID: 38582684 DOI: 10.1016/j.acra.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/16/2024] [Accepted: 03/17/2024] [Indexed: 04/08/2024]
Abstract
RATIONALE AND OBJECTIVES To explore and validate the clinical value of ultrasound (US) viscosity imaging in differentiating breast lesions by combining with BI-RADS, and then comparing the diagnostic performances with BI-RADS alone. MATERIALS AND METHODS This multicenter, prospective study enrolled participants with breast lesions from June 2021 to November 2022. A development cohort (DC) and validation cohort (VC) were established. Using histological results as reference standard, the viscosity-related parameter with the highest area under the receiver operating curve (AUC) was selected as the optimal one. Then the original BI-RADS would upgrade or not based on the value of this parameter. Finally, the results were validated in the VC and total cohorts. In the DC, VC and total cohorts, all breast lesions were divided into the large lesion, small lesion and overall groups respectively. RESULTS A total of 639 participants (mean age, 46 years ± 14) with 639 breast lesions (372 benign and 267 malignant lesions) were finally enrolled in this study including 392 participants in the DC and 247 in the VC. In the DC, the optimal viscosity-related parameter in differentiating breast lesions was calculated to be A'-S2-Vmax, with the AUC of 0.88 (95% CI: 0.84, 0.91). Using > 9.97 Pa.s as the cutoff value, the BI-RADS was then modified. The AUC of modified BI-RADS significantly increased from 0.85 (95% CI: 0.81, 0.88) to 0.91 (95% CI: 0.87, 0.93), 0.85 (95% CI: 0.80, 0.89) to 0.90 (95% CI: 0.85, 0.93) and 0.85 (95% CI: 0.82, 0.87) to 0.90 (95% CI: 0.88, 0.92) in the DC, VC and total cohorts respectively (P < .05 for all). CONCLUSION The quantitative viscous parameters evaluated by US viscosity imaging contribute to breast cancer diagnosis when combined with BI-RADS.
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Affiliation(s)
- WanRu Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - ShuJun Xia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - XiaoHong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - BingHui Tang
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - ShuZhen Cheng
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - MeiYuan Nie
- Department of Ultrasound, Nanchang People's Hospital, Nanchang, Jiangxi Province 330000, China
| | - Ling Guan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - Ying Duan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - MengYan Zhang
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, Gansu Province, China
| | - Xia Chen
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Hui Zhang
- Department of Ultrasound, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - BaoYan Bai
- Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - HaiYun Jia
- Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - Ning Li
- Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, No.2 Ganghenan Road, Anning, Yunnan Province 650330, China
| | - CongCong Yuan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - EnHeng Cai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - JingWen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Yi Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - ZhenYun Tang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - XiaoXiao Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ying Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, 200025 Shanghai, China; College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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18
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Tamura K, Ito K, Kishimoto R, Yoshida K, Kishimoto T, Obata T, Yamaguchi T. The Effect of Steatosis on Shear-Wave Velocity and Viscoelastic Properties Related to Liver Fibrosis Progression in Rat Models. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:592-599. [PMID: 38238201 DOI: 10.1016/j.ultrasmedbio.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Hepatic fibrosis has recently been evaluated using ultrasonography or magnetic resonance elastography. Although the shear wave velocity (SWV) obtained using point shear wave elastography (pSWE) provides a valuable measure of fibrosis, underlying steatosis may affect its measurement. METHODS Using hepatic fibrosis samples, this study evaluated the effect of steatosis on the shear wave velocity of pSWE (Vs) and viscoelastic properties (assessed by dynamic mechanical analysis) of rat liver. Fifty rats with various grades of steatosis and fibrosis underwent open abdominal in vivo Vs measurements using a commercial ultrasound scanner. The mechanical properties of hepatic tissue were also characterized under ex vivo conditions using dynamic mechanical analysis and the Zener model of viscoelasticity. RESULTS Fibrosis and steatosis progression influenced Vs and elasticity. The SWV computed using the Zener model and Vs showed a substantial correlation (r > 0.8). Fibrosis progression increased SWV. Steatosis was also related to SWV. Steatosis progression obscured the SWV change associated with fibrosis progression. CONCLUSION We conclude that steatosis progression affects the evaluation of fibrosis progression. This finding could aid discrimination of non-alcoholic steatohepatitis from non-alcoholic fatty liver disease using SWV.
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Affiliation(s)
- Kazuki Tamura
- Preeminent Medical Photonics Education & Research, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan.
| | - Kazuyo Ito
- Institute of Engineering, Tokyo University of Agriculture and Technology, Koganei-shi, Tokyo 184-8588 Japan
| | - Riwa Kishimoto
- Applied MRI Research, Department of Molecular Imaging and Theranostics, National Institutes for Quantum and Radiological Science and Technology, Inage-ku, Chiba 263-0024, Japan
| | - Kenji Yoshida
- Center for Frontier Medical Engineering, Chiba University, Inage-ku, Chiba 263-8522, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba 260-8670, Japan
| | - Takayuki Obata
- Applied MRI Research, Department of Molecular Imaging and Theranostics, National Institutes for Quantum and Radiological Science and Technology, Inage-ku, Chiba 263-0024, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, Inage-ku, Chiba 263-8522, Japan
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19
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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.
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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
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Yin H, Xiong B, Yu J, Fan Y, Zhou B, Sun Y, Wang L, Xu H, Zhu Y. Interoperator reproducibility of quantitative ultrasound analysis of hepatic steatosis in participants with suspected MASLD: A prospective study. Eur J Radiol 2024; 175:111427. [PMID: 38522397 DOI: 10.1016/j.ejrad.2024.111427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES To evaluate the reproducibility of tissue attenuation imaging (TAI) and tissue scatter distribution imaging (TSI) measurements in adults with suspected metabolic dysfunction-associated steatotic liver disease (MASLD) between radiologists with varying experience. MATERIALS AND METHODS Participants with suspected MASLD were prospectively recruited. TAI and TSI were performed for each participant by two radiologists with different levels of experience. Interoperability reliability was assessed on the basis of Bland-Altman analysis and intraclass correlation coefficients (ICCs). The study determined and compared the diagnostic performance of TAI and TSI with clinical prediction models using proton magnetic resonance spectroscopy (1H-MRS) as a reference. RESULTS A total of 180 participants (women, n = 56; men, n = 124, mean age, 46.98 ± 14.92 years; mean BMI, 25.81 ± 4.47) were enrolled from August 2022 to September 2022. Bland-Altman plots showed only slight deviation in the TAI and TSI results of the two radiologists; there was good interoperator reproducibility for TAI (ICC = 0.92) and TSI (ICC = 0.86). Senior and junior radiologists performed examinations labeled as TAI-1 and TSI-1, and TAI-2 and TSI-2, respectively. The areas under the curves (AUCs) of TAI-1, TAI-2, TSI-1, and TAI-2 for the detection of ≥5 % hepatic steatosis were 0.90, 0.96, 0.91 and 0.96, respectively. According to ROC analysis, the diagnostic performance of both radiologists for TAI and TSI was statistically similar and superior to that of the clinical prediction model. CONCLUSIONS TAI and TSI have good reproducibility between radiologists with different levels of experience. Meanwhile, both TAI and TSI demonstrated good diagnostic performance for hepatic steatosis (≥5%), surpassing that of clinical prediction models.
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Affiliation(s)
- Haohao Yin
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai 200032, China; Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
| | - Bing Xiong
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Shanghai Institute of Medical Imaging, Fudan University, Shanghai 200032, China; Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai 200032, China
| | - Jifeng Yu
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yunling Fan
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Boyang Zhou
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yikang Sun
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lifan Wang
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Huixiong Xu
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Yuli Zhu
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Seyrek S, Ayyildiz H, Bulakci M, Salmaslioglu A, Seyrek F, Gultekin B, Cavus B, Berker N, Buyuk M, Yuce S. Comparison of Fibroscan, Shear Wave Elastography, and Shear Wave Dispersion Measurements in Evaluating Fibrosis and Necroinflammation in Patients Who Underwent Liver Biopsy. Ultrasound Q 2024; 40:74-81. [PMID: 38345402 DOI: 10.1097/ruq.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Our aim was to predict these stages of hepatic fibrosis and necroinflammation using measurements from two-dimensional shear wave elastography (2D-SWE), transient elastography (Fibroscan, TE), and shear wave dispersion (SWD). MATERIALS AND METHODS In this prospectively designed study, chronic liver patients with nonspecific etiology whose biopsy was performed for up to 1 week were included. Two-dimensional SWE, SWD, and TE measurements were performed. The METAVIR and F-ISHAK classification was used for histopathological evaluation. RESULTS Two-dimensional SWE and TE were considered significant for detecting hepatic fibrosis. In distinguishing ≥F2, for 2D-SWE, area under the receiver operating characteristics (AUROC) was 0.86 (confidence interval [CI], 0.75-0.96) for the cutoff value of 8.05 kPa ( P = 0.003); for TE, AUROC was 0.79 (CI, 0.65-0.94) for the cutoff value of 10.4 kPa ( P < 0.001). No significance was found for TE in distinguishing ≥F3 ( P = 0.132). However, for 2D-SWE, a cutoff value of 10.45 kPa ( P < 0.001), with AUROC = 0.87 (CI, 0.78-0.97) was determined for ≥F3. Shear wave dispersion was able to determine the presence of necroinflammation ( P = 0.016) and a cutoff value of 15.25 (meter/second)/kiloHertz ([m/s]/kHz) ( P = 0.006) and AUROC of 0.71 (CI, 0.57-0.85) were calculated for distinguishing ≥A2. In addition, a cutoff value of 17.25 (m/s)/kHz ( P = 0.023) and AUROC = 0.72 (CI, 0.51-0.93) were found to detect severe necroinflammation. The cutoff value for SWD was 15.25 (m/s)/kHz ( P = 0.013) for detecting ≥A2 in the reversible stage of fibrosis (F0, F1, and F2), and AUROC = 0.72 (CI, 0.56-0.88). CONCLUSIONS Two-dimensional SWE and TE measurements were significant in detecting the irreversible stage and the stage that should be treated in hepatic fibrosis noninvasively. Shear wave dispersion measurements were significant in detecting necroinflammation noninvasively.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Servet Yuce
- Public Health Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Liu F, Bi M, Jing X, Ding H, Zeng J, Zheng R, Chen Y, Wang W, Xie X, Mi C, Chen M, Cheng W, Zhang S, Wang Z, Zhang C, Zhou H, Cheng Z, Han Z, Yu J, Liang P. Multiparametric US for Identifying Metabolic Dysfunction-associated Steatohepatitis: A Prospective Multicenter Study. Radiology 2024; 310:e232416. [PMID: 38501954 DOI: 10.1148/radiol.232416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Background Noninvasive evaluation of metabolic dysfunction-associated fatty liver disease (MAFLD) with multiparametric US is essential, but multicenter studies are lacking. Purpose To evaluate the ability of multiparametric US with attenuation imaging (ATI) and two-dimensional (2D) shear-wave elastography (SWE) for predicting metabolic dysfunction-associated steatohepatitis (MASH) in participants with MAFLD, regardless of hepatitis B virus infection status. Materials and Methods This prospective cross-sectional multicenter study of consecutive adults with MAFLD who underwent multiparametric US with ATI and 2D SWE, as well as liver biopsy, from September 2020 to June 2022 was conducted in 12 tertiary hospitals in China. Multivariable logistic regression was performed to assess risk factors associated with MASH. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate diagnostic performance in predicting MASH in training and validation groups (6:4 ratio of participants), and for a post hoc subgroup analysis of hepatitis B virus infection and diabetes. Results A total of 424 participants (median age, 47 years; IQR, 34-59 years; 244 male) were evaluated, including 332 participants (78%) with MASH and 92 (22%) without. Attenuation coefficient (AC) (odds ratio [OR], 3.32 [95% CI: 1.94, 5.71]; P < .001), alanine aminotransferase (ALT) level (OR, 4.42 [95% CI: 1.78, 10.94]; P = .001), and international normalized ratio (INR) (OR, 0.59 [95% CI: 0.37, 0.95]; P = .03) were independently associated with MASH. A combined model (AC, ALT, and INR) had AUCs of 0.85 (95% CI: 0.79, 0.91) and 0.77 (95% CI: 0.69, 0.85) for predicting MASH in the training and validation groups, respectively. AUC values for the subgroups with and without diabetes were 0.83 (95% CI: 0.72, 0.94) and 0.81 (95% CI: 0.75, 0.87) and for the subgroups with and without hepatitis B were 0.82 (95% CI: 0.74, 0.90) and 0.79 (95% CI: 0.71, 0.87), respectively. Conclusion A model combining AC, ALT level, and INR showed good discrimination ability for predicting MASH in participants with MAFLD. Clinical trial registration no. NCT04551716 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Reuter in this issue.
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Affiliation(s)
- Fangyi Liu
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Mingsen Bi
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Xiang Jing
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Hong Ding
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Jie Zeng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Rongqin Zheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Yaqing Chen
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Wenping Wang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Xiaoyan Xie
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Chengrong Mi
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Man Chen
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Wen Cheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Shuhua Zhang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhanbo Wang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Chunquan Zhang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Hongyu Zhou
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhigang Cheng
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Zhiyu Han
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Fifth Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing 100853, China (F.L., M.B., Z.C., Z.H., J.Y., P.L.); Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China (X.J., H.Z.); Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China (H.D.); Department of Medical Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (J.Z., R.Z.); Department of Ultrasound in Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.C.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (W.W.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X.); Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, China (C.M.); Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.C.); Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China (W.C.); Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China (S.Z.); Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, China (Z.W.); and Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, China (C.Z.)
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23
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Reuter KL. Noninvasive Identification of Metabolic Dysfunction-associated Steatohepatitis Globally. Radiology 2024; 310:e240436. [PMID: 38501949 DOI: 10.1148/radiol.240436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Karen L Reuter
- From the Department of Radiology, Tufts University School of Medicine, Boston, Mass; and Commonwealth Radiology Associates, Tufts New England Medical Center, 800 Washington St, Boston, MA 02116
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Hänni O, Ruby L, Paverd C, Frauenfelder T, Rominger MB, Martin A. Confounders of Ultrasound Attenuation Imaging in a Linear Probe Using the Canon Aplio i800 System: A Phantom Study. Diagnostics (Basel) 2024; 14:271. [PMID: 38337786 PMCID: PMC10855333 DOI: 10.3390/diagnostics14030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
There have been studies showing attenuation imaging (ATI) with ultrasound as an approach to diagnose liver diseases such as steatosis or cirrhosis. So far, this technique has only been used on a convex probe. The goal of the study was to investigate the feasibility of ATI measurements using the linear array on a canon Aplio i800 scanner on certified phantoms. Three certified liver tissue attenuation phantoms were measured in five different positions using a linear probe. The effects of positioning and depth were explored and compared. The values were compared to the certified expected value for each phantom as well as the different measurement values for each measurement position. The ATI measurements on phantoms showed significant effect for the different probe positions and region of interest (ROI) depths. Values taken in the center with the probe perpendicular to the phantom were closest to certified values. Median values at 2.5-4.5 cm depth for phantoms 1 and 2 and 0.5-2.5 cm for phantom 3 were comparable with certified values. Measurements taken at a depth greater than 6 cm in any position were the least representative of the certified values (p-value < 0.01) and had the widest range throughout the different sessions. ATI measurements can be performed with the linear probe in phantoms; however, careful consideration should be given to depth dependency, as it can significantly affect measurement values. Remaining measurements at various depths within the 0.5-6.0 cm range showed deviation from the certified values of approximately 25%.
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Affiliation(s)
- Olivia Hänni
- Faculty of Medicine, University of Zurich, Dekanat Pestalozzistrasse 3, 8032 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Catherine Paverd
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Marga B. Rominger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
| | - Alexander Martin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (M.B.R.)
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Torkzaban M, Wessner CE, Halegoua-DeMarzio D, Lyshchik A, Nam K. Diagnostic Performance of Quantitative Ultrasound Parameters in Non-alcoholic Fatty Liver Disease. Acad Radiol 2024; 31:199-211. [PMID: 37507328 DOI: 10.1016/j.acra.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
RATIONALE AND OBJECTIVES Marked liver steatosis, steatohepatitis, and significant fibrosis are risk factors for unfavorable outcomes in non-alcoholic fatty liver disease (NAFLD). In this study, the diagnostic performance of attenuation coefficient (AC), liver stiffness (LS), and dispersion slope (DS) was evaluated separately and combined in the diagnosis of liver steatosis and fibrosis in NAFLD suspects using biopsy or magnetic resonance imaging (MRI) as a reference standard. MATERIALS AND METHODS Seventy-four NAFLD suspects were prospectively imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). AC, LS, and DS measurements were obtained from the right liver lobe. RESULTS Thirty-four patients underwent liver biopsy, and 40 had MRI. There were 32 patients (43%) with liver steatosis and fibrosis (S + F), 22 (30%) with steatosis (S), 5 (7%) with fibrosis (F), and 15 (20%) with normal liver (N). Mean ACs were significantly higher in steatotic livers (n = 54) than in non-steatotic livers (n = 20) (P < 0.0001). LS and DS were significantly higher in patients with liver fibrosis (n = 37) compared to non-fibrotic livers (n = 37) (P = 0.0004 and P = 0.0002, respectively). In detecting (S + F), the area under the receiver operating characteristic curve (AUROCC) was 0.87 for combined ultrasound parameters of LS and AC (negative predictive value [NPV]: 75%, positive predictive value [PPV]: 77%, P < 0.0001). In detecting patients with liver steatosis and fibrosis stage ≥2, LS had an AUROCC of 0.93 (NPV: 87%, PPV: 82%, P < 0.0001). In the biopsy group, 32% (11/34) were diagnosed with non-alcoholic steatohepatitis (NASH). DS values showed a significant difference among patients with (n = 23) or without (n = 11) hepatocellular ballooning (P = 0.02). AUROCC was 0.87 for combined ultrasound parameters of AC, LS, and DS with body mass index (BMI) in detecting NASH (NPV: 80%, PPV: 87%, P = 0.0006). CONCLUSION AC and LS showed high diagnostic value in detecting liver steatosis and fibrosis, respectively. The combined AC and LS values further improved the diagnostic accuracy in detecting NAFLD and high-risk NAFLD patients.
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Affiliation(s)
- Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania (D.H.)
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.)
| | - Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107 (M.T., C.E.W., A.L., K.N.).
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26
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Okada Y, Nakagawa C, Shigeta M, Nomura Y, Inoue E, Ichizuka K, Yoshimura Y. Evaluation of levator ani muscle elasticity after vaginal delivery and cesarean section using shear wave elastography. J Med Ultrason (2001) 2024; 51:95-101. [PMID: 37740863 PMCID: PMC10904486 DOI: 10.1007/s10396-023-01369-w] [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: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE The risk of pelvic floor muscle injury is commonly considered to be higher in vaginal than in cesarean delivery. This study aimed to compare levator ani muscle (LAM) elasticity after vaginal and cesarean delivery using shear wave elastography (SWE). METHODS Postpartum women who underwent a single SWE evaluation 1 month after their first delivery were divided into vaginal and cesarean delivery groups. The elastic moduli of both sides of the LAM were measured in a horizontal section and compared between the groups. In addition, a subgroup analysis was performed to compare LAM elasticity according to the delivery method within the vaginal delivery group-normal vaginal delivery, episiotomy, and operative vaginal delivery. RESULTS Sixty-two women were included (vaginal delivery, n = 47; elective cesarean section, n = 15). Multiple regression analysis revealed that the LAM elastic modulus was significantly lower in the vaginal delivery group than in the cesarean delivery group (right LAM: 44.2 vs. 72.7 kPa, p = 0.0036; left LAM 40.4 vs. 82.7 kPa, p < 0.0001). In the subgroup analysis, the right LAM elastic modulus was significantly lower in the operative vaginal delivery subgroup than in the normal vaginal delivery subgroup (p = 0.0131). However, there was no significant difference in the left LAM elastic modulus between the three subgroups. CONCLUSION LAM elasticity was significantly lower after vaginal delivery than after cesarean delivery. Furthermore, the elasticity of the right LAM was lower after operative vaginal delivery than after normal vaginal delivery. SWE has the potential to provide an objective quantitative assessment of postpartum pelvic floor muscle recovery.
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Affiliation(s)
- Yoshiyuki Okada
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan.
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
| | - Chie Nakagawa
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Miwa Shigeta
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan
| | - Yukiko Nomura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Tokyo, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yasukuni Yoshimura
- Department of Female Pelvic Health Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-Ku, Yokohama City, Kanagawa, 224-8503, Japan
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27
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Thomas M, Dighe M, Kolokythas O, Zecevic M, Wilson A, Erpelding T, Dubinsky TJ. Ultrasound Attenuation Imaging vs MRI-PDFF, Echogenicity and Liver Function for Assessing Degree of Steatosis in NAFLD and Non-NAFLD Patients. Ultrasound Q 2023; 39:188-193. [PMID: 37543732 DOI: 10.1097/ruq.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Nonalcoholic fatty liver disease (NAFLD) is a primary cause of parenchymal liver disease globally. There are currently several methods available to test the degree of steatosis in NAFLD patients, but all have drawbacks that limit their use.The objective of this study is to determine if a new technique, ultrasound (US) attenuation imaging (ATI), correlates with magnetic resonance proton density fat fraction imaging and hepatic echogenicity as seen on gray scale US imaging.Fifty-four patients were recruited at the University of Washington Medical Center from individuals who had already been scheduled for hepatic US or magnetic resonance imaging (MRI). All participants then underwent both hepatic MRI proton density fat fraction and US. Ultrasound images were then evaluated using ATI with 2 observers who individually determined relative grayscale echogenicity.Analysis showed positive correlation between ATI- and MRI-determined fat percentage in the case group (Spearman correlation: 0.50; P = 0.015). Furthermore, participants with NAFLD tended to have a higher ATI than controls (median: 0.70 vs 0.54 dB/cm/MHz; P < 0.001).This study demonstrates that US ATI combined with grayscale imaging is an effective way of assessing the degree of steatosis in patients with moderate to severe NAFLD.
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Cetinic I, de Lange C, Boström H, Ekvall N, Bennet W, Lagerstrand K, Hebelka H. Shear wave elastography and shear wave dispersion correlated to biopsy at the scheduled follow-up of pediatric liver grafts. Pediatr Transplant 2023; 27:e14591. [PMID: 37583096 DOI: 10.1111/petr.14591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND It is unknown how shear wave dispersion (SWD) is displayed in pediatric liver transplant recipients and not fully elucidated how ultrasound shear wave elastography (2D-SWE) display within this cohort, which is important to determine to improve noninvasive surveillance of these patients. The study aimed to compare SWE and SWD values with histopathology in pediatric liver recipients. METHODS Forty-eight pediatric liver recipients were examined with SWE in conjunction with an elective liver biopsy (clinically without complication). Additionally, SWD values were measured in 21 children. SWE and SWD values were compared to histologically determined fibrosis graded as none-to-mild (F0-1) and moderate-to-severe (F2-4), and inflammation graded as low (grade 0-1) and high (grade 2-4). RESULTS Two children were excluded due to SWE IQR/median > 30% kPa. The mean age across 46 included patients was 10.9 years (range 1.4-18). The number of patients and median (range) SWE value (kPa) for each stage of fibrosis were: F0-1 [n = 23; 5.8 (3.2-16.1)], F2 [n = 22; 6.0 (4.5-25.9)], F3 [n = 1; 33.3], and F4 [n = 0]. Significantly higher SWE values and greater variability were registered in F2-4 vs. F0-1 (p = .05). Grade of fibrosis correlated weakly to SWE values (r = .3; p = .05), but not to SWD values (r = .2; p = .27). In patients with low-grade inflammation, median SWD was 13.7 m/s KHz (10.7-17.6). Only one patient had high-grade inflammation. CONCLUSIONS Uncomplicated transplanted liver grafts in a small pediatric cohort revealed slightly increased SWE and SWD values compared to previously reported values in healthy children. This likely reflect both the fibrotic and inflammatory elements in the grafts; however, other confounders impacting the liver's viscoelastic properties are also probable factors.
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Affiliation(s)
- Ivan Cetinic
- Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte de Lange
- Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Boström
- Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils Ekvall
- Department of Pediatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - William Bennet
- Department of Transplantation Surgery, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Pediatric Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Yao S, Cai Y, Hu S, Liu X, Gao X, Li G, Wang H, Yu H. The value of shear wave elasticity and shear wave dispersion imaging to evaluate the viscoelasticity of renal parenchyma in children with glomerular diseases. BMC Nephrol 2023; 24:306. [PMID: 37858094 PMCID: PMC10588180 DOI: 10.1186/s12882-023-03357-1] [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: 06/19/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To study the value of shear wave elasticity and shear wave dispersion imaging to evaluate the viscoelasticity of renal parenchyma in children with glomerular diseases. METHODS Forty-three children with glomerular diseases were prospectively evaluated by shear wave elasticity (SWE) and shear wave dispersion imaging (SWD); 43 healthy volunteers served as the control group. The shear wave velocities (SWV) and the dispersion slopes were measured at the upper, middle, and lower poles of both kidneys. The analysis of mean SWV and mean dispersion slope in control and patient groups was used to further evaluate the value of SWE and SWD in the viscoelasticity of renal parenchyma in children with glomerular disease. RESULTS The mean SWV in children with glomerular disease was higher than that in the healthy control group (1.61 ± 0.09 m/s vs. 1.43 ± 0.07 m/s, p < 0.001). Compared with healthy group, the mean dispersion slope in children with glomerular disease was significantly increased (13.5 ± 1.39 (m/s)/kHz vs. 12.4 ± 1.40 (m/s)/kHz, p < 0.001). Correlation analysis showed absence of correlation between the SWV and dispersion slope of occult blood, serum creatinine, 24-h urine protein, blood albumin, BMI and ROI box depth of children with glomerular disease. CONCLUSIONS The present study shows that it is feasible to use SWE and SWD to evaluate the difference of viscoelasticity of the renal parenchyma between healthy children and those with glomerular disease.
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Affiliation(s)
- Shixiang Yao
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Yingying Cai
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Shanshan Hu
- The Sixth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xiao Liu
- Department of Ultrasonography, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xia Gao
- Nephrology department, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's medical center, Guangzhou city, China
| | - Guanyu Li
- Nephrology department, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou Women and Children's medical center, Guangzhou city, China
| | - Hongying Wang
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China
| | - Hongkui Yu
- Department of Ultrasonography, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9, Jinsui Road, Guangzhou, Guangdong, China.
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Bae JS, Lee DH, Suh KS, Lee KW, Yi NJ, Hong SK. Application of attenuation imaging for the detection of fatty liver in potential liver donors. Eur J Radiol 2023; 166:110958. [PMID: 37451137 DOI: 10.1016/j.ejrad.2023.110958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE In living donor liver transplantation (LDLT), fatty liver adversely affects the outcome in donors or in recipients. The attenuation imaging (ATI) may be valuable for detecting fatty liver in potential liver donors. We aimed to investigate the role of ATI in screening liver donors. METHOD In this prospective study, potential liver donors undergoing MR examination, including proton MR spectroscopy (1H-MRS), were enrolled between January 2020 and December 2021 (study identifier: KCT0004486). All participants underwent ATI examinations to assess fatty liver disease. The reference standard for fatty liver was the hepatic fat fraction (HFF) on 1H-MRS, with 8% defined as the threshold for significant fatty liver. The correlation between attenuation coefficient (AC) and HFF was evaluated using Spearman's correlation coefficient. The diagnostic performance of AC for the detection of fatty liver disease was evaluated using receiver operating characteristic curve analysis. RESULTS A total of 102 participants (median age, 37 [range, 20-61] years; 65 men) were enrolled. Nineteen participants (18.6%) had significant fatty liver on 1H-MRS. AC significantly correlated with HFF on 1H-MRS (ρ = 0.674, P < 0.001), and was significantly higher in patients with HFF on 1H-MRS ≥ 8% than in patients with HFF on 1H-MRS < 8% (0.76 vs. 0.59, P < 0.001). By using the cutoff value of 0.66, the area under the curve of AC for the detection of significant fatty liver on 1H-MRS was 0.923 (95% confidence interval [CI]: 0.853-0.967), with sensitivity, specificity, and negative predictive values of 89.5% (95% CI: 66.9-98.7%), 83.1% (95% CI: 73.3-90.5%), and 97.2% (95% CI: 90.3-99.2%), respectively. CONCLUSIONS ATI showed good diagnostic performance with a high negative predictive value for the detection of significant fatty liver among potential liver donors.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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Torkzaban M, Wessner CE, Halegoua-DeMarzio D, Rodgers SK, Lyshchik A, Nam K. Diagnostic Performance Comparison Between Ultrasound Attenuation Measurements From Right and Left Hepatic Lobes for Steatosis Detection in Non-alcoholic Fatty Liver Disease. Acad Radiol 2023; 30:1838-1845. [PMID: 36586759 PMCID: PMC10307925 DOI: 10.1016/j.acra.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is currently diagnosed by liver biopsy or MRI proton density fat fraction (MRI-PDFF) from left hepatic lobe (LTHL) and/or right hepatic lobe (RTHL). The objective of this study was to compare the diagnostic value of ultrasound attenuation coefficients (ACs) from RTHL and LTHL in detecting hepatic steatosis using biopsy or MRI-PDFF as a reference standard. MATERIALS AND METHODS Sixty-six patients with suspected NAFLD were imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). Five AC measurements from RTHL and LTHL were averaged separately and together to be compared with the reference standard. RESULTS Forty-seven patients (71%) were diagnosed with NAFLD. Mean ACs were significantly higher in fatty livers than non-fatty livers (RTHL: 0.73 ± 0.10 vs. 0.63 ± 0.07 dB/cm/MHZ; p < 0.0001, LTHL: 0.78 ± 0.11 vs. 0.63 ± 0.06 dB/cm/MHz; p < 0.0001, RTHL & LTHL: 0.76 ± 0.09 vs. 0.63 ± 0.05 dB/cm/MHz; p < 0.0001). Biopsy steatosis grades (n =31) were better correlated with the mean ACs of RTHL & LTHL (r = 0.72) compared to LTHL (r = 0.67) or RTHL (r = 0.61). Correlation between MRI-PDFF (n = 35) and mean ACs was better for LTHL (r = 0.69) compared to the RTHL & LTHL (r = 0.66) or RTHL (r = 0.45). Higher diagnostic accuracy was shown for the mean ACs of RTHL & LTHL (AUC 0.89, specificity 94%, sensitivity 78%) compared to LTHL (AUC 0.89, specificity 88%, sensitivity 82%) or RTHL (AUC 0.81, specificity 89%, sensitivity 68%). CONCLUSION Ultrasound ACs from RTHL and LTHL showed comparable diagnostic values in detection of hepatic steatosis with the highest diagnostic accuracy when they were averaged together.
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Affiliation(s)
- Mehnoosh Torkzaban
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dina Halegoua-DeMarzio
- Department of Medicine, Division of Gastroenterology & Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shuchi K Rodgers
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kibo Nam
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Karlas T, Blank V, Trenker C, Ignee A, Dietrich CF. [Ultrasound systems for abdominal diagnostics - current methods, clinical applications and new technologies]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1235-1245. [PMID: 36634681 DOI: 10.1055/a-1993-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abdominal ultrasound is the method of first choice in many clinical situations. Gray scale imaging (B-mode) and conventional Doppler techniques are nowadays complemented by contrast-enhanced ultrasound (CEUS), elastography, fat quantification and further technologies which allow multimodal characterization of organs and tissue structure using panoramic imaging, 3D-techniques and image fusion. The development of small portable devices augments the spectrum for sonographic diagnostics. In this review, we describe the current status of ultrasound technology based on published evidence. In addition, we provide guidance for quality assurance.
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Affiliation(s)
- Thomas Karlas
- Medizinischen Klinik 2, Bereich Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Valentin Blank
- Medizinischen Klinik 2, Bereich Gastroenterologie, Universitätsklinikum Leipzig, Leipzig, Germany
- Klinik für Innere Medizin I (Gastroenterologie, Pneumologie) und Interdisziplinäre Ultraschallabteilung, Universitätsklinikum Halle (Saale), Halle, Germany
| | - Corinna Trenker
- Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Marburg, Marburg, Germany
| | - André Ignee
- Medizinische Klinik mit Schwerpunkt Gastroenterologie & Rheumatologie, Klinikum Würzburg Mitte gGmbH Standort Juliusspital, Wurzburg, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Huang YL, Bian H, Zhu YL, Yan HM, Wang WP, Xia MF, Dong Y, Gao X. Quantitative Diagnosis of Nonalcoholic Fatty Liver Disease with Ultrasound Attenuation Imaging in a Biopsy-Proven Cohort. Acad Radiol 2023; 30 Suppl 1:S155-S163. [PMID: 37407373 DOI: 10.1016/j.acra.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of attenuation imaging (ATI) based on ultrasound for detection of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS This prospective study was approved by our institutional review board (B2021-092R). Written informed consent was obtained from all patients. This study included 60 patients who had clinical suspicion of NAFLD and were referred for liver biopsy after ATI and controlled attenuation parameter (CAP) examinations between September 2020 and December 2021. The histologic hepatic steatosis was graded. The area under curve (AUC) analysis was performed. RESULTS The success rate of the ATI examination was 100%. The intraobserver reproducibility of ATI was 0.981. The AUCs of ATI for detecting ≥S1, ≥S2, and S3 were 0.968 (cut-off value of 0.671 dB/cm/MHz), 0.911 (cut-off value of 0.726 dB/cm/MHz), and 0.766 (cut-off value of 0.757 dB/cm/MHz), respectively. The AUCs of CAP for detecting ≥S1, ≥S2, and S3 were 0.916 (cut-off value of 258.5 dB/m), 0.872 (cut-off value of 300.0 dB/m), and 0.807 (cut-off value of 315.0 dB/m), respectively. The diagnostic values showed no significant difference between ATI and CAP in detecting ≥S1, ≥S2, and S3 (P = .281, P = .254, and P = .330, respectively). The ATI had significant correlations with high-density lipoprotein cholesterol (P < .001), and with triglycerides (P = .015). CONCLUSION ATI showed good feasibility and diagnostic performance in the detection of varying degrees of hepatic steatosis in NAFLD patients.
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Affiliation(s)
- Yun-Lin Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.); Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665th Kongjiang Road, Shanghai 200092, China (Y.-L.H., Y.D.)
| | - Hua Bian
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Yu-Li Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.)
| | - Hong-Mei Yan
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (Y.-L.H., Y.-L.Z., W.-P.W.)
| | - Ming-Feng Xia
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665th Kongjiang Road, Shanghai 200092, China (Y.-L.H., Y.D.).
| | - Xin Gao
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai, China (H.B., H.-M.Y., M.-F.X., X.G.)
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Obrist A, Ruby L, Martin A, Frauenfelder T, Rominger M, Paverd C. Influence of Measurement Depth and Acquisition Parameters on Shear Wave Speed and Shear Wave Dispersion in Certified Phantoms Using a Canon Aplio Clinical Ultrasound Scanner. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1742-1759. [PMID: 37156674 DOI: 10.1016/j.ultrasmedbio.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of the work described here was to investigate the relative contribution of confounding factors on liver shear wave speed (SWS) and shear wave dispersion slope (SWDS) measurements in three certified phantoms using a Canon Aplio clinical ultrasound scanner. METHODS A Canon Aplio i800 i-series ultrasound system (Canon Medical Systems Corporation, Otawara, Tochigi, Japan) with i8CX1 convex array (center frequency = 4 MHz) was used to examine dependencies caused by the depth, width and height of the acquisition box (AQB), the depth and size of the region of interest (ROI), the AQB angle and the pressure of the ultrasound probe on the surface of the phantom. RESULTS Results revealed that depth is the most significant confounder in both SWS and SWDS measurements. AQB angle, height and width and ROI size exhibited minimal confounding effects on measurements. For SWS, the most consistent measurement depth is when the top of the AQB is placed between 2 and 4 cm, and the ROI is located between 3 and 7 cm deep. For SWDS, results indicate that measurement values significantly decrease with depth from the surface of the phantom until approximately 7 cm deep, and consequently no stable area of AQB placement or ROI depth exists. CONCLUSION In contrast to SWS, the same ideal acquisition depth range cannot necessarily be applied to SWDS measurements because of a significant depth dependency.
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Affiliation(s)
- Anika Obrist
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Lisa Ruby
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Alexander Martin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Marga Rominger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Catherine Paverd
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland.
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Fetzer DT, Pierce TT, Robbin ML, Cloutier G, Mufti A, Hall TJ, Chauhan A, Kubale R, Tang A. US Quantification of Liver Fat: Past, Present, and Future. Radiographics 2023; 43:e220178. [PMID: 37289646 DOI: 10.1148/rg.220178] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fatty liver disease has a high and increasing prevalence worldwide, is associated with adverse cardiovascular events and higher long-term medical costs, and may lead to liver-related morbidity and mortality. There is an urgent need for accurate, reproducible, accessible, and noninvasive techniques appropriate for detecting and quantifying liver fat in the general population and for monitoring treatment response in at-risk patients. CT may play a potential role in opportunistic screening, and MRI proton-density fat fraction provides high accuracy for liver fat quantification; however, these imaging modalities may not be suited for widespread screening and surveillance, given the high global prevalence. US, a safe and widely available modality, is well positioned as a screening and surveillance tool. Although well-established qualitative signs of liver fat perform well in moderate and severe steatosis, these signs are less reliable for grading mild steatosis and are likely unreliable for detecting subtle changes over time. New and emerging quantitative biomarkers of liver fat, such as those based on standardized measurements of attenuation, backscatter, and speed of sound, hold promise. Evolving techniques such as multiparametric modeling, radiofrequency envelope analysis, and artificial intelligence-based tools are also on the horizon. The authors discuss the societal impact of fatty liver disease, summarize the current state of liver fat quantification with CT and MRI, and describe past, currently available, and potential future US-based techniques for evaluating liver fat. For each US-based technique, they describe the concept, measurement method, advantages, and limitations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- David T Fetzer
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Theodore T Pierce
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Michelle L Robbin
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Guy Cloutier
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Arjmand Mufti
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Timothy J Hall
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Anil Chauhan
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - Reinhard Kubale
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
| | - An Tang
- From the Department of Radiology (D.T.F.) and Department of Internal Medicine, Division of Digestive and Liver Diseases (A.M.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6-230-BF, Dallas, TX 75390-9316; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (T.T.P.); Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (M.L.R.); Departments of Radiology and Biomedical Engineering, Laboratory of Biorheology and Medical Ultrasonics, University of Montréal Hospital Research Center, Montréal, Quebec, Canada (G.C.); Department of Medical Physics, University of Wisconsin, Madison, Wis (T.J.H.); Department of Radiology, University of Kansas Medical Center, Kansas City, Kan (A.C.); Department of Diagnostic and Interventional Radiology, University Hospital Homburg/Saar, Homburg, Germany (R.K.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Montréal, Quebec, Canada (A.T.)
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Bao J, Lv Y, Wang K, Wang Q, Chen Y, Dong Y, Zhu Y, Wang W. A Comparative Study of Ultrasound Attenuation Imaging, Controlled Attenuation Parameters, and Magnetic Resonance Spectroscopy for the Detection of Hepatic Steatosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1481-1489. [PMID: 36583414 DOI: 10.1002/jum.16158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis. METHODS A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (1 H-MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between 1 H-MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated. RESULTS The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P = .0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis. CONCLUSIONS ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.
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Affiliation(s)
- Jingwen Bao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Medical Science, Hexi University, Zhangye, China
| | - Yueming Lv
- Department of General Surgery, Zhangye Second People's Hospital, Zhangye, China
| | - Kun Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quanwen Wang
- School of Medical Science, Hexi University, Zhangye, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuli Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Dardanelli EP, Orozco ME, Oliva V, Lutereau JF, Ferrari FA, Bravo MG, Ruvinsky S, Roel M, Barvosa PC, Armeno M, Kaplan JS. Ultrasound attenuation imaging: a reproducible alternative for the noninvasive quantitative assessment of hepatic steatosis in children. Pediatr Radiol 2023; 53:1618-1628. [PMID: 36869263 DOI: 10.1007/s00247-023-05601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Pediatric hepatic steatosis is a global public health concern, as an increasing number of children are affected by this condition. Liver biopsy is the gold standard diagnostic method; however, this procedure is invasive. Magnetic resonance imaging (MRI)-derived proton density fat fraction has been accepted as an alternative to biopsy. However, this method is limited by cost and availability. Ultrasound (US) attenuation imaging is an upcoming tool for noninvasive quantitative assessment of hepatic steatosis in children. A limited number of publications have focused on US attenuation imaging and the stages of hepatic steatosis in children. OBJECTIVE To analyze the usefulness of ultrasound attenuation imaging for the diagnosis and quantification of hepatic steatosis in children. MATERIAL AND METHODS Between July and November 2021, 174 patients were included and divided into two groups: group 1, patients with risk factors for steatosis (n = 147), and group 2, patients without risk factors for steatosis (n = 27). In all cases, age, sex, weight, body mass index (BMI), and BMI percentile were determined. B-mode US (two observers) and US attenuation imaging with attenuation coefficient acquisition (two independent sessions, two different observers) were performed in both groups. Steatosis was classified into four grades (0: absent, 1: mild, 2: moderate and 3: severe) using B-mode US. Attenuation coefficient acquisition was correlated with steatosis score according to Spearman's correlation. Attenuation coefficient acquisition measurements' interobserver agreement was assessed using intraclass correlation coefficients (ICC). RESULTS All attenuation coefficient acquisition measurements were satisfactory without technical failures. The median values for group 1 for the first session were 0.64 (0.57-0.69) dB/cm/MHz and 0.64 (0.60-0.70) dB/cm/MHz for the second session. The median values for group 2 for the first session were 0.54 (0.51-0.56) dB/cm/MHz and 0.54 (0.51-0.56) dB/cm/MHz for the second. The average attenuation coefficient acquisition was 0.65 (0.59-0.69) dB/cm/MHz for group 1 and 0.54 (0.52-0.56) dB/cm/MHz for group 2. There was excellent interobserver agreement at 0.94 (95% CI 0.92-0.96). There was substantial agreement between both observers (κ = 0.77, with a P < 0.001). There was a positive correlation between ultrasound attenuation imaging and B-mode scores for both observers (r = 0.87, P < 0.001 for observer 1; r = 0.86, P < 0.001 for observer 2). Attenuation coefficient acquisition median values were significantly different for each steatosis grade (P < 0.001). In the assessment of steatosis by B-mode US, the agreement between the two observers was moderate (κ = 0.49 and κ = 0.55, respectively, with a P < 0.001 in both cases). CONCLUSION US attenuation imaging is a promising tool for the diagnosis and follow-up of pediatric steatosis, which provides a more repeatable form of classification, especially at low levels of steatosis detectable in B-mode US.
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Affiliation(s)
- Esteban P Dardanelli
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina.
| | - María Eugenia Orozco
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Vanesa Oliva
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Juan Francisco Lutereau
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Facundo Agustín Ferrari
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Mónica G Bravo
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Department of Research and Development, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Macarena Roel
- Department of Research and Development, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
| | - Pablo C Barvosa
- Department of Pediatrics, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Marisa Armeno
- Department Nutrition, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881, Buenos Aires, Argentina
| | - Julio S Kaplan
- Department of Radiology, Hospital de Pediatría Dr. Juan P. Garrahan, Combate de los Pozos 1881 (C 1245 AAM), Buenos Aires, Argentina
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Funada K, Kusano Y, Gyotoku Y, Shirahashi R, Suda T, Tamano M. Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index. World J Gastroenterol 2023; 29:3703-3714. [PMID: 37398885 PMCID: PMC10311609 DOI: 10.3748/wjg.v29.i23.3703] [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: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Shear wave speed (SWS), shear wave dispersion (SWD), and attenuation imaging (ATI) are new diagnostic parameters for non-alcoholic fatty liver disease. To differentiate between non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver (NAFL), we developed a clinical index we refer to as the “NASH pentagon” consisting of the 3 abovementioned parameters, body mass index (BMI), and Fib-4 index.
AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.
METHODS This non-invasive, prospective, observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography, SWD, and ATI were measured. Histological diagnosis based on liver biopsy was performed in 31 patients. The large pentagon group (LP group) and the small pentagon group (SP group), using an area of 100 as the cutoff, were compared; the NASH diagnosis rate was also investigated. In patients with a histologically confirmed diagnosis, receiver-operating characteristic (ROC) curve analyses were performed.
RESULTS One hundred-seven patients (61 men, 46 women; mean age 55.1 years; mean BMI 26.8 kg/m2) were assessed. The LP group was significantly older (mean age: 60.8 ± 15.2 years vs 46.4 ± 13.2 years; P < 0.0001). Twenty-five patients who underwent liver biopsies were diagnosed with NASH, and 6 were diagnosed with NAFL. On ROC curve analyses, the areas under the ROC curves for SWS, dispersion slope, ATI value, BMI, Fib-4 index, and the area of the NASH pentagon were 0.88000, 0.82000, 0.58730, 0.63000, 0.59333, and 0.93651, respectively; the largest was that for the area of the NASH pentagon.
CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.
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Affiliation(s)
- Kei Funada
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Yumi Kusano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Yoshinori Gyotoku
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Ryosaku Shirahashi
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Toshikuni Suda
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
| | - Masaya Tamano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
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Garcovich M, Paratore M, Ainora ME, Riccardi L, Pompili M, Gasbarrini A, Zocco MA. Shear Wave Dispersion in Chronic Liver Disease: From Physical Principles to Clinical Usefulness. J Pers Med 2023; 13:945. [PMID: 37373934 DOI: 10.3390/jpm13060945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
The development of new applications in ultrasound (US) imaging in recent years has strengthened the role of this imaging technique in the management of different pathologies, particularly in the setting of liver disease. Improved B-mode imaging (3D and 4D), contrast-enhanced US (CEUS) and especially US-based elastography techniques have created the concept of multiparametric ultrasound (MP-US), a term borrowed from radiological sectional imaging. Among the new elastography techniques, shear wave dispersion is a newly developed imaging technology which enables the assessment of the shear waves' dispersion slope. The analysis of the dispersion qualities of shear waves might be indirectly related to the tissue viscosity, thus providing biomechanical information concerning the pathologic state of the liver such as necroinflammation. Some of the most recent US devices have been embedded with software that evaluate the dispersion of shear waves/liver viscosity. In this review, the feasibility and the clinical applications of liver viscosity are reviewed based on the preliminary findings of both animal and human studies.
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Affiliation(s)
- Matteo Garcovich
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Mattia Paratore
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Elena Ainora
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Laura Riccardi
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maurizio Pompili
- Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
- Medicina Interna e del Trapianto di Fegato, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Assunta Zocco
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
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40
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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.
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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
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Dana J, Debray D, Vilgrain V. Reply to: "The effects of CFTR modulator therapies on liver stiffness and bile flow: a single centre experience". J Hepatol 2023:S0168-8278(23)00222-2. [PMID: 37044220 DOI: 10.1016/j.jhep.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Jérémy Dana
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada; Université de Strasbourg, Strasbourg, France; Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Pôle Hépato-digestif, Nouvel Hôpital Civil, Strasbourg, France.
| | - Dominique Debray
- Department of Pediatric Hepatology, Necker-Enfants Malades Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France; Necker-Enfants Malades Institute, Inserm U1121, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, Université de Paris, Clichy, France
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42
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Wang K, Zhang S, Zhou W, Wen L, Zhang S, Yu D. Clinical Application of Shear Wave Elastography With Shear Wave Dispersion Imaging in the Preoperative Evaluation of Hepatic Parenchyma in Patients With Liver Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:797-807. [PMID: 35730210 DOI: 10.1002/jum.16029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to compare the diagnostic accuracy of shear wave elastography (SWE) with that of shear wave dispersion (SWD) in evaluation of hepatic parenchyma in patients with liver tumors before resection. METHODS A total of 174 patients with liver tumors were prospectively enrolled. SWE and SWD examinations were performed. Fibrosis stage and necroinflammatory activity were determined histopathologically according to the Scheuer standard. We compared the diagnostic accuracy of SWE and SWD. RESULTS Both SWE and SWD values of the liver were highly correlated with liver fibrosis stage (P < .05, respectively). Both SWE and SWD values of the liver were moderately correlated with necroinflammatory activity (P < .05, respectively). Both SWE and SWD values of the liver were not correlated with steatosis (P > .05, respectively). Both SWE and SWD values were significantly different among the patients with different stages of liver fibrosis (P < .001, respectively). The area under the receiver operating characteristic (ROC) curve of SWE value was 0.982, 0.977, 0.969, and 0.984 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWE values were 6.9, 7.9, 8.7, and 10.6 kPa for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The area under the ROC curve of SWD value was 0.967, 0.960, 0.925, and 0.954 for predicting S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. The optimal cutoff SWD values were 11.2, 12.0, 13.2, and 16.0 m/s/kHz for S ≥ 1, S ≥ 2, S ≥ 3, and S = 4, respectively. CONCLUSIONS SWE and SWD could be noninvasive and accurate for predicting the stage of liver fibrosis in patients with liver tumors before surgery. SWE was more accurate than SWD in predicting severe fibrosis (S ≥ 3) and cirrhosis (S = 4).
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Affiliation(s)
- Kun Wang
- Department of Ultrasound, The Affiliated Hospital of Binzhou Medical University, Binzhou, China
| | - Shuchen Zhang
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Wenyan Zhou
- Department of Ultrasound, Yancheng City, No. 1 People' s Hospital, Yancheng, China
| | - Li Wen
- Function, The Special Care Hospital of Hebei Province, Shijiazhuang, China
| | - Shanshan Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Yu
- Department of Ultrasound, North China Medical Treatment Health Group, Fengfeng General Hospital, Handan, China
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Platz Batista da Silva N, Scharf G, Lürken L, Verloh N, Schleder S, Stroszczynski C, Jung EM, Haimerl M. Different Ultrasound Shear Wave Elastography Techniques as Novel Imaging-Based Approaches for Quantitative Evaluation of Hepatic Steatosis-Preliminary Findings. Tomography 2023; 9:681-692. [PMID: 36961013 PMCID: PMC10037607 DOI: 10.3390/tomography9020054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Modern ultrasound (US) shear-wave dispersion (SWD) and attenuation imaging (ATI) can be used to quantify changes in the viscosity and signal attenuation of the liver parenchyma, which are altered in hepatic steatosis. We aimed to evaluate modern shear-wave elastography (SWE), SWD and ATI for the assessment of hepatic steatosis. METHODS We retrospectively analyzed the US data of 15 patients who underwent liver USs and MRIs for the evaluation of parenchymal disease/liver lesions. The USs were performed using a multifrequency convex probe (1-8 MHz). The quantitative US measurements for the SWE (m/s/kPa), the SWD (kPa-m/s/kHz) and the ATI (dB/cm/MHz) were acquired after the mean value of five regions of interest (ROIs) was calculated. The liver MRI (3T) quantification of hepatic steatosis was performed by acquiring proton density fat fraction (PDFF) mapping sequences and placing five ROIs in artifact-free areas of the PDFF scan, measuring the fat-signal fraction. We correlated the SWE, SWD and ATI measurements to the PDFF results. RESULTS Three patients showed mild steatosis, one showed moderate steatosis and eleven showed no steatosis in the PDFF sequences. The calculated SWE cut-off (2.5 m/s, 20.4 kPa) value identified 3/4 of patients correctly (AUC = 0.73, p > 0.05). The SWD cut-off of 18.5 m/s/kHz, which had a significant correlation (r = 0.55, p = 0.034) with the PDFF results (AUC = 0.73), identified four patients correctly (p < 0.001). The ideal ATI (AUC = 0.53 (p < 0.05)) cut-off was 0.59 dB/cm/MHz, which showed a significantly good correlation with the PDFF results (p = 0.024). CONCLUSION Hepatic steatosis can be accurately detected using all the US-elastography techniques applied in this study, although the SWD and the SWE showed to be more sensitive than the PDFF.
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Affiliation(s)
| | - Gregor Scharf
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lukas Lürken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Hugstetter Straße 55, 79106 Freiburg im Breisgau, Germany
| | - Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, 94315 Straubing, Germany
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Department of Diagnostic and Interventional Radiology, Hospital Wuerzburg Mitte, 97074 Wuerzburg, Germany
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Impact of Breathing Phase, Liver Segment, and Prandial State on Ultrasound Shear Wave Speed, Shear Wave Dispersion, and Attenuation Imaging of the Liver in Healthy Volunteers. Diagnostics (Basel) 2023; 13:diagnostics13050989. [PMID: 36900133 PMCID: PMC10001107 DOI: 10.3390/diagnostics13050989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES Measurement location and patient state can impact noninvasive liver assessment and change clinical staging in ultrasound examinations. Research into differences exists for Shear Wave Speed (SWS) and Attenuation Imaging (ATI), but not for Shear Wave Dispersion (SWD). The aim of this study is to assess the effect of breathing phase, liver lobe, and prandial state on SWS, SWD, and ATI ultrasound measurements. METHODS Two experienced examiners performed SWS, SWD, and ATI measurements in 20 healthy volunteers using a Canon Aplio i800 system. Measurements were taken in the recommended condition (right lobe, following expiration, fasting state), as well as (a) following inspiration, (b) in the left lobe, and (c) in a nonfasting state. RESULTS SWS and SWD measurements were strongly correlated (r = 0.805, p < 0.001). Mean SWS was 1.34 ± 0.13 m/s in the recommended measurement position and did not change significantly under any condition. Mean SWD was 10.81 ± 2.05 m/s/kHz in the standard condition and significantly increased to 12.18 ± 1.41 m/s/kHz in the left lobe. Individual SWD measurements in the left lobe also had the highest average coefficient of variation (19.68%). No significant differences were found for ATI. CONCLUSION Breathing and prandial state did not significantly affect SWS, SWD, and ATI values. SWS and SWD measurements were strongly correlated. SWD measurements in the left lobe showed a higher individual measurement variability. Interobserver agreement was moderate to good.
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Sugimoto K, Lee DH, Itoi T. Response to "Limitations of a Multiparametric US Score for NASH Prediction". Radiology 2023; 306:e221498. [PMID: 36255310 DOI: 10.1148/radiol.221498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Dong Ho Lee
- Department of Radiology, Seoul National University, Seoul, Korea
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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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.
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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
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Grant EG. Calibrated US for Quantification of Fatty Liver Disease. Radiology 2023; 306:e221540. [PMID: 36255316 DOI: 10.1148/radiol.221540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Edward G Grant
- From the Department of Radiology, USC Keck Hospital, 1500 San Pablo St, Los Angeles, CA 90033
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48
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Sugimoto K, Yano H, Itoi T. US Dispersion Slope in Patients with Varying Liver Pathology. Radiology 2023; 307:e222251. [PMID: 36853180 DOI: 10.1148/radiol.222251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Taru MG, Neamti L, Taru V, Procopciuc LM, Procopet B, Lupsor-Platon M. How to Identify Advanced Fibrosis in Adult Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) Using Ultrasound Elastography-A Review of the Literature and Proposed Multistep Approach. Diagnostics (Basel) 2023; 13:diagnostics13040788. [PMID: 36832276 PMCID: PMC9955630 DOI: 10.3390/diagnostics13040788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), and its progressive form, non-alcoholic steatohepatitis (NASH), represent, nowadays, real challenges for the healthcare system. Liver fibrosis is the most important prognostic factor for NAFLD, and advanced fibrosis is associated with higher liver-related mortality rates. Therefore, the key issues in NAFLD are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. We critically reviewed the ultrasound (US) elastography techniques for the quantitative characterization of fibrosis, steatosis, and inflammation in NAFLD and NASH, with a specific focus on how to differentiate advanced fibrosis in adult patients. Vibration-controlled transient elastography (VCTE) is still the most utilized and validated elastography method for liver fibrosis assessment. The recently developed point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) techniques that use multiparametric approaches could bring essential improvements to diagnosis and risk stratification.
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Affiliation(s)
- Madalina-Gabriela Taru
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Lidia Neamti
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vlad Taru
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria
- Christian Doppler Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, 1090 Vienna, Austria
| | - Lucia Maria Procopciuc
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Bogdan Procopet
- Hepatology Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Monica Lupsor-Platon
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Medical Imaging Department, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400162 Cluj-Napoca, Romania
- Correspondence:
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50
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Gao J, Zapata I, Chen J, Erpelding TN, Adamson C, Park D. Quantitative Ultrasound Biomarkers to Assess Nonalcoholic Fatty Liver Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36744595 DOI: 10.1002/jum.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To assess diagnostic performance of quantitative ultrasound (QUS) biomarkers in assessing hepatic steatosis. METHODS We prospectively recruited 125 participants (mean age 54 years) who underwent liver QUS, magnetic resonance imaging (MRI), and laboratory tests within 30 days in this IRB approved study. Based on MRI-proton density fat fraction (MRI-PDFF) and MRE, we divided 125 participants into normal liver, nonalcoholic fatty liver (NAFL) and liver fibrosis (≥F1) groups. We examined diagnostic performance of ultrasound attenuation coefficient (AC), normalized local variance (NLV), superb microvascular imaging-based vascularity index (SMI-VI), and shear wave velocity (SWV) for determining hepatic steatosis and fibrosis using area under receiver operating characteristic curve (AUC). We also analyzed correlations of QUS biomarkers to MRI using Spearman correlation coefficient. RESULTS We observed significant differences in AC, NLV, and SMI-VI among the three groups (22 participants with normal liver, 78 with NAFL, and 25 with liver fibrosis). AUC of AC, NLV, and SMI-VI for determining ≥ mild steatotic livers (MRI-PDFF ≥5%) was 0.95, 0.90, and 0.92, respectively. AUC of SWV for determining ≥ F1 liver fibrosis was 0.93. The correlation of MRI-PDFF was positive to AC (r = 0.91) and negative to NLV (r = -0.74), SMI-VI (r = -0.8) in NAFL group. There was a significant difference in regression slope of AC to MRI-PDFF in livers with and without ≥F1 (0.84 vs 0.91, P = .02). CONCLUSIONS QUS biomarkers have high sensitivity and specificity to determine and grade hepatic steatosis and detect liver fibrosis. The effect of liver fibrosis on the performance of QUS biomarkers in quantifying liver fat content warrants further investigation.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, Utah, USA
- Weill Cornell Medicine, Cornell University, New York, New York, USA
| | | | - Johnson Chen
- Weill Cornell Medicine, Cornell University, New York, New York, USA
| | | | | | - David Park
- Rocky Vista University, Ivins, Utah, USA
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