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Blank V, Karlas T, Anderegg U, Wiegand J, Arnold J, Bundalian L, Le Duc GD, Körner C, Ebert T, Saalbach A. Thy-1 restricts steatosis and liver fibrosis in steatotic liver disease. Liver Int 2024; 44:2075-2090. [PMID: 38702958 DOI: 10.1111/liv.15956] [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: 02/07/2024] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND AIMS Steatotic liver disease (SLD) is generally considered to represent a hepatic manifestation of metabolic syndrome and includes a disease spectrum comprising isolated steatosis, metabolic dysfunction-associated steatohepatitis, liver fibrosis and ultimately cirrhosis. A better understanding of the detailed underlying pathogenic mechanisms of this transition is crucial for the design of new and efficient therapeutic interventions. Thymocyte differentiation antigen (Thy-1, also known as CD90) expression on fibroblasts controls central functions relevant to fibrogenesis, including proliferation, apoptosis, cytokine responsiveness, and myofibroblast differentiation. METHODS The impact of Thy-1 on the development of SLD and progression to fibrosis was investigated in high-fat diet (HFD)-induced SLD wild-type and Thy-1-deficient mice. In addition, the serum soluble Thy-1 (sThy-1) concentration was analysed in patients with metabolic dysfunction-associated SLD stratified according to steatosis, inflammation, or liver fibrosis using noninvasive markers. RESULTS We demonstrated that Thy-1 attenuates the development of fatty liver and the expression of profibrogenic genes in the livers of HFD-induced SLD mice. Mechanistically, Thy-1 directly inhibits the profibrotic activation of nonparenchymal liver cells. In addition, Thy-1 prevents palmitic acid-mediated amplification of the inflammatory response of myeloid cells, which might indirectly contribute to the pronounced development of liver fibrosis in Thy-1-deficient mice. Serum analysis of patients with metabolically associated steatotic liver disease syndrome revealed that sThy-1 expression is correlated with liver fibrosis status, as assessed by liver stiffness, the Fib4 score, and the NAFLD fibrosis score. CONCLUSION Our data strongly suggest that Thy-1 may function as a fibrosis-protective factor in mouse and human SLD.
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Affiliation(s)
- Valentin Blank
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
- Division of Interdisciplinary Ultrasound, Department of Internal Medicine I - Gastroenterology and Pneumology, University Hospital Halle, Halle, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Ulf Anderegg
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Josi Arnold
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
| | - Linnaeus Bundalian
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Gabriela-Diana Le Duc
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Christiane Körner
- Division of Hepatology, Clinic of Oncology, Gastroenterology, Hepatology, and Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Ebert
- Division of Endocrinology, Department of Medicine III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anja Saalbach
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
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Holzhey M, Petroff D, Wirkner K, Engel C, Baber R, Tönjes A, Zeynalova S, Yahiaoui-Doktor M, Berg T, Karlas T, Wiegand J. Relevance of GLP-1 receptor agonists or SGLT-2 inhibitors on the recruitment for clinical studies in patients with NAFLD. Eur J Gastroenterol Hepatol 2024; 36:107-112. [PMID: 37823453 DOI: 10.1097/meg.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Guidelines increasingly recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) to prevent cardiovascular and cardiorenal endpoints. Both drugs also show beneficial effects in nonalcoholic fatty liver disease (NAFLD). Preexisting GLP-1 RA and SGLT2i therapies are frequently defined as exclusion criterion in clinical studies to avoid confounding effects. We therefore investigated how this might limit recruitment and design of NAFLD studies. METHODS GLP-1 RA and SGLT2i prescriptions were analyzed in NAFLD patients with diabetes mellitus recruited at a tertiary referral center and from the population-based LIFE-Adult-Study. Individuals were stratified according to noninvasive parameters of liver fibrosis based on vibration-controlled transient elastography (VCTE). RESULTS 97 individuals were recruited at tertiary care and 473 from the LIFE-Adult-Study. VCTE was available in 97/97 and 147/473 cases.GLP-1 RA or SGLT2i were used in 11.9% of the population-based cohort (LSM < 8 kPa), but in 32.0% with LSM ≥ 8 kPa. In the tertiary clinic, it was 30.9% overall, independent of LSM, and 36.8% in patients with medium and high risk for fibrotic NASH (FAST score > 0.35). At baseline, 3.1% of the patients in tertiary care were taking GLP-1 RA and 4.1% SGLT2i. Four years later, the numbers had increased to 15.5% and 21.6%. CONCLUSION GLP-1 RA and SGLT2i are frequently and increasingly prescribed. In candidates for liver biopsy for NASH studies (VCTE ≥ 8 kPa) the use of them exceeds 30%, which needs careful consideration when designing NASH trials.
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Affiliation(s)
- Michael Holzhey
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | | | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Ronny Baber
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig
| | - Anke Tönjes
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig, Germany
| | - Samira Zeynalova
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Maryam Yahiaoui-Doktor
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
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Zeng KY, Bao WYG, Wang YH, Liao M, Yang J, Huang JY, Lu Q. Non-invasive evaluation of liver steatosis with imaging modalities: New techniques and applications. World J Gastroenterol 2023; 29:2534-2550. [PMID: 37213404 PMCID: PMC10198053 DOI: 10.3748/wjg.v29.i17.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/26/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the world, nonalcoholic fatty liver disease (NAFLD) accounts for majority of diffuse hepatic diseases. Notably, substantial liver fat accumulation can trigger and accelerate hepatic fibrosis, thus contributing to disease progression. Moreover, the presence of NAFLD not only puts adverse influences for liver but is also associated with an increased risk of type 2 diabetes and cardiovascular diseases. Therefore, early detection and quantified measurement of hepatic fat content are of great importance. Liver biopsy is currently the most accurate method for the evaluation of hepatic steatosis. However, liver biopsy has several limitations, namely, its invasiveness, sampling error, high cost and moderate intraobserver and interobserver reproducibility. Recently, various quantitative imaging techniques have been developed for the diagnosis and quantified measurement of hepatic fat content, including ultrasound- or magnetic resonance-based methods. These quantitative imaging techniques can provide objective continuous metrics associated with liver fat content and be recorded for comparison when patients receive check-ups to evaluate changes in liver fat content, which is useful for longitudinal follow-up. In this review, we introduce several imaging techniques and describe their diagnostic performance for the diagnosis and quantified measurement of hepatic fat content.
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Affiliation(s)
- Ke-Yu Zeng
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wu-Yong-Ga Bao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yun-Han Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Min Liao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Bozic D, Podrug K, Mikolasevic I, Grgurevic I. Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal. Diagnostics (Basel) 2022; 12:2287. [PMID: 36291976 PMCID: PMC9600709 DOI: 10.3390/diagnostics12102287] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 08/10/2023] Open
Abstract
The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology and Hepatology, University Hospital Center Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Kristian Podrug
- Department of Gastroenterology and Hepatology, University Hospital Center Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Ivana Mikolasevic
- Department of Gastroenterology and Hepatology, University Hospital Center Rijeka, Krešimirova 42, 51 000 Rijeka, Croatia
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Šalata 2, 10 000 Zagreb, Croatia
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Park J, Lee JM, Lee G, Jeon SK, Joo I. Quantitative Evaluation of Hepatic Steatosis Using Advanced Imaging Techniques: Focusing on New Quantitative Ultrasound Techniques. Korean J Radiol 2022; 23:13-29. [PMID: 34983091 PMCID: PMC8743150 DOI: 10.3348/kjr.2021.0112] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease, characterized by excessive accumulation of fat in the liver, is the most common chronic liver disease worldwide. The current standard for the detection of hepatic steatosis is liver biopsy; however, it is limited by invasiveness and sampling errors. Accordingly, MR spectroscopy and proton density fat fraction obtained with MRI have been accepted as non-invasive modalities for quantifying hepatic steatosis. Recently, various quantitative ultrasonography techniques have been developed and validated for the quantification of hepatic steatosis. These techniques measure various acoustic parameters, including attenuation coefficient, backscatter coefficient and speckle statistics, speed of sound, and shear wave elastography metrics. In this article, we introduce several representative quantitative ultrasonography techniques and their diagnostic value for the detection of hepatic steatosis.
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Affiliation(s)
- Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Gunwoo Lee
- Ultrasound R&D 2 Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Seoul, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Ferraioli G, Berzigotti A, Barr RG, Choi BI, Cui XW, Dong Y, Gilja OH, Lee JY, Lee DH, Moriyasu F, Piscaglia F, Sugimoto K, Wong GLH, Wong VWS, Dietrich CF. Quantification of Liver Fat Content with Ultrasound: A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2803-2820. [PMID: 34284932 DOI: 10.1016/j.ultrasmedbio.2021.06.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
New ultrasound methods that can be used to quantitatively assess liver fat content have recently been developed. These quantitative ultrasound (QUS) methods are based on the analysis of radiofrequency echoes detected by the transducer, allowing calculation of parameters for quantifying the fat in the liver. In this position paper, after a section dedicated to the importance of quantifying liver steatosis in patients with non-alcoholic fatty liver disease and another section dedicated to the assessment of liver fat with magnetic resonance, the current clinical studies performed using QUS are summarized. These new methods include spectral-based techniques and techniques based on envelope statistics. The spectral-based techniques that have been used in clinical studies are those estimating the attenuation coefficient and those estimating the backscatter coefficient. Clinical studies that have used tools based on the envelope statistics of the backscattered ultrasound are those performed by using the acoustic structure quantification or other parameters derived from it, such as the normalized local variance, and that performed by estimating the speed of sound. Experts' opinions are reported.
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Affiliation(s)
- Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Medical School University of Pavia, Pavia, Italy
| | - Annalisa Berzigotti
- Hepatology Dept., University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, Switzerland
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | - Byung I Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Jae Young Lee
- Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
| | - Fabio Piscaglia
- Unit of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan
| | - Grace Lai-Hung Wong
- Medical Data Analytic Centre and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Choi C, Choi W, Kim J, Kim C. Non-Invasive Photothermal Strain Imaging of Non-Alcoholic Fatty Liver Disease in Live Animals. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2487-2495. [PMID: 33999818 DOI: 10.1109/tmi.2021.3081097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The prevalence of non-alcoholic fatty liver diseases (NAFLD) has increased steadily over the past decade. Thus, diagnosing NAFLD at the earliest stage, which is a reversible condition, has become increasingly important. Here, photothermal strain imaging (pTSI) is presented as a novel non-invasive tool for NAFLD diagnosis. The pTSI uses ultrasound to detect the difference in thermal strain between fat and water during a light-induced temperature rise, which is directly related to the pathological evidence of NAFLD. To demonstrate its feasibility, fat accumulation in in vivo rat livers is monitored non-invasively using pTSI, based on clinical ultrasound B-mode images. A total of 21 male Wistar rats of 3 weeks of age were prepared. Of these, 18 rats received methionine-choline deficient diet for 1 to 6 weeks (n = 3 per week) to induce NAFLD, whereas 3 rats received normal diet as controls (n = 3). Livers were heated by a lipid-sensitive continuous-wave laser, and strain was measured. Quantitative results from the pTSI were compared with histological analysis results using Oil-Red-O (ORO). The receiver operating characteristic curve of in vivo pTSI results for detecting moderate steatosis (ORO-stained area ≥33%) was constructed based on strain change rate measured in the liver region. The sensitivity and specificity of pTSI were 90% and 82%, respectively, and the area-under-the-curve was measured as 0.85 ± 0.03 (95% confidence interval). The pTSI results tested in the rodent NAFLD model showed great potential for pTSI to be used as a new diagnostic tool for NAFLD in the future.
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Tsai YW, Zhou Z, Gong CSA, Tai DI, Cristea A, Lin YC, Tang YC, Tsui PH. Ultrasound Detection of Liver Fibrosis in Individuals with Hepatic Steatosis Using the Homodyned K Distribution. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:84-94. [PMID: 33109381 DOI: 10.1016/j.ultrasmedbio.2020.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/15/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023]
Abstract
Acoustic structure quantification (ASQ) based on the analysis of ultrasound backscattered statistics has been reported to detect liver fibrosis without significant hepatic steatosis. This study proposed using ultrasound parametric imaging based on the parameter α of the homodyned K (HK) distribution for staging liver fibrosis in patients with significant hepatic steatosis. Raw ultrasound image data were acquired from patients (n = 237) to construct B-mode and HK α parametric images, which were compared with the focal disturbance (FD) ratio obtained from ASQ on the basis of histologic evidence (METAVIR fibrosis score and hepatic steatosis severity). The data were divided into group I (n = 173; normal to mild hepatic steatosis) and group II (n = 64; with moderate to severe hepatic steatosis) for statistical analysis through one-way analysis of variance and receiver operating characteristic (ROC) curve analysis. The results showed that the HK α parameter monotonically decreased as the liver fibrosis stage increased (p < .05); concurrently, the FD ratio increased (p < .05). For group I, the areas under the ROC (AUROCs) obtained using the FD ratio and the α parameter (AUROCFD and AUROCα) were, respectively, 0.56 and 0.55, 0.68 and 0.68, 0.64 and 0.64 and 0.62 and 0.62 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. The values of AUROCFD and AUROCα for group II were, respectively, 0.88 and 0.91, 0.81 and 0.81, 0.77 and 0.76 and 0.78 and 0.73 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. As opposed to previous studies, ASQ was found to fail in characterizing liver fibrosis in group I; however, it was workable for identifying liver fibrosis in patients with significant hepatic steatosis (group II). Compared with ASQ, HK imaging provided improved diagnostic performance in the early detection of liver fibrosis coexisting with moderate to severe hepatic steatosis. Ultrasound HK imaging is recommended as a strategy to evaluate early fibrosis risk in patients with significant hepatic steatosis.
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Affiliation(s)
- Yu-Wei Tsai
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Cihun-Siyong Alex Gong
- Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Anca Cristea
- Department of Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, at Keelung and Chang Gung University, Taiwan
| | - Ya-Chun Tang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Miele L, Zocco MA, Pizzolante F, De Matthaeis N, Ainora ME, Liguori A, Gasbarrini A, Grieco A, Rapaccini G. Use of imaging techniques for non-invasive assessment in the diagnosis and staging of non-alcoholic fatty liver disease. Metabolism 2020; 112:154355. [PMID: 32916154 DOI: 10.1016/j.metabol.2020.154355] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and represent a common finding in highly prevalent metabolic disorders (i.e. type 2 diabetes, metabolic syndrome, obesity). Non-alcoholic steatohepatitis (NASH) requires liver biopsy for grading and staging the liver damage by the assessment of steatosis, inflammation and fibrosis. In parallel with the development of numerous 'liquid' biomarkers and algorithms that combine anthropometric and laboratory parameters, innovative hepatic imaging techniques have increasingly been developed to attempt to overcome the need for biopsy, both in diagnosis and staging of NAFLD, and in possible use in the follow-up of the disease. In this review, we focused on the different imaging techniques trying to highlight the strengths and disadvantages of different approaches, particularly for ultrasound techniques, in stratifying liver injury and fibrosis in patients with NAFLD / NASH.
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Affiliation(s)
- Luca Miele
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy.
| | - Maria A Zocco
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Fabrizio Pizzolante
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Nicoletta De Matthaeis
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Maria E Ainora
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy
| | - Antonio Liguori
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Antonio Grieco
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
| | - Gianludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Roma, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del S. Cuore, Roma. Italy
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Pirmoazen AM, Khurana A, El Kaffas A, Kamaya A. Quantitative ultrasound approaches for diagnosis and monitoring hepatic steatosis in nonalcoholic fatty liver disease. Theranostics 2020; 10:4277-4289. [PMID: 32226553 PMCID: PMC7086372 DOI: 10.7150/thno.40249] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Nonalcoholic fatty liver disease is a major global health concern with increasing prevalence, associated with obesity and metabolic syndrome. Recently, quantitative ultrasound-based imaging techniques have dramatically improved the ability of ultrasound to detect and quantify hepatic steatosis. These newer ultrasound techniques possess many inherent advantages similar to conventional ultrasound such as universal availability, real-time capability, and relatively low cost along with quantitative rather than a qualitative assessment of liver fat. In addition, quantitative ultrasound-based imaging techniques are less operator dependent than traditional ultrasound. Here we review several different emerging quantitative ultrasound-based approaches used for detection and quantification of hepatic steatosis in patients at risk for nonalcoholic fatty liver disease. We also briefly summarize other clinically available imaging modalities for evaluating hepatic steatosis such as MRI, CT, and serum analysis.
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Affiliation(s)
- Amir M. Pirmoazen
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Aman Khurana
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, California
| | - Aya Kamaya
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
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11
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Zhou Z, Gao A, Zhang Q, Wu W, Wu S, Tsui PH. Ultrasound Backscatter Envelope Statistics Parametric Imaging for Liver Fibrosis Characterization: A Review. ULTRASONIC IMAGING 2020; 42:92-109. [PMID: 32100633 DOI: 10.1177/0161734620907886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Early detection and diagnosis of liver fibrosis is of critical importance. Currently the gold standard for diagnosing liver fibrosis is biopsy. However, liver biopsy is invasive and associated with sampling errors and can lead to complications such as bleeding. Therefore, developing noninvasive imaging techniques for assessing liver fibrosis is of clinical value. Ultrasound has become the first-line tool for the management of chronic liver diseases. However, the commonly used B-mode ultrasound is qualitative and can cause interobserver or intraobserver difference. Ultrasound backscatter envelope statistics parametric imaging is an important group of quantitative ultrasound techniques that have been applied to characterizing different kinds of tissue. However, a state-of-the-art review of ultrasound backscatter envelope statistics parametric imaging for liver fibrosis characterization has not been conducted. In this paper, we focused on the development of ultrasound backscatter envelope statistics parametric imaging techniques for assessing liver fibrosis from 1998 to September 2019. We classified these techniques into six categories: constant false alarm rate, fiber structure extraction technique, acoustic structure quantification, quantile-quantile probability plot, the multi-Rayleigh model, and the Nakagami model. We presented the theoretical background and algorithms for liver fibrosis assessment by ultrasound backscatter envelope statistics parametric imaging. Then, the specific applications of ultrasound backscatter envelope statistics parametric imaging techniques to liver fibrosis evaluation were reviewed and analyzed. Finally, the pros and cons of each technique were discussed, and the future development was suggested.
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Affiliation(s)
- Zhuhuang Zhou
- Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Anna Gao
- Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Qiyu Zhang
- Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Weiwei Wu
- College of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Shuicai Wu
- Department of Biomedical Engineering, College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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12
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Abstract
To evaluate the diagnostic accuracy of ultrasonic acoustic structure quantification (ASQ) for grading hepatic fibrosis/cirrhosis by comparing ultrasonographic features of regions of interest on ASQ images with the pathological characteristics of stage F0-F4 hepatic fibrosis cases.We retrospectively analyzed the medical records of 97 patients with chronic hepatitis who underwent ASQ evaluation at the Ultrasound Room of Dongfang Hepatobiliary Surgery Hospital (Shanghai, China) between July 2012 and October 2013. Regions of interest on stored ASQ images were analyzed to obtain cm values on modes, averages, and standard deviations. Correlation analysis, principal component analysis (PCA), and multivariate analysis of variance (MANOVA) of the mean cm values with hepatic fibrosis staging were performed. A receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of ASQ.The mean cm of ASQ correlated with the pathological stage of hepatic fibrosis, with the best correlation coefficient (r = 0.81) in the right lobe below rib 2. The best cm average 1 and 2 values, which differed significantly among different hepatic fibrosis/cirrhosis stages, were also found in this area. The maximal area under the ROC curve (0.969) was for cmaverage 1 for the F0 versus F1 to F4 group, with a low criterion (110), while the maximal criterion (145) was for cm average 2 for the F0-F3 versus F4 group, with a relatively small AUC (0.882).With objective and accurate results, ASQ analysis is a promising non-invasive method for grading hepatic fibrosis, although this should be verified in further studies.
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Affiliation(s)
- Lei Cheng
- Department of Echocardiography, Huashan Hospital, Fudan University
| | - Yongan Chen
- Department of Oncology, The 455th Hospital of Chinese People's Liberation Army, Shanghai, China
| | - Rui Xiao
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Yan Pan
- Department of Ultrasound, Yu Huang Ding Hospital, Yan Tai
| | - Jia Guo
- Department of Ultrasound, Eastern Hepatobilary Surgery Hospital, Shanghai, China
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13
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Lin YH, Wan YL, Tai DI, Tseng JH, Wang CY, Tsai YW, Lin YR, Chang TY, Tsui PH. Considerations of Ultrasound Scanning Approaches in Non-alcoholic Fatty Liver Disease Assessment through Acoustic Structure Quantification. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1955-1969. [PMID: 31130411 DOI: 10.1016/j.ultrasmedbio.2019.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a risk factor for hepatic fibrosis and cirrhosis. Acoustic structure quantification (ASQ), based on statistical analysis of ultrasound echoes, is an emerging technique for hepatic steatosis diagnosis. A standardized measurement protocol for ASQ analysis was suggested previously; however, an optimal ultrasound scanning approach has not been concluded thus far. In this study, the suitability of scanning approaches for the ASQ-based evaluation of hepatic steatosis was investigated. Hepatic fat fractions (HFFs; liver segments VIII, III and VI) of 70 living liver donors were assessed with magnetic resonance spectroscopy. A clinical ultrasound machine equipped with a 3-MHz convex transducer was used to scan each participant using the intercostal, epigastric and subcostal planes to acquire raw data for estimating two ASQ parameters (Cm2 and focal disturbance [FD] ratio) of segments VIII, III and VI, respectively. The parameters were plotted as functions of the HFF for calculating the values of the correlation coefficient (r) and probability value (p). The diagnostic performance of the parameters in discriminating between the normal and steatotic (≥5 and ≥10%) groups was also compared using receiver operating characteristic (ROC) curves. The Cm2 and FD ratio values measured using the epigastric and subcostal planes did not correlate with the severity of hepatic steatosis. However, intercostal imaging exhibited a higher correlation between the ASQ parameters and HFF (r = -0.64, p < 0.001). The diagnostic performance of Cm2 and FD ratio in detecting hepatic steatosis using intercostal imaging was also satisfactory (areas under ROC curves >0.8). Intercostal imaging is an appropriate scanning approach for ASQ analysis of the liver.
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Affiliation(s)
- Ying-Hsiu Lin
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wei Tsai
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ru Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Tu-Yung Chang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Ballestri S, Nascimbeni F, Lugari S, Lonardo A, Francica G. A critical appraisal of the use of ultrasound in hepatic steatosis. Expert Rev Gastroenterol Hepatol 2019; 13:667-681. [PMID: 31104523 DOI: 10.1080/17474124.2019.1621164] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Nonalcoholic fatty liver disease (NAFLD) spans steatosis through nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NAFLD carries an increased risk of cardio-metabolic and liver-related events accounting for a substantial economic burden. Given that the natural history of NAFLD is critically dependent on the stage of fibrosis, non-invasively identifying the subgroup of patients at a higher risk of progressive disease is key. Areas covered: This review highlights the recent developments in the use of ultrasound-based techniques in NAFLD and their performance in predicting metabolic derangements, cardiovascular risk, and progression of liver disease, notably including diagnosis of fibrosing NASH, identification, and treatment of HCC. Expert opinion: Our ability to identify NAFLD patients and to estimate steatofibrosis with various ultrasound-based techniques has undergone tremendous progress over the last few years. However, it is more difficult to capture the inflammatory component of NASH with such ultrasound-assisted techniques. Moreover, semi-quantitative, quantitative, elastographic, and contrast-enhanced ultrasound techniques are increasingly being appreciated and made available but not all such techniques will gain success in the clinical and research area. Therefore, further research will precisely define the role of the most innovative ultrasonographic techniques, while reducing costs and increasing feasibility.
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Affiliation(s)
- Stefano Ballestri
- a Internal Medicine Unit , Azienda USL of Modena, Pavullo Hospital , Modena , Italy
| | - Fabio Nascimbeni
- b Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero Universitaria of Modena , Modena , Italy
| | - Simonetta Lugari
- c Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero-Universitaria of Modena and University of Modena and Reggio Emilia , Modena , Italy
| | - Amedeo Lonardo
- b Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero Universitaria of Modena , Modena , Italy
| | - Giampiero Francica
- d Interventional Ultrasound Unit , Pineta Grande Hospital , Castel Volturno , Italy
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15
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Jeon SK, Lee JM, Joo I, Yoon JH, Lee DH, Lee JY, Han JK. Prospective Evaluation of Hepatic Steatosis Using Ultrasound Attenuation Imaging in Patients with Chronic Liver Disease with Magnetic Resonance Imaging Proton Density Fat Fraction as the Reference Standard. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1407-1416. [PMID: 30975533 DOI: 10.1016/j.ultrasmedbio.2019.02.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
The purpose of our study was to investigate the diagnostic performance of 2-D ultrasound attenuation imaging (ATI) for the assessment of hepatic steatosis in patients with chronic liver disease using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard. We prospectively analyzed 87 patients with chronic liver disease who had reliable measurements at both ATI and MRI-PDFF. For the detection of hepatic steatosis of MRI-PDFF ≥5% and MRI-PDFF ≥10%, ATI measurements yielded areas under the receiver operating characteristic curve of 0.76 and 0.88, respectively (95% confidence intervals: 0.66-0.85 and 0.79-0.94). Attenuation coefficients at ATI were moderately correlated with MRI-PDFF (ρ = 0.66). In conclusion, attenuation coefficients at ultrasound ATI were well correlated with MRI-PDFF and, thus, may provide good diagnostic performance in the assessment of hepatic steatosis, making these coefficients a promising tool for the non-invasive assessment and quantification of hepatic steatosis.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
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16
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Wangüemert Pérez AL, González Delgado C, Fernández Ramos J. Ultrasound Application with Acoustic Structure Quantification (ASQ) in Interstitial Lung Diseases. Arch Bronconeumol 2019; 55:537-539. [PMID: 30982693 DOI: 10.1016/j.arbres.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 02/07/2023]
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17
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Yang KC, Liao YY, Tsui PH, Yeh CK. Ultrasound imaging in nonalcoholic liver disease: current applications and future developments. Quant Imaging Med Surg 2019; 9:546-551. [PMID: 31143646 PMCID: PMC6511724 DOI: 10.21037/qims.2019.03.14] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Kuen Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei 10800, Taiwan
- Health Science & Wellness Center, National Taiwan University, Taipei 10617, Taiwan
| | - Yin-Yin Liao
- Department of Biomedical Engineering, Hungkuang University, Taichung 43302, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
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18
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Zhang Y, Zheng Y, Yang X, Liu X, Zhang H, Xu X, Meng F. Comparison of Acoustic Structure Quantification, Transient Elastography (FibroScan) and Histology in Patients with Chronic Hepatitis B and without Moderate to Severe Hepatic Steatosis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:684-692. [PMID: 30638967 DOI: 10.1016/j.ultrasmedbio.2018.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/29/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to compare acoustic structure quantification (ASQ) with transient elastography for staging liver fibrosis. One hundred eighty-two patients with chronic hepatitis B and without moderate to severe hepatic steatosis scheduled for liver biopsy underwent ASQ and transient elastography examinations. All ASQ parameters, including total mode, total average, red mode, red average, red standard deviation, blue mode, blue average, blue standard deviation and focal disturbance (FD) ratio and liver stiffness obtained via transient elastography were found to correlate with fibrosis stage (Spearman's r = 0.783, 0.791, 0.750, 0.771, 0.544, 0.718, 0.691, 0.439, 0.815 and 0.814, respectively; all p values < 0.001). Among the ASQ parameters, the FD ratio had the highest correlation with the stage of fibrosis. The areas under the receiver operating characteristic curves (AUCs) of FD ratio and liver stiffness were 0.911 and 0.906 for F ≥ F1, 0.918 and 0.882 for F ≥ F2, 0.911 and 0.914 for F ≥ F3 and 0.926 and 0.978 for F = F4, respectively. There was no significant difference in AUCs between FD ratio and liver stiffness in predicting different stages of fibrosis (p = 0.062-0.912). ASQ is a promising technique for assessing liver fibrosis in the absence of moderate to severe hepatic steatosis.
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Affiliation(s)
- Yuan Zhang
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Ying Zheng
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Xuesong Yang
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Xuqing Liu
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Haiying Zhang
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Xiaoluan Xu
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China
| | - Fankun Meng
- Department of Ultrasound, You'an Hospital, Capital Medical University, Beijing, China.
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19
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Hepatic Steatosis Assessment Using Quantitative Ultrasound Parametric Imaging Based on Backscatter Envelope Statistics. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9040661] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic steatosis is a key manifestation of non-alcoholic fatty liver disease (NAFLD). Early detection of hepatic steatosis is of critical importance. Currently, liver biopsy is the clinical golden standard for hepatic steatosis assessment. However, liver biopsy is invasive and associated with sampling errors. Ultrasound has been recommended as a first-line diagnostic test for the management of NAFLD. However, B-mode ultrasound is qualitative and can be affected by factors including image post-processing parameters. Quantitative ultrasound (QUS) aims to extract quantified acoustic parameters from the ultrasound backscattered signals for ultrasound tissue characterization and can be a complement to conventional B-mode ultrasound. QUS envelope statistics techniques, both statistical model-based and non-model-based, have shown potential for hepatic steatosis characterization. However, a state-of-the-art review of hepatic steatosis assessment using envelope statistics techniques is still lacking. In this paper, envelope statistics-based QUS parametric imaging techniques for characterizing hepatic steatosis are reviewed and discussed. The reviewed ultrasound envelope statistics parametric imaging techniques include acoustic structure quantification imaging, ultrasound Nakagami imaging, homodyned-K imaging, kurtosis imaging, and entropy imaging. Future developments are suggested.
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20
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Ultrasound Entropy Imaging of Nonalcoholic Fatty Liver Disease: Association with Metabolic Syndrome. ENTROPY 2018; 20:e20120893. [PMID: 33266617 PMCID: PMC7512475 DOI: 10.3390/e20120893] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of advanced liver diseases. Fat accumulation in the liver changes the hepatic microstructure and the corresponding statistics of ultrasound backscattered signals. Acoustic structure quantification (ASQ) is a typical model-based method for analyzing backscattered statistics. Shannon entropy, initially proposed in information theory, has been demonstrated as a more flexible solution for imaging and describing backscattered statistics without considering data distribution. NAFLD is a hepatic manifestation of metabolic syndrome (MetS). Therefore, we investigated the association between ultrasound entropy imaging of NAFLD and MetS for comparison with that obtained from ASQ. A total of 394 participants were recruited to undergo physical examinations and blood tests to diagnose MetS. Then, abdominal ultrasound screening of the liver was performed to calculate the ultrasonographic fatty liver indicator (US-FLI) as a measure of NAFLD severity. The ASQ analysis and ultrasound entropy parametric imaging were further constructed using the raw image data to calculate the focal disturbance (FD) ratio and entropy value, respectively. Tertiles were used to split the data of the FD ratio and entropy into three groups for statistical analysis. The correlation coefficient r, probability value p, and odds ratio (OR) were calculated. With an increase in the US-FLI, the entropy value increased (r = 0.713; p < 0.0001) and the FD ratio decreased (r = –0.630; p < 0.0001). In addition, the entropy value and FD ratio correlated with metabolic indices (p < 0.0001). After adjustment for confounding factors, entropy imaging (OR = 7.91, 95% confidence interval (CI): 0.96–65.18 for the second tertile; OR = 20.47, 95% CI: 2.48–168.67 for the third tertile; p = 0.0021) still provided a more significant link to the risk of MetS than did the FD ratio obtained from ASQ (OR = 0.55, 95% CI: 0.27–1.14 for the second tertile; OR = 0.42, 95% CI: 0.15–1.17 for the third tertile; p = 0.13). Thus, ultrasound entropy imaging can provide information on hepatic steatosis. In particular, ultrasound entropy imaging can describe the risk of MetS for individuals with NAFLD and is superior to the conventional ASQ technique.
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21
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Zhou Z, Tai DI, Wan YL, Tseng JH, Lin YR, Wu S, Yang KC, Liao YY, Yeh CK, Tsui PH. Hepatic Steatosis Assessment with Ultrasound Small-Window Entropy Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1327-1340. [PMID: 29622501 DOI: 10.1016/j.ultrasmedbio.2018.03.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/21/2018] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease is a type of hepatic steatosis that is not only associated with critical metabolic risk factors but can also result in advanced liver diseases. Ultrasound parametric imaging, which is based on statistical models, assesses fatty liver changes, using quantitative visualization of hepatic-steatosis-caused variations in the statistical properties of backscattered signals. One constraint with using statistical models in ultrasound imaging is that ultrasound data must conform to the distribution employed. Small-window entropy imaging was recently proposed as a non-model-based parametric imaging technique with physical meanings of backscattered statistics. In this study, we explored the feasibility of using small-window entropy imaging in the assessment of fatty liver disease and evaluated its performance through comparisons with parametric imaging based on the Nakagami distribution model (currently the most frequently used statistical model). Liver donors (n = 53) and patients (n = 142) were recruited to evaluate hepatic fat fractions (HFFs), using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate and severe), using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct B-mode, small-window entropy and Nakagami images to correlate with HFF analyses and fatty liver stages. The diagnostic values of the imaging methods were evaluated using receiver operating characteristic curves. The results demonstrated that the entropy value obtained using small-window entropy imaging correlated well with log10(HFF), with a correlation coefficient r = 0.74, which was higher than those obtained for the B-scan and Nakagami images. Moreover, small-window entropy imaging also resulted in the highest area under the receiver operating characteristic curve (0.80 for stages equal to or more severe than mild; 0.90 for equal to or more severe than moderate; 0.89 for severe), which indicated that non-model-based entropy imaging-using the small-window technique-performs more favorably than other techniques in fatty liver assessment.
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Affiliation(s)
- Zhuhuang Zhou
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China; Faculty of Information Technology, Beijing University of Technology, Beijing, China
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ru Lin
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Shuicai Wu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan
| | - Yin-Yin Liao
- Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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22
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23
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Ebert T, Linder N, Schaudinn A, Busse H, Berger J, Lichtinghagen R, Keim V, Wiegand J, Karlas T. Association of fetuin B with markers of liver fibrosis in nonalcoholic fatty liver disease. Endocrine 2017; 58:246-252. [PMID: 28914407 DOI: 10.1007/s12020-017-1417-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The liver-derived plasma protein fetuin B is associated with nonalcoholic fatty liver disease (NAFLD) and impaired glucose homeostasis in mice. However, its association with non-invasive ultrasound- and magnetic resonance (MR)-based markers of liver fibrosis and steatosis, the enhanced liver fibrosis (ELF) score, liver biopsy, as well as rs738409 in PNPLA3, has not been elucidated in NAFLD, so far. DESIGN AND METHODS The association of circulating fetuin B and transient elastography (TE), controlled attenuation parameter (CAP), 1H-MR-spectroscopy, the ELF score, liver biopsy, as well as risk alleles in rs738409 in PNPLA3, was studied in 101 NAFLD patients as compared to 15 healthy controls. RESULTS Serum fetuin B levels did not differ between NAFLD patients and controls (p = 0.863). Fetuin B was independently and negatively associated with transient elastography liver stiffness measurement (LSM) (p = 0.002), but not with the steatosis markers CAP or 1H-MR-spectroscopy. Fetuin B serum concentrations were significantly lower in individuals with LSM > 7.0 kPa as compared to patients with LSM < 7.0 kPa (p = 0.024). Furthermore, the ELF score and histologically proven fibrosis were independent and negative predictors of circulating fetuin B. Moreover, serum fetuin B significantly depended on number of rs738409 risk alleles (p = 0.026). CONCLUSIONS Fetuin B is independently and negatively associated with non-invasive markers of liver fibrosis and PNPLA3 status in NAFLD patients but does not show a correlation with the hepatic lipid content. Future studies need to elucidate the pathophysiological significance of fetuin B in NAFLD and its potential value as predictor for disease severity.
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Affiliation(s)
- Thomas Ebert
- Department of Endocrinology and Nephrology, University of Leipzig, 04103, Leipzig, Germany.
- Leipzig University Medical Center, IFB AdiposityDiseases, 04103, Leipzig, Germany.
| | - Nicolas Linder
- Leipzig University Medical Center, IFB AdiposityDiseases, 04103, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Joachim Berger
- Division of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625, Hannover, Germany
| | - Volker Keim
- Division of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Johannes Wiegand
- Division of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology and Rheumatology, University Hospital Leipzig, 04103, Leipzig, Germany
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Lee DH. Imaging evaluation of non-alcoholic fatty liver disease: focused on quantification. Clin Mol Hepatol 2017; 23:290-301. [PMID: 28994271 PMCID: PMC5760010 DOI: 10.3350/cmh.2017.0042] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/17/2017] [Indexed: 12/26/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has been an emerging major health problem, and the most common cause of chronic liver disease in Western countries. Traditionally, liver biopsy has been gold standard method for quantification of hepatic steatosis. However, its invasive nature with potential complication as well as measurement variability are major problem. Thus, various imaging studies have been used for evaluation of hepatic steatosis. Ultrasonography provides fairly good accuracy to detect moderate-to-severe degree hepatic steatosis, but limited accuracy for mild steatosis. Operator-dependency and subjective/qualitative nature of examination are another major drawbacks of ultrasonography. Computed tomography can be considered as an unsuitable imaging modality for evaluation of NAFLD due to potential risk of radiation exposure and limited accuracy in detecting mild steatosis. Both magnetic resonance spectroscopy and magnetic resonance imaging using chemical shift technique provide highly accurate and reproducible diagnostic performance for evaluating NAFLD, and therefore, have been used in many clinical trials as a non-invasive reference of standard method.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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25
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Controlled attenuation parameter and magnetic resonance spectroscopy-measured liver steatosis are discordant in obese HIV-infected adults. AIDS 2017; 31:2119-2125. [PMID: 28723710 DOI: 10.1097/qad.0000000000001601] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatic steatosis is common in HIV-infected individuals. Magnetic resonance spectroscopy (MRS) is the preferred noninvasive method for hepatic steatosis measurement but is expensive. Controlled attenuation parameter (CAP) also assesses hepatic steatosis and is conveniently performed concomitantly with transient elastography. We aimed to assess the accuracy of CAP in the setting of HIV infection. DESIGN Cross-sectional study. METHODS CAP and MRS were performed in 82 study participants (39 HIV monoinfected; seven hepatitis C virus (HCV) monoinfected; 21 HIV/HCV coinfected; 15 with neither infection). We used concordance correlation coefficients to compare log-transformed and standardized CAP and MRS values and linear regression to examine factors associated with CAP and MRS-measured hepatic steatosis (MRS-HS). The accuracy of CAP to detect at least mild hepatic steatosis, defined as MRS-liver fat fraction more than 0.05, and the factors associated with discordance between CAP and MRS were evaluated. RESULTS Overall, CAP-measured hepatic steatosis and MRS-HS correlated moderately well (rc = 0.63; P < 0.001), and correlation was strongest in the HIV-monoinfected group (rc = 0.67; P < 0.001). Body composition factors (higher BMI, waist circumference, visceral and abdominal subcutaneous adipose tissue) and insulin resistance were significantly associated with both greater CAP-measured hepatic steatosis and MRS-HS. Using a validated CAP cut-off of at least 238 dB/m, sensitivity and specificity for at least mild hepatic steatosis were 84% and 75% in the entire cohort; 89% and 80% in the HIV-monoinfected group. Participants with higher body composition parameters were more likely to be misclassified as having hepatic steatosis by CAP. CONCLUSION Our findings suggest CAP is an acceptable noninvasive surrogate for hepatic steatosis in HIV-infected individuals but may overestimate hepatic steatosis prevalence, especially in individuals with high BMI. Evaluation of factors that improve CAP accuracy and determination of optimal cut-offs are warranted.
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26
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Effect of ultrasound frequency on the Nakagami statistics of human liver tissues. PLoS One 2017; 12:e0181789. [PMID: 28763461 PMCID: PMC5538657 DOI: 10.1371/journal.pone.0181789] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022] Open
Abstract
The analysis of the backscattered statistics using the Nakagami parameter is an emerging ultrasound technique for assessing hepatic steatosis and fibrosis. Previous studies indicated that the echo amplitude distribution of a normal liver follows the Rayleigh distribution (the Nakagami parameter m is close to 1). However, using different frequencies may change the backscattered statistics of normal livers. This study explored the frequency dependence of the backscattered statistics in human livers and then discussed the sources of ultrasound scattering in the liver. A total of 30 healthy participants were enrolled to undergo a standard care ultrasound examination on the liver, which is a natural model containing diffuse and coherent scatterers. The liver of each volunteer was scanned from the right intercostal view to obtain image raw data at different central frequencies ranging from 2 to 3.5 MHz. Phantoms with diffuse scatterers only were also made to perform ultrasound scanning using the same protocol for comparisons with clinical data. The Nakagami parameter-frequency correlation was evaluated using Pearson correlation analysis. The median and interquartile range of the Nakagami parameter obtained from livers was 1.00 (0.98-1.05) for 2 MHz, 0.93 (0.89-0.98) for 2.3 MHz, 0.87 (0.84-0.92) for 2.5 MHz, 0.82 (0.77-0.88) for 3.3 MHz, and 0.81 (0.76-0.88) for 3.5 MHz. The Nakagami parameter decreased with the increasing central frequency (r = -0.67, p < 0.0001). However, the effect of ultrasound frequency on the statistical distribution of the backscattered envelopes was not found in the phantom results (r = -0.147, p = 0.0727). The current results demonstrated that the backscattered statistics of normal livers is frequency-dependent. Moreover, the coherent scatterers may be the primary factor to dominate the frequency dependence of the backscattered statistics in a liver.
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27
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Weng WC, Tsui PH, Lin CW, Lu CH, Lin CY, Shieh JY, Lu FL, Ee TW, Wu KW, Lee WT. Evaluation of muscular changes by ultrasound Nakagami imaging in Duchenne muscular dystrophy. Sci Rep 2017; 7:4429. [PMID: 28667314 PMCID: PMC5493629 DOI: 10.1038/s41598-017-04131-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/10/2017] [Indexed: 12/12/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is the most common debilitating muscular disorder. Developing a noninvasive measure for monitoring the progression of this disease is critical. The present study tested the effectiveness of using ultrasound Nakagami imaging to evaluate the severity of the dystrophic process. A total of 47 participants (40 with DMD and 7 healthy controls) were recruited. Patients were classified into stage 1 (presymptomatic and ambulatory), stage 2 (early nonambulatory), and stage 3 (late nonambulatory). All participants underwent ultrasound examinations on the rectus femoris, tibialis anterior, and gastrocnemius. The results revealed that the ultrasound Nakagami parameter correlated positively with functional severity in the patients with DMD. The median Nakagami parameter of the gastrocnemius muscle increased from 0.50 to 0.85, corresponding to the largest dynamic range between normal and stage 3. The accuracy, sensitivity, and specificity of diagnosing walking function were 85.52%, 76.31%, and 94.73%, respectively. The Nakagami parameter of the rectus femoris and gastrocnemius muscles correlated negatively with the 6-minute walking distance in the ambulatory patients. Therefore, changes in the Nakagami parameter for the gastrocnemius muscle are suitable for monitoring disease progression in ambulatory patients and for predicting ambulation loss. Ultrasound Nakagami imaging shows potential for evaluating patients with DMD.
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Affiliation(s)
- Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chun-Hao Lu
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yen Lin
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, Yong-He Cardinal Tien Hospital, Taipei, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ting-Wei Ee
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan. .,Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan.
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28
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Karlas T, Weise L, Kuhn S, Krenzien F, Mehdorn M, Petroff D, Linder N, Schaudinn A, Busse H, Keim V, Pratschke J, Wiegand J, Splith K, Schmelzle M. Correlation of cell-free DNA plasma concentration with severity of non-alcoholic fatty liver disease. J Transl Med 2017; 15:106. [PMID: 28521774 PMCID: PMC5437653 DOI: 10.1186/s12967-017-1208-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The assessment of fibrosis and inflammatory activity is essential to identify patients with non-alcoholic fatty liver disease (NAFLD) at risk for progressive disease. Serum markers and ultrasound-based methods can replace liver biopsy for fibrosis staging, whereas non-invasive characterization of inflammatory activity remains a clinical challenge. Cell-free DNA (cfDNA) is a novel non-invasive biomarker for assessing cellular inflammation and cell death, which has not been evaluated in NAFLD. METHODS Patients and healthy controls from two previous studies were included. NAFLD disease activity and severity were non-invasively characterized by liver stiffness measurement (transient elastography, TE) including steatosis assessment with controlled attenuation parameter (CAP), single-proton magnetic resonance spectroscopy (1H-MRS) for determination of hepatic fat fraction, aminotransferases and serum ferritin. cfDNA levels (90 and 222 bp fragments) were analyzed using quantitative real-time PCR. RESULTS Fifty-eight NAFLD patients (age 62 ± 11 years, BMI 28.2 ± 3.5 kg/m2) and 13 healthy controls (age 38 ± 12 years, BMI 22.4 ± 2.1 kg/m2) were included. 90 bp cfDNA levels were significantly higher in NAFLD patients compared to healthy controls: 3.7 (1.3-23.1) vs. 2.9 (1.4-4.1) ng/mL (p = 0.014). In the NAFLD cohort, circulating cfDNA correlated significantly with disease activity and severity, especially in patients with elevated liver stiffness (n = 13, 22%) compared to cases with TE values ≤7 kPa: cf90 bp 6.05 (2.41-23.13) vs. 3.16 (1.29-7.31) ng/mL (p < 0.001), and cf222 bp 14.41 (9.27-22.90) vs. 11.32 (6.05-18.28) ng/mL (p = 0.0041). CONCLUSIONS Cell-free DNA plasma concentration correlates with established non-invasive markers of NAFLD activity and severity. Therefore, cfDNA should be further evaluated as biomarker for identifying patients at risk for progressive NAFLD.
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Affiliation(s)
- Thomas Karlas
- 0000 0000 8517 9062grid.411339.dDepartment of Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
- 0000 0001 2230 9752grid.9647.cIFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Lara Weise
- 0000 0001 2230 9752grid.9647.cMedical Faculty, Leipzig University, Leipzig, Germany
| | - Stephanie Kuhn
- 0000 0004 0492 3830grid.7492.8Department Environmental Immunology, Helmholtz Centre for Environmental Research GmbH-UFZ, Leipzig, Germany
| | - Felix Krenzien
- 0000 0001 2218 4662grid.6363.0Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Mehdorn
- 0000 0000 8517 9062grid.411339.dDepartment of Visceral-, Transplantation-, Thoracic- and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- 0000 0001 2230 9752grid.9647.cClinical Trial Centre, Leipzig University, Leipzig, Germany
| | - Nicolas Linder
- 0000 0000 8517 9062grid.411339.dDepartment of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Alexander Schaudinn
- 0000 0000 8517 9062grid.411339.dDepartment of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Harald Busse
- 0000 0000 8517 9062grid.411339.dDepartment of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Volker Keim
- 0000 0000 8517 9062grid.411339.dDepartment of Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Johann Pratschke
- 0000 0001 2218 4662grid.6363.0Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Wiegand
- 0000 0000 8517 9062grid.411339.dDepartment of Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Katrin Splith
- 0000 0001 2218 4662grid.6363.0Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- 0000 0001 2218 4662grid.6363.0Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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29
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Effects of Fatty Infiltration of the Liver on the Shannon Entropy of Ultrasound Backscattered Signals. ENTROPY 2016. [DOI: 10.3390/e18090341] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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30
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Tsui PH, Ho MC, Tai DI, Lin YH, Wang CY, Ma HY. Acoustic structure quantification by using ultrasound Nakagami imaging for assessing liver fibrosis. Sci Rep 2016; 6:33075. [PMID: 27605260 PMCID: PMC5015103 DOI: 10.1038/srep33075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023] Open
Abstract
Acoustic structure quantification (ASQ) is a recently developed technique widely used for detecting liver fibrosis. Ultrasound Nakagami parametric imaging based on the Nakagami distribution has been widely used to model echo amplitude distribution for tissue characterization. We explored the feasibility of using ultrasound Nakagami imaging as a model-based ASQ technique for assessing liver fibrosis. Standard ultrasound examinations were performed on 19 healthy volunteers and 91 patients with chronic hepatitis B and C (n = 110). Liver biopsy and ultrasound Nakagami imaging analysis were conducted to compare the METAVIR score and Nakagami parameter. The diagnostic value of ultrasound Nakagami imaging was evaluated using receiver operating characteristic (ROC) curves. The Nakagami parameter obtained through ultrasound Nakagami imaging decreased with an increase in the METAVIR score (p < 0.0001), representing an increase in the extent of pre-Rayleigh statistics for echo amplitude distribution. The area under the ROC curve (AUROC) was 0.88 for the diagnosis of any degree of fibrosis (≥F1), whereas it was 0.84, 0.69, and 0.67 for ≥F2, ≥F3, and ≥F4, respectively. Ultrasound Nakagami imaging is a model-based ASQ technique that can be beneficial for the clinical diagnosis of early liver fibrosis.
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Affiliation(s)
- Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsiu Lin
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chiao-Yin Wang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Yang Ma
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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31
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Ma HY, Lin YH, Wang CY, Chen CN, Ho MC, Tsui PH. Ultrasound window-modulated compounding Nakagami imaging: Resolution improvement and computational acceleration for liver characterization. ULTRASONICS 2016; 70:18-28. [PMID: 27125557 DOI: 10.1016/j.ultras.2016.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/16/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
Ultrasound Nakagami imaging is an attractive method for visualizing changes in envelope statistics. Window-modulated compounding (WMC) Nakagami imaging was reported to improve image smoothness. The sliding window technique is typically used for constructing ultrasound parametric and Nakagami images. Using a large window overlap ratio may improve the WMC Nakagami image resolution but reduces computational efficiency. Therefore, the objectives of this study include: (i) exploring the effects of the window overlap ratio on the resolution and smoothness of WMC Nakagami images; (ii) proposing a fast algorithm that is based on the convolution operator (FACO) to accelerate WMC Nakagami imaging. Computer simulations and preliminary clinical tests on liver fibrosis samples (n=48) were performed to validate the FACO-based WMC Nakagami imaging. The results demonstrated that the width of the autocorrelation function and the parameter distribution of the WMC Nakagami image reduce with the increase in the window overlap ratio. One-pixel shifting (i.e., sliding the window on the image data in steps of one pixel for parametric imaging) as the maximum overlap ratio significantly improves the WMC Nakagami image quality. Concurrently, the proposed FACO method combined with a computational platform that optimizes the matrix computation can accelerate WMC Nakagami imaging, allowing the detection of liver fibrosis-induced changes in envelope statistics. FACO-accelerated WMC Nakagami imaging is a new-generation Nakagami imaging technique with an improved image quality and fast computation.
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Affiliation(s)
- Hsiang-Yang Ma
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsiu Lin
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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