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Published in: European Radiology 4/2020

01-04-2020 | Ultrasound | Gastrointestinal

Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort

Authors: Marco Dioguardi Burgio, Maxime Ronot, Edouard Reizine, Pierre-Emmanuel Rautou, Laurent Castera, Valérie Paradis, Philippe Garteiser, Bernard Van Beers, Valérie Vilgrain

Published in: European Radiology | Issue 4/2020

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Abstract

Objectives

To prospectively assess the role of the US attenuation imaging coefficient (AC) for the diagnosis and quantification of hepatic steatosis.

Methods

One hundred and one patients underwent liver biopsy and US-AC measurement on the same day. Liver steatosis was graded according to biopsy as absent (S0 < 5%), mild (S1 5–33%), moderate (S2 33–66%), or severe (S3 > 66%); liver fibrosis was graded from F0 to F4. The correlation between AC and steatosis on pathology (%) was calculated using the Pearson correlation coefficient. The Student t or Mann–Whitney U test was used to compare continuous variables and ROC curve analysis was used to assess diagnostic performance of AC in diagnosing steatosis.

Results

Overall, 43 (42%), 35 (35%), 12 (12%), and 11 (11%) patients were classified as S0, S1, S2, and S3, respectively. The AC was positively correlated with steatosis as a continuous variable (%) on pathology (r = 0.58, p < 0.01). Patients with steatosis of any grade had a higher AC than those without steatosis (mean 0.77 ± 0.13 vs. 0.63 ± 0.09 dB/cm/MHz, respectively; p < 0.01, AUROC = 0.805). Patients with S2–S3 had a higher AC than patients with S0–1 (0.85 ± 0.11 vs. 0.67 ± 0.11 dB/cm/MHz, respectively; p < 0.01, AUROC = 0.892). AC > 0.69 dB/cm/MHz had a sensitivity and specificity of 76% and 86%, respectively, for diagnosing any grade of steatosis (S1–S3), and AC > 0.72 dB/cm/MHz had a sensitivity and specificity of 96% and 74%, respectively, for diagnosing S2–S3. The presence of advanced fibrosis (F3–F4) did not affect the calculated AC.

Conclusions

The attenuation imaging coefficient is a promising quantitative technique for the non-invasive diagnosis and quantification of hepatic steatosis.

Key Points

• Measurement of the attenuation coefficient is achieved with a very high rate of technical success.
• We found a significant positive correlation between the attenuation coefficient and the grade of steatosis on pathology.
• The attenuation imaging coefficient is a promising quantitative technique for the noninvasive diagnosis and quantification of hepatic steatosis.
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Literature
1.
go back to reference European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO) (2016) EASLEASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 64:1388–1402 European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO) (2016) EASLEASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 64:1388–1402
2.
go back to reference Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395CrossRef Browning JD, Szczepaniak LS, Dobbins R et al (2004) Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 40:1387–1395CrossRef
3.
go back to reference Vernon G, Baranova A, Younossi ZM (2011) Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34:274–285CrossRef Vernon G, Baranova A, Younossi ZM (2011) Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34:274–285CrossRef
4.
go back to reference Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M (2016) Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64:73–84CrossRef Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M (2016) Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 64:73–84CrossRef
5.
go back to reference Bellentani S, Bedogni G, Miglioli L, Tiribelli C (2004) The epidemiology of fatty liver. Eur J Gastroenterol Hepatol 16:1087–1093CrossRef Bellentani S, Bedogni G, Miglioli L, Tiribelli C (2004) The epidemiology of fatty liver. Eur J Gastroenterol Hepatol 16:1087–1093CrossRef
6.
go back to reference Ballestri S, Zona S, Targher G et al (2016) Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis. J Gastroenterol Hepatol 31:936–944CrossRef Ballestri S, Zona S, Targher G et al (2016) Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta-analysis. J Gastroenterol Hepatol 31:936–944CrossRef
7.
go back to reference Adinolfi LE, Gambardella M, Andreana A, Tripodi MF, Utili R, Ruggiero G (2001) Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity. Hepatology 33:1358–1364CrossRef Adinolfi LE, Gambardella M, Andreana A, Tripodi MF, Utili R, Ruggiero G (2001) Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific HCV genotype and visceral obesity. Hepatology 33:1358–1364CrossRef
8.
go back to reference McCormack L, Petrowsky H, Jochum W, Furrer K, Clavien PA (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930CrossRef McCormack L, Petrowsky H, Jochum W, Furrer K, Clavien PA (2007) Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg 245:923–930CrossRef
9.
go back to reference d’Assignies G, Fayard C, Leitao H et al (2016) Liver steatosis assessed by preoperative MRI: an independent risk factor for severe complications after major hepatic resection. Surgery 159:1050–1057CrossRef d’Assignies G, Fayard C, Leitao H et al (2016) Liver steatosis assessed by preoperative MRI: an independent risk factor for severe complications after major hepatic resection. Surgery 159:1050–1057CrossRef
10.
go back to reference Koneru B, Dikdan G (2002) Hepatic steatosis and liver transplantation current clinical and experimental perspectives. Transplantation 73:325–330CrossRef Koneru B, Dikdan G (2002) Hepatic steatosis and liver transplantation current clinical and experimental perspectives. Transplantation 73:325–330CrossRef
11.
go back to reference Palmentieri B, de Sio I, La Mura V et al (2006) The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis. Dig Liver Dis 38:485–489CrossRef Palmentieri B, de Sio I, La Mura V et al (2006) The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis. Dig Liver Dis 38:485–489CrossRef
12.
go back to reference Bohte AE, van Werven JR, Bipat S, Stoker J (2011) The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol 21:87–97CrossRef Bohte AE, van Werven JR, Bipat S, Stoker J (2011) The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol 21:87–97CrossRef
13.
go back to reference Sasso M, Beaugrand M, de Ledinghen V et al (2010) Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol 36:1825–1835CrossRef Sasso M, Beaugrand M, de Ledinghen V et al (2010) Controlled attenuation parameter (CAP): a novel VCTE guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol 36:1825–1835CrossRef
14.
go back to reference de Ledinghen V, Vergniol J, Capdepont M et al (2014) Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 60:1026–1031CrossRef de Ledinghen V, Vergniol J, Capdepont M et al (2014) Controlled attenuation parameter (CAP) for the diagnosis of steatosis: a prospective study of 5323 examinations. J Hepatol 60:1026–1031CrossRef
15.
go back to reference Tada T, Kumada T, Toyoda H et al (2019) Utility of attenuation coefficient measurement using an ultrasound-guided attenuation parameter for evaluation of hepatic steatosis: comparison with MRI-determined proton density fat fraction. AJR Am J Roentgenol 212:332–341CrossRef Tada T, Kumada T, Toyoda H et al (2019) Utility of attenuation coefficient measurement using an ultrasound-guided attenuation parameter for evaluation of hepatic steatosis: comparison with MRI-determined proton density fat fraction. AJR Am J Roentgenol 212:332–341CrossRef
17.
go back to reference Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474CrossRef Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474CrossRef
18.
go back to reference Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457CrossRef Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457CrossRef
19.
go back to reference Hamaguchi M, Kojima T, Itoh Y et al (2007) The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol 102:2708–2715CrossRef Hamaguchi M, Kojima T, Itoh Y et al (2007) The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol 102:2708–2715CrossRef
20.
go back to reference Ballestri S, Lonardo A, Romagnoli D et al (2012) Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int 32:1242–1252CrossRef Ballestri S, Lonardo A, Romagnoli D et al (2012) Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int 32:1242–1252CrossRef
21.
go back to reference Fishbein M, Castro F, Cheruku S et al (2005) Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 39:619–625CrossRef Fishbein M, Castro F, Cheruku S et al (2005) Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound. J Clin Gastroenterol 39:619–625CrossRef
22.
go back to reference Stern C, Castera L (2017) Non-invasive diagnosis of hepatic steatosis. Hepatol Int 11:70–78CrossRef Stern C, Castera L (2017) Non-invasive diagnosis of hepatic steatosis. Hepatol Int 11:70–78CrossRef
23.
go back to reference Strauss S, Gavish E, Gottlieb P, Katsnelson L (2007) Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR Am J Roentgenol 189:W320–W323CrossRef Strauss S, Gavish E, Gottlieb P, Katsnelson L (2007) Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR Am J Roentgenol 189:W320–W323CrossRef
24.
go back to reference Friedrich-Rust M, Ong MF, Martens S et al (2008) Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 134:960–974CrossRef Friedrich-Rust M, Ong MF, Martens S et al (2008) Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology 134:960–974CrossRef
25.
go back to reference Suh CH, Kim SY, Kim KW et al (2014) Determination of normal hepatic elasticity by using real-time shear-wave elastography. Radiology 271:895–900CrossRef Suh CH, Kim SY, Kim KW et al (2014) Determination of normal hepatic elasticity by using real-time shear-wave elastography. Radiology 271:895–900CrossRef
26.
go back to reference Karlas T, Petroff D, Sasso M et al (2017) Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 66:1022–1030CrossRef Karlas T, Petroff D, Sasso M et al (2017) Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol 66:1022–1030CrossRef
27.
go back to reference Shi KQ, Tang JZ, Zhu XL et al (2014) Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: a meta-analysis of diagnostic accuracy. J Gastroenterol Hepatol 29:1149–1158CrossRef Shi KQ, Tang JZ, Zhu XL et al (2014) Controlled attenuation parameter for the detection of steatosis severity in chronic liver disease: a meta-analysis of diagnostic accuracy. J Gastroenterol Hepatol 29:1149–1158CrossRef
28.
go back to reference Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906CrossRef Ratziu V, Charlotte F, Heurtier A et al (2005) Sampling variability of liver biopsy in nonalcoholic fatty liver disease. Gastroenterology 128:1898–1906CrossRef
Metadata
Title
Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort
Authors
Marco Dioguardi Burgio
Maxime Ronot
Edouard Reizine
Pierre-Emmanuel Rautou
Laurent Castera
Valérie Paradis
Philippe Garteiser
Bernard Van Beers
Valérie Vilgrain
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06480-6

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