Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy

Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Ultrasound-based transient elastography (TE) or TE of the liver is a noninvasive tool for effectively evaluating liver stiffness and fibrosis. The study aimed to compare the accuracy of TE as assessed by Fibroscan with liver biopsy in staging fibrosis in patients with NAFLD. Consecutive NAFLD patients (N = 72) were prospectively enrolled. TE evaluation was performed with Fibroscan and compared with liver biopsy, which is a reference standard. Fibrosis was staged according to the METAVIR scoring system (Meta-analysis of Histological Data in Viral Hepatitis). TE scores and biopsy-related fibrosis stages were correlated. Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of TE was evaluated. Data were analyzed using software R v3.6.3. Liver biopsy showed that 36.11% of patients did not exhibit fibrosis, whereas 25, 16.67, 15.28, and 6.94% of patients had stage F1 (por-tal/mild fibrosis), F2 (periportal/moderate fibrosis), F3 (bridging/severe fibrosis), and F4 (cirrhosis/advanced fibrosis), respectively. TE showed that 50% of patients had cirrhosis, whereas 20.83,15.28, and 13.86% of patients had mild, moderate, and severe fibrosis, respectively. TE had 71% accuracy, 89% sensitivity, and 38% specificity in diagnosing the severity of fibrosis. Hence, it can be implemented as a noninvasive alternative diagnostic tool for understanding the severity of fibrosis in patients with NAFLD. Moreover, it can also be used for quick early diagnosis of NAFLD, reliable staging of fibrosis, and understanding the need for liver transplantation in patients with NAFLD.

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Prevalence of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Among a Largely Middle-Aged Population Utilizing Ultrasound and Liver Biopsy: A Prospective Study

Gastroenterology ◽

10.1053/j.gastro.2010.09.038 ◽

2011 ◽

Vol 140 (1) ◽

pp. 124-131 ◽

Cited By ~ 1210

Author(s):

Christopher D. Williams ◽

Joel Stengel ◽

Michael I. Asike ◽

Dawn M. Torres ◽

Janet Shaw ◽

...

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Prospective Study ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Nonalcoholic Steatohepatitis ◽

Fatty Liver Disease ◽

Nonalcoholic Fatty Liver ◽

Aged Population ◽

A Prospective Study

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Editorial for “Assessment of Imaging Modalities Against Liver Biopsy in Nonalcoholic Fatty Liver Disease: The Amsterdam NAFLD‐NASH Cohort”

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.27808 ◽

2021 ◽

Author(s):

Paul D. Hockings ◽

Ferenc E. Mózes ◽

Michael Pavlides

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Imaging Modalities ◽

Nonalcoholic Fatty Liver

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Elevated Th22 cells correlated with Th17 cells in patients with high liver stiffness in nonalcoholic fatty liver disease

European Journal of Inflammation ◽

10.1177/2058739218802678 ◽

2018 ◽

Vol 16 ◽

pp. 205873921880267 ◽

Cited By ~ 2

Author(s):

Si-Biao Su ◽

Wen Chen ◽

Fei-Fei Huang ◽

Jian-Feng Zhang

Keyword(s):

Flow Cytometry ◽

Liver Disease ◽

Plasma Level ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Th17 Cells ◽

Liver Stiffness ◽

Nonalcoholic Fatty Liver ◽

Th22 Cells

The aims of this article are to investigate the effects of Th22 and Th17 cells and plasma cytokines in patients with nonalcoholic fatty liver disease (NAFLD) and to examine the correlation between Th22 and Th17 cells levels and disease progression. Blood samples from 70 patients with NAFLD and 26 healthy controls (HCs) were collected. Flow cytometry and enzyme-linked immunosorbent assay (ELISA) analysis were performed. ELISA revealed interleukin (IL)-22 plasma level in FibroScan subgroup patients was 2.2-fold higher than that in the HCs ( P < 0.01), body mass index (BMI) subgroup patients were 2.3-fold higher than HCs ( P < 0.01), IL-17A plasma level was 5.6-fold higher in FibroScan subgroup patients than that in the HCs ( P < 0.01), and 5.8-fold higher in BMI subgroup than HCs ( P < 0.01). Flow cytometry revealed median proportions of Th22 cells in FibroScan group was greater than that in the HCs (3.85% vs 0.86%; P < 0.001). Similar results were obtained for Th17 cells (6.36% vs 0.9%; P < 0.001). The liver stiffness measurement value was highly correlated with the proportion of Th17 and Th22 cells and moderately correlated with the plasma level of IL-17A, IL-22, and the BMI value. In conclusion, the elevated proportions of Th17 and Th22 cells were significantly correlated with the degree of liver cirrhosis in NAFLD patients. They may play an inflammatory and immune response role in progression from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) or fibrosis.

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Diagnosis and Evaluation of Nonalcoholic Fatty Liver Disease

Experimental Diabetes Research ◽

10.1155/2012/145754 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 105

Author(s):

Mikako Obika ◽

Hirofumi Noguchi

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Liver Function Tests ◽

Adverse Outcomes ◽

Noninvasive Methods ◽

Nonalcoholic Fatty Liver

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver function tests results, after the commonly investigated causes have been excluded, and frequently coexists with type 2 diabetes mellitus (T2DM) because the conditions have common risk factors. As both T2DM and NAFLD are related to adverse outcomes of the other, diagnosis and valuation of fatty liver is an important part of the management of diabetes. Although noninvasive methods, such as biomarkers, panel markers, and imaging, may support a diagnostic evaluation of NAFLD patients, accurate histopathological findings cannot be achieved without a liver biopsy. As it is important to know whether steatohepatitis and liver fibrosis are present for the management of NAFLD, liver biopsy remains the gold standard for NAFLD diagnosis and evaluation. Therefore, new investigations of the pathogenesis of NAFLD are necessary to develop useful biomarkers that could provide a reliable noninvasive alternative to liver biopsy.

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Influence of liver stiffness heterogeneity on staging fibrosis in patients with nonalcoholic fatty liver disease

Hepatology ◽

10.1002/hep.32302 ◽

2021 ◽

Author(s):

Nobuyoshi Kawamura ◽

Kento Imajo ◽

Kyle J. Kalutkiewicz ◽

Koki Nagai ◽

Michihiro Iwaki ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Liver Stiffness ◽

Nonalcoholic Fatty Liver

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The Utility of Xenon-133 Liver Scan in the Diagnosis and Management of Nonalcoholic Fatty Liver Disease

Canadian Journal of Gastroenterology ◽

10.1155/2012/796313 ◽

2012 ◽

Vol 26 (3) ◽

pp. 155-159 ◽

Cited By ~ 5

Author(s):

Said A Al-Busafi ◽

Peter Ghali ◽

Philip Wong ◽

Javier A Novales-Diaz ◽

Marc Deschênes

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Common Condition ◽

Nonalcoholic Fatty Liver ◽

Liver Scan ◽

Xenon 133 ◽

Liver Scanning

Nonalcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver damage and is the most common cause of chronic liver diseases in Western countries. Although a relatively common condition affecting approximately 20% of the general population, NAFLD is especially prevalent in obese individuals, a figure likely to rise as obesity rates in Western countries continue to increase. Liver biopsy remains the gold standard diagnostic method; however, its invasive nature, among other factors, has prompted the need to develop less invasive, alternative methods to quantify hepatic fat and determine disease severity. Xenon-133 liver scanning is one such method that has been in use for more than 10 years in the evaluation of patients with suspected NAFLD. This study compared Xenon-133 liver scan with other currently used, invasive and noninvasive methods of liver assessment.BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an important and common condition affecting approximately 20% of the general population. Given the limitation of radiological investigations, diagnosis often requires a liver biopsy.OBJECTIVE: To compare Xenon-133 (Xe-133) liver scanning with ultrasonography in the diagnosis of NAFLD.METHODS: From January 2003 to February 2007, 258 consecutive patients with suspected NAFLD underwent Xe-133 liver scanning at Royal Victoria Hospital (Montreal, Quebec). Of these, 43 patients underwent ultrasonography and liver biopsy for the evaluation of NAFLD. Patients with other liver diseases and significant alcohol consumption were excluded. Two nuclear medicine physicians assessed liver Xe-133 uptake and measured the grade of steatosis using a standardized protocol. The degree of steatosis was determined from biopsy specimens assessed by two hepatopathologists.RESULTS: NAFLD was identified by liver biopsy in 35 of 43 patients (81.4%). Xe-133 scan demonstrated 94.3% sensitivity (95% CI 81.4% to 98.4%) and 87.5% specificity (95% CI 52.9% to 99.4%) for the presence of NAFLD. The positive and negative predictive values for detection of steatosis by Xe-133 scan were 97.1% (95% CI 85.1% to 99.8%) and 77.8% (95% CI 45.3% to 93.7%), respectively. The positive and negative likelihood ratios were 7.54 (95% CI 1.20 to 47.26) and 0.07 (95% CI 0.02 to 0.26), respectively. Two patients with NAFLD (5.7%) who had a negative Xe-133 scan result had histologically mild steatosis (<10%). The grade of steatosis on liver biopsy was highly correlated with the results of the Xe-133 scan (r=0.87; P<0.001). The sensitivity and specificity of ultrasound in diagnosing steatosis were 62.9% and 75%, respectively.CONCLUSION: Xe-133 liver scan proved to be a safe, reliable, non-invasive method for diagnosing and quantifying hepatic steatosis, and was superior to ultrasound.

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Nonalcoholic Fatty Liver Disease: An Update on the Diagnosis

Gene Expression ◽

10.3727/105221619x15553433838609 ◽

2019 ◽

Vol 19 (3) ◽

pp. 187-198 ◽

Cited By ~ 3

Author(s):

Jia-Zhen Zhang ◽

Jing-Jing Cai ◽

Yao Yu ◽

Zhi-Gang She ◽

Hongliang Li

Keyword(s):

Liver Disease ◽

Liver Biopsy ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Current Status ◽

Imaging Biomarkers ◽

Nonalcoholic Fatty Liver ◽

Advantages And Disadvantages ◽

Diagnostic Approaches

Nonalcoholic fatty liver disease (NAFLD) is a common liver disease and a major cause of related complications such as cirrhosis and hepatocellular carcinoma (HCC). NAFLD progresses through the stages of simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and HCC. However, NAFLD usually cannot be diagnosed in a timely manner, which is largely attributed to the asymptomatic features of NAFLD patients and the lack of an effective and accurate noninvasive screening approach. Although liver biopsy has been recognized as a gold standard for diagnosing NAFLD, this approach is not suitable for screening and monitoring NAFLD because of its high cost and invasiveness. Several noninvasive screening and diagnostic systemic assessments have been developed in recent years for NAFLD evaluation. Here we summarize the current status and methods for NAFLD diagnosis, including both noninvasive (imaging, biomarkers) and invasive (liver biopsy) assessments. We further discuss the advantages and disadvantages of these developed diagnostic approaches for NAFLD.

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