Utility of ultrasound-guided attenuation parameter for grading steatosis with reference to MRI-PDFF in a large cohort

Abstract Objective The controlled attenuation parameter (CAP) measured by transient elastography allows for the noninvasive assessment of hepatic steatosis. However, discrepant results between CAP values and histological evaluation have been reported in particular with high CAP values. We therefore investigated the diagnostic validity of high CAP measurements. Methods Forty patients with liver disease and CAP measurements > 300 dB/m that underwent ultrasound-guided or minilaparoscopic liver biopsy were retrospectively enrolled. CAP values were compared with the respective histological and macroscopic evaluation and correlated with clinical parameters. Results CAP values > 300 dB/m had an 87.5 % specificity for detection of hepatic steatosis but failed to discriminate between steatosis grade S1 – S3. Discordant results, defined as a discrepancy of at least 2 steatosis grades between transient elastography and liver biopsy, were observed in 40 % of cases. The interquartile range (IQR) of CAP was confirmed as a predictor of discrepant findings. Macroscopic evaluation as part of minilaparoscopy detected hepatic steatosis in 74 % of patients with histological grade S2 – S3 in contrast to only 10 % classified as histological grade S0 – S1. Conclusion High CAP measurements need to be interpreted with care and with regard to clinical parameters, in particular when high IQR values are registered.

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Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis

PLoS ONE ◽

10.1371/journal.pone.0249493 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249493

Author(s):

Hidekatsu Kuroda ◽

Yudai Fujiwara ◽

Tamami Abe ◽

Tomoaki Nagasawa ◽

Takuma Oguri ◽

...

Keyword(s):

Shear Wave ◽

Attenuation Coefficient ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Two Dimensional ◽

Ultrasound Guided ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Attenuation Parameter ◽

Alcoholic Steatohepatitis

Background and aims We investigated the usefulness of combining two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter for assessing the risk of progressive non-alcoholic steatohepatitis, defined as non-alcoholic steatohepatitis with a non-alcoholic fatty liver disease activity score of ≥4 and a fibrosis stage of ≥2. Methods This prospective study included 202 patients with non-alcoholic fatty liver disease who underwent two-dimensional shear wave elastography, ultrasound-guided attenuation parameter, vibration-controlled transient elastography, the controlled attenuation parameter, and liver biopsy on the same day. Patients were grouped according to liver stiffness measurement using two-dimensional shear wave elastography and the attenuation coefficient, assessed using the ultrasound-guided attenuation parameter: A, low liver stiffness measurement/low attenuation coefficient; B, low liver stiffness measurement/high attenuation coefficient; C, high liver stiffness measurement/low attenuation coefficient; and D, high liver stiffness measurement/high attenuation coefficient. Results Two-dimensional shear wave elastography and vibration-controlled transient elastography had equivalent diagnostic performance for fibrosis. The areas under the curve of the ultrasound-guided attenuation parameter for identifying steatosis grades ≥S1, ≥S2, and S3 were 0.89, 0.91, and 0.92, respectively, which were significantly better than those of the controlled attenuation parameter (P<0.05). The percentages of progressive non-alcoholic steatohepatitis in Groups A, B, C, and D were 0.0%, 7.7%, 35.7%, and 50.0%, respectively (P<0.001). The prediction model was established as logit (p) = 0.5414 × liver stiffness measurement (kPa) + 7.791 × attenuation coefficient (dB/cm/MHz)—8.401, with area under the receiver operating characteristic curve, sensitivity, and specificity values of 0.832, 80.9%, and 74.6%, respectively; there was no significant difference from the FibroScan-aspartate aminotransferase score. Conclusion Combined assessment by two-dimensional shear wave elastography and the ultrasound-guided attenuation parameter is useful for risk stratification of progressive non-alcoholic steatohepatitis and may be convenient for evaluating the necessity of specialist referral and liver biopsy.

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Mo1460 ULTRASOUND-GUIDED ATTENUATION PARAMETER (UGAP) FOR THE QUANTIFICATION OF LIVER STEATOSIS USING CONTROLLED ATTENUATION PARAMETER (CAP) AS THE REFERENCE METHOD

Gastroenterology ◽

10.1016/s0016-5085(20)34196-2 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1411

Author(s):

Felix Bende ◽

Ioan Sporea ◽

Victor Baldea ◽

Alin Lazar ◽

Raluca Lupusoru ◽

...

Keyword(s):

Liver Steatosis ◽

Reference Method ◽

Ultrasound Guided ◽

Controlled Attenuation Parameter ◽

Attenuation Parameter

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Diagnostic accuracy of ultrasound-guided attenuation parameter as a noninvasive test for steatosis in non-alcoholic fatty liver disease

Journal of Medical Ultrasonics ◽

10.1007/s10396-021-01123-0 ◽

2021 ◽

Author(s):

Hidekatsu Kuroda ◽

Tamami Abe ◽

Yudai Fujiwara ◽

Tomoaki Nagasawa ◽

Yasuhiro Takikawa

Keyword(s):

Liver Disease ◽

Diagnostic Accuracy ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Ultrasound Guided ◽

Alcoholic Fatty Liver ◽

Noninvasive Test ◽

Attenuation Parameter ◽

Alcoholic Fatty Liver Disease

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Reproducibility of Ultrasound-Guided Attenuation Parameter (UGAP) to the Noninvasive Evaluation of Hepatic Steatosis

10.21203/rs.3.rs-1064546/v1 ◽

2021 ◽

Author(s):

Yanan Zhao ◽

Minyue Jia ◽

Chao Zhang ◽

Xinxu Feng ◽

Jifan Chen ◽

...

Keyword(s):

Clinical Practice ◽

Hepatic Steatosis ◽

Supine Position ◽

Linear Regression Analysis ◽

Free Breathing ◽

Breath Holding ◽

Multivariate Linear Regression Analysis ◽

Ultrasound Guided ◽

Attenuation Parameter ◽

Significant Difference

Abstract Background and aim The aim of this study was to identify the applicability of an ultrasound-guided attenuation parameter (UGAP) for the noninvasive assessment of hepatic steatosis in clinical practice and to compare its correlation with B-mode ultrasound (US). Methods We enrolled 63 subjects with different body mass index (BMI) grades from May to July 2021. All of the participants fasted for at least 8 hours before the study. UGAP measurements were performed on liver segment V in the supine position during breath holding, free breathing, expiration, and deep inspiration, and in the lateral decubitus position when breath holding and free breathing, and on another segment in the supine position. Then, the participants were measured again 2 hours after a meal. To validate the intraoperator and interoperator agreements, additional measurements were performed in the supine position by the same radiologist A after 15 minutes intervals and by another experienced radiologist B, who was blinded to the results of radiologist A. Finally, the UGAP values were also compared with the visual grades of hepatic steatosis on B-mode US using a 4-point scale method. Results The intraclass correlation (ICC) of the UGAP values between the two radiologists was 0.862 (p<0.001), and the ICCs of the UGAP values on the same day and different days by radiologist A were 0.899 (p<0.001) and 0.910 (p<0.001), respectively. There were no significant differences in UGAP values under different breathing manipulations (p>0.05), positions (p>0.05), or diet statuses (p=0.300). The UGAP values in the fasting (supine position, segment V, 1) condition among the lean (BMI<24 kg/m2), overweight (24 kg/m2≤BMI<28 kg/m2) and obese groups (BMI≥28 kg/m2) were 0.60±0.12, 0.66±0.14, and 0.71±0.11 dB/cm/MHz, respectively, with a significant difference (p=0.006). The correlation coefficients (Rho) between the UGAP values and the visual grades of hepatic steatosis by the two reviewers were 0.845 (p<0.001) and 0.850 (p<0.001), corresponding to a strong relationship. Steatosis grades by reviewer 1 (p=0.036) and reviewer 2 (p=0.003) were significant factors determining the UGAP values according to the multivariate linear regression analysis. Conclusion UGAP demonstrated excellent intraobserver and interobserver reproducibility in the assessment of hepatic steatosis. UGAP may be a promising tool in clinical practice to predict hepatic steatosis.

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Ultrasound-Guided Attenuation Parameter Is Useful for Quantifying Hepatic Steatosis in Nonalcoholic Steatohepatitis

10.21203/rs.3.rs-113530/v1 ◽

2020 ◽

Author(s):

Yu Ogino ◽

Noritaka Wakui ◽

Hidenari Nagai ◽

Yoshinori Igarashi

Keyword(s):

Hepatic Steatosis ◽

Nonalcoholic Steatohepatitis ◽

Operating Characteristic ◽

Liver Fat ◽

Ultrasound Guided ◽

Characteristic Analysis ◽

Liver Fat Content ◽

Nonalcoholic Fatty Liver ◽

Attenuation Parameter ◽

Number Of Patients

Abstract Background: The number of patients with nonalcoholic fatty liver disease has been steadily increasing, and around 10%-20% of these patients are classified as having nonalcoholic steatohepatitis (NASH). The first step to identifying patients with NASH is assessing for hepatic steatosis, which is commonly done noninvasively by ultrasound examination. However, conventional methods are not always effective at lower levels of steatosis. Thus, we sought to determine the utility of a new method using the ultrasound-guided attenuation parameter (UGAP) for quantifying hepatic steatosis in NASH.Methods: Subjects were 36 patients with NASH (20 men, 16 women; mean age 56 [37 to 73] years) who underwent liver biopsy and ultrasonography using a GE LOGIQ E9 system and C1-6 probe at our hospital between 2017 and 2020. B-Mode imaging of segment V in the liver was acquired and echo attenuation was assessed using UGAP. Steatosis score (S0: <5%; S1: 5%-33%; S2: 34%-66%; S3: ≥67%) from liver specimens was compared with the attenuation coefficient (AC; dB/cm/MHz) using UGAP.Results: Steatosis score was S0 in 4 patients, S1 in 16, S2 in 10, and S3 in 6. AC by steatosis score was 0.54 ± 0.06, 0.63 ± 0.05, 0.74 ± 0.05, and 0.79 ± 0.05 dB/cm/MHz for S0, S1, S2, and S3, respectively. AC by UGAP differed significantly between S0 and S2 (p < 0.05), S0 and S3 (p < 0.05), S1 and S2 (p < 0.01), and S1 and S3 (p < 0.01), demonstrating a significant increase with steatosis score. Receiver operating characteristic analysis showed good diagnostic performance of UGAP for patients with steatosis score ≥1, ≥2, and ≥3 (AUROC = 0.95, 0.96, and 0.93, respectively). Liver fat content (%) from liver specimens and AC (r = 0.83, p < 0.01) showed a significant positive correlation.Conclusions: UGAP is useful for quantifying hepatic steatosis in patients with NASH.

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