Liver biopsy may facilitate pancreatic graft evaluation: Positive association between liver steatosis and pancreatic graft adipose infiltration

Detection of liver fibrosis and steatosis at early stages is a difficult task for clinical practice, due to the lack of early signs in routine radiation diagnostics. Aim. To evaluate the efficacy of ultrasound shear elastography and ultrasound steatometry of the liver with the use of domestic ultrasonic diagnostic system Angiodin-Sono/N-Ultra. Materials and methods. 264 people held ultrasound elastography and ultrasound steatometry. 38 patients underwent percutaneous puncture liver biopsy and subsequent pathophysiological examination. Results. High correlation of fibrosis obtained at the Angiodin-Sono/N-Ultra and the leading ultrasonic systems with shear elastography was revealed. Cross-sectional comparative analysis of elasticity with the results of liver steatometry was conducted. Conclusions. Results obtained in all groups correlate with the data obtained in studies on Fibroscan. When working with system Angiodin we got a simultaneous comparative analysis of elasticity with the results of liver steatosis. Results appear to be much more stable and compact than those obtained in studies on the Fibroscan. A new diagnostic criterion was revealed the phenomenon of independence of fibrosis and steatosis indices.

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Application of artificial intelligence in chronic liver diseases: a systematic review and meta-analysis

BMC Gastroenterology ◽

10.1186/s12876-020-01585-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pakanat Decharatanachart ◽

Roongruedee Chaiteerakij ◽

Thodsawit Tiyarattanachai ◽

Sombat Treeprasertsuk

Keyword(s):

Artificial Intelligence ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Predictive Value ◽

Characteristic Curve ◽

Liver Steatosis ◽

Diagnostic Tools ◽

Summary Receiver Operating Characteristic ◽

Subgroup Analyses ◽

Sensitivity Specificity

Abstract Background The gold standard for the diagnosis of liver fibrosis and nonalcoholic fatty liver disease (NAFLD) is liver biopsy. Various noninvasive modalities, e.g., ultrasonography, elastography and clinical predictive scores, have been used as alternatives to liver biopsy, with limited performance. Recently, artificial intelligence (AI) models have been developed and integrated into noninvasive diagnostic tools to improve their performance. Methods We systematically searched for studies on AI-assisted diagnosis of liver fibrosis and NAFLD on MEDLINE, Scopus, Web of Science and Google Scholar. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic odds ratio (DOR) with their 95% confidence intervals (95% CIs) were calculated using a random effects model. A summary receiver operating characteristic curve and the area under the curve was generated to determine the diagnostic accuracy of the AI-assisted system. Subgroup analyses by diagnostic modalities, population and AI classifiers were performed. Results We included 19 studies reporting the performances of AI-assisted ultrasonography, elastrography, computed tomography, magnetic resonance imaging and clinical parameters for the diagnosis of liver fibrosis and steatosis. For the diagnosis of liver fibrosis, the pooled sensitivity, specificity, PPV, NPV and DOR were 0.78 (0.71–0.85), 0.89 (0.81–0.94), 0.72 (0.58–0.83), 0.92 (0.88–0.94) and 31.58 (11.84–84.25), respectively, for cirrhosis; 0.86 (0.80–0.90), 0.87 (0.80–0.92), 0.85 (0.75–0.91), 0.88 (0.82–0.92) and 37.79 (16.01–89.19), respectively; for advanced fibrosis; and 0.86 (0.78–0.92), 0.81 (0.77–0.84), 0.88 (0.80–0.93), 0.77 (0.58–0.89) and 26.79 (14.47–49.62), respectively, for significant fibrosis. Subgroup analyses showed significant differences in performance for the diagnosis of fibrosis among different modalities. The pooled sensitivity, specificity, PPV, NPV and DOR were 0.97 (0.76–1.00), 0.91 (0.78–0.97), 0.95 (0.87–0.98), 0.93 (0.80–0.98) and 191.52 (38.82–944.81), respectively, for the diagnosis of liver steatosis. Conclusions AI-assisted systems have promising potential for the diagnosis of liver fibrosis and NAFLD. Validations of their performances are warranted before implementing these AI-assisted systems in clinical practice. Trial registration: The protocol was registered with PROSPERO (CRD42020183295).

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Diagnostic Value of MRI Proton Density Fat Fraction for Assessing Liver Steatosis in Chronic Viral C Hepatitis

BioMed Research International ◽

10.1155/2015/758164 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 13

Author(s):

Francesco Paparo ◽

Giovanni Cenderello ◽

Matteo Revelli ◽

Lorenzo Bacigalupo ◽

Mariangela Rutigliani ◽

...

Keyword(s):

Liver Biopsy ◽

Diagnostic Accuracy ◽

Hepatic Steatosis ◽

Transient Elastography ◽

Liver Steatosis ◽

Liver Stiffness ◽

Diagnostic Value ◽

Proton Density ◽

Time Interval ◽

Fat Fraction

Objective.To assess the diagnostic performance of a T1-independent, T2*-corrected multiecho magnetic resonance imaging (MRI) technique for the quantification of hepatic steatosis in a cohort of patients affected by chronic viral C hepatitis, using liver biopsy as gold standard.Methods.Eighty-one untreated patients with chronic viral C hepatitis were prospectively enrolled. All included patients underwent MRI, transient elastography, and liver biopsy within a time interval <10 days.Results.Our cohort of 77 patients included 43/77 (55.8%) males and 34/77 (44.2%) females with a mean age of 51.31 ± 11.27 (18–81) years. The median MRI PDFF showed a strong correlation with the histological fat fraction (FF) (r=0.754, 95% CI 0.637 to 0.836,P<0.0001), and the correlation was influenced by neither the liver stiffness nor the T2*decay. The median MRI PDFF result was significantly lower in the F4 subgroup (P<0.05). The diagnostic accuracy of MRI PDFF evaluated by AUC-ROC analysis was 0.926 (95% CI 0.843 to 0.973) forS≥1and 0.929 (95% CI 0.847 to 0.975) forS=2.Conclusions.Our MRI technique of PDFF estimation allowed discriminating with a good diagnostic accuracy between different grades of hepatic steatosis.

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Attenuation Imaging with Ultrasound as a Novel Evaluation Method for Liver Steatosis

Journal of Clinical Medicine ◽

10.3390/jcm10050965 ◽

2021 ◽

Vol 10 (5) ◽

pp. 965

Author(s):

Po-Ke Hsu ◽

Li-Sha Wu ◽

Hsu-Heng Yen ◽

Hsiu Ping Huang ◽

Yang-Yuan Chen ◽

...

Keyword(s):

Liver Biopsy ◽

Confidence Interval ◽

Evaluation Method ◽

Characteristic Curve ◽

Liver Steatosis ◽

Non Invasive ◽

Grade 3 ◽

Attenuation Imaging ◽

Diagnostic Measurement ◽

Retrospective Database

In recent years, ultrasound attenuation imaging (ATI) has emerged as a new method to detect liver steatosis. However, thus far, no studies have confirmed the clinical utility of this technology. Using a retrospective database analysis of 28 patients with chronic liver disease who underwent ultrasound liver biopsy and ATI, we compared the presence and degree of steatosis measured by ATI with the results obtained through liver biopsy. The area under the receiver operating characteristic curve (AUROC) of the ATI for differentiating between normal and hepatic steatosis was 0.97 (95% confidence interval: 0.83–1.00). The AUROC of the ATI was 0.99 (95% confidence interval: 0.86–1.00) in grade ≥2 liver steatosis and 0.97 (95% confidence interval: 0.82–1.00) in grade 3. ATI showed good consistency and accuracy for the steatosis grading of liver biopsy. Therefore, ATI represents a novel diagnostic measurement to support the diagnosis of liver steatosis in non-invasive clinical practice.

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Transient elastography in HIV infected patients with liver steatosis identifies a high risk group for non-alcoholic steatohepatitis

Current HIV Research ◽

10.2174/1570162x19666210225085002 ◽

2021 ◽

Vol 19 ◽

Author(s):

Marina Ferri Pezzini ◽

Hugo Cheinquer ◽

Alexandre de Araujo ◽

Carlos T. Schmidt-Cerski ◽

Eduardo Sprinz ◽

...

Keyword(s):

High Risk ◽

Liver Biopsy ◽

Transient Elastography ◽

Liver Steatosis ◽

Liver Stiffness ◽

High Risk Group ◽

Hiv Viral Load ◽

Significant Fibrosis ◽

Male Sex

Objective: To assess the role of TE in HIV infected patients with NAFLD. Methods: HIV infected patients undergoing ART were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20g/day and co-infection with hepatitis B or C. Patients underwent abdominal US to diagnose liver steatosis. Significant fibrosis (≥F2) was considered when APRI>1.0, FIB4>3 and liver stiffness ≥7.1kPa. Subjects with TE ≥7.1kPa were proposed a liver biopsy and the NAFLD Scoring System ≥3 was considered as diagnosis of NASH. Poisson regression model was used to identify factors associated with liver steatosis. Results: 98 patients were included. Mean age was 49±11 years and 53 (54.1%) were male. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male sex (PR= 2.18) and higher BMI (PR=1.08). Among the 31 patients with NAFLD, 26 had results for TE, APRI and FIB4. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients (26.9%) had a TE result ≥7.1kPa, which was associated with higher triglyceride levels, FIB4 score and CAP values. Six of those with TE ≥7.1kPa performed a liver biopsy and NASH was found in 5 (83.3%) and liver fibrosis without NASH in one. Conclusions: NAFLD prevalence in HIV infected patients is higher than general population. TE ≥7.1kPa was not able to diagnose significant fibrosis, but accurately detect a subgroup of patients with high risk for NASH among HIV monoinfected individuals with steatosis.

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The value of transabdominal ultrasound for assessment of the severity of liver steatosis as compared to liver biopsy

Open Medicine ◽

10.2478/s11536-009-0067-9 ◽

2009 ◽

Vol 4 (4) ◽

pp. 490-495 ◽

Cited By ~ 1

Author(s):

Ioan Sporea ◽

Roxana Şirli ◽

Elena Başa ◽

Maria Cornianu ◽

Alina Popescu ◽

...

Keyword(s):

Chronic Hepatitis ◽

Liver Biopsy ◽

Predictive Value ◽

Gold Standard ◽

Liver Steatosis ◽

Pathological Examination ◽

Transabdominal Ultrasound ◽

Moderate Severity ◽

Ultrasound Evaluation ◽

The Us

AbstractThe purpose of our paper was to evaluate the performance of ultrasound (US) for assessment of the severity of liver steatosis as compared to a pathological examination, which is presently considered to be the gold standard, in patients that have undergone liver biopsy for various reasons. We performed echo-assisted liver biopsy in 161 patients with chronic hepatitis with the US aspect of “bright liver” with “posterior attenuation”, using modified Menghini needles. Following the US examination, the severity of liver steatosis was estimated as minimal, mild, moderate. or severe according to the Hepburn classification: absent (affecting 0% to 2% of the hepatocytes), minimal (2% to 10%), mild (10% to 30%), moderate (30% to 60%), and severe (more than 60% of the hepatocytes). The results of this study showed that the sensitivity of US for the prediction of histological steatosis of at least moderate severity was 0.64, with 0.77 specificity, 0.55 positive predictive value, and 0.94 negative predictive value. The overall accuracy was 0.75. This study showed that the transabdominal ultrasound evaluation of the fatty liver is a quite good predictor, perhaps sufficient for most purposes, for the estimation of the severity of liver steatosis in the moderate to severe range.

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Lysosomal Acid Lipase: Can it be a New Non-Invasive Serum Biomarker of Cryptogenic Liver Fibrosis and Cirrhosis?

Annals of Hepatology ◽

10.5604/01.3001.0012.2118 ◽

2018 ◽

Vol 17 (5) ◽

pp. 0-10

Author(s):

Marta Gravito-Soares ◽

Elisa Gravito-Soares ◽

Dário Gomes ◽

Luis Tomé

Keyword(s):

Liver Fibrosis ◽

Liver Biopsy ◽

Liver Steatosis ◽

Acid Lipase ◽

Cross Sectional ◽

Lysosomal Acid ◽

Significant Fibrosis ◽

Non Invasive ◽

Lysosomal Acid Lipase ◽

Elevated Liver Enzymes

Introduction and aim. The association between lysosomal acid lipase (LAL) activity and liver steatosis or fibrosis is poorly studied. The aim of our study was to determine the predictive power of LAL for cryptogenic liver steatosis and cryptogenic significant fibrosis/ cirrhosis. Material and methods. Cross-sectional observational study of 101 adult patients with unexplained elevated liver enzymes/hepatomegaly with or without dyslipidemia submitted to the determination of LAL activity and LIPA gene (E8SJMC. 894G→A) mutation. Seventy-one patients underwent liver biopsy or FibroScan®. Patients with an identifiable liver dysfunction cause and well-stablished NAFLD/NASH risk factors were excluded. Predictors for liver steatosis, significant fibrosis (≥ F2) or cirrosis (F4) were evaluated. Results. Liver steatosis and fibrosis were mainly assessed by liver biopsy (74.6%; n = 53). Steatosis was present in 62.0% (n = 44), significant fibrosis in 47.9% (n = 34) and cirrhosis in 39.4% (n = 28). The median LAL was 0.36 (0.21-0.46)nmol/spot/h (vs. 0.29 (0.20-0.47); p = 0.558) for liver steatosis, 0.22 (0.11-0.29) nmol/spot/h (vs. 0.40 (0.34-0.51); p < 0.001) for significant fibrosis and 0.21 (0.11-0.27) nmol/spot/h (vs. 0.40 (0.32-0.52); p < 0.001) for cirrhosis. No LIPA gene mutations were found. LAL activity was the strongest predictor of significant fibrosis (AUROC: 0.833; p < 0.001) with a cut-off of 0.265 (sensitivity: 85.9%; specificity: 75.0%) and cirrhosis (AUROC: 0.859; p < 0.001) with a cut-off of 0.235 (sensitivity: 86.2%; specificity: 75.0%), being higher than FIB4, GUCI or APRI. However, LAL activity was not associated with liver steatosis (AUROC: 0.536; p = 0.558). Conclusion. LAL activity can be considered a non-invasive new marker of cryptogenic liver fibrosis with higher accuracy than other known biomarkers. LAL activity < 0.265 nmol/spot/h was strongly associated with cryptogenic significant fibrosis and < 0.235 nmol/spot/h with cryptogenic cirrhosis. LAL activity was not associated with cryptogenic liver steatosis.

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The value of transabdominal ultrasound for the evaluation of the severity of liver steatosis when compared to liver biopsy

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2008-1079739 ◽

2008 ◽

Vol 29 (S 1) ◽

Author(s):

RL Sirli ◽

I Sporea ◽

S Bota ◽

M Cornianu ◽

A Popescu ◽

...

Keyword(s):

Liver Biopsy ◽

Liver Steatosis ◽

Transabdominal Ultrasound

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Predictive Value of Serum Ferritin in Combination with Alanine Aminotransferase and Glucose Levels for Noninvasive Assessment of NAFLD: Fatty Liver in Obesity (FLiO) Study

Diagnostics ◽

10.3390/diagnostics10110917 ◽

2020 ◽

Vol 10 (11) ◽

pp. 917

Author(s):

Cristina Galarregui ◽

Bertha Araceli Marin-Alejandre ◽

Nuria Perez-Diaz-Del-Campo ◽

Irene Cantero ◽

J. Ignacio Monreal ◽

...

Keyword(s):

Fatty Liver ◽

Serum Ferritin ◽

Alanine Aminotransferase ◽

Liver Steatosis ◽

Area Under The Curve ◽

Positive Association ◽

Liver Fat ◽

Liver Iron ◽

Nonalcoholic Fatty Liver ◽

Liver Health

The identification of affordable noninvasive biomarkers for the diagnosis and characterization of nonalcoholic fatty liver disease (NAFLD) is a major challenge for the research community. This study aimed to explore the usefulness of ferritin as a proxy biomarker of NAFLD condition, alone or in combination with other routine biochemical parameters. Subjects with overweight/obesity and ultrasound-confirmed liver steatosis (n = 112) from the Fatty Liver in Obesity (FLiO) study were assessed. The hepatic evaluation considered magnetic resonance imaging, ultrasonography, and credited routine blood liver biomarkers. Anthropometry and body composition, dietary intake (by means of a validated 137-item food frequency questionnaire), and specific biochemical markers were also determined. Serum ferritin levels were analyzed using a chemiluminescent microparticle immunoassay kit. Lower serum ferritin concentrations were associated with general better liver health and nutritional status. The evaluation of ferritin as a surrogate of liver damage by means of quantile regression analyses showed a positive association with alanine aminotransferase (ALT) (β = 19.21; p ≤ 0.001), liver fat content (β = 8.70; p = 0.008), and hepatic iron (β = 3.76; p ≤ 0.001), after adjusting for potential confounders. In receiver operating characteristic (ROC) analyses, the panel combination of blood ferritin, glucose, and ALT showed the best prediction for liver fat mass (area under the curve (AUC) 0.82). A combination of ferritin and ALT showed the higher predictive ability for estimating liver iron content (AUC 0.73). This investigation demonstrated the association of serum ferritin with liver health as well as with glucose and lipid metabolism markers in subjects with NAFLD. Current findings led to the identification of ferritin as a potential noninvasive predictive biomarker of NAFLD, whose surrogate value increased when combined with other routine biochemical measurements (glucose/ALT).

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Ultrasound Stratification of Hepatic Steatosis Using Hepatorenal Index

Diagnostics ◽

10.3390/diagnostics11081443 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1443

Author(s):

Stephen I. Johnson ◽

Daniel Fort ◽

Kenneth J. Shortt ◽

George Therapondos ◽

Gretchen E. Galliano ◽

...

Keyword(s):

Liver Biopsy ◽

Positive Predictive Value ◽

Hepatic Steatosis ◽

Retrospective Review ◽

Predictive Value ◽

Liver Steatosis ◽

Liver Biopsies ◽

Biopsy Methods

Hepatorenal index (HRI) has been shown to be an effective, noninvasive ultrasound tool to screen patients for those with or without >5% hepatic steatosis. Objective: The aim of this study was to further refine this HRI tool in order to stratify patients according to their degree of liver steatosis and give direction as to which patients should undergo random liver biopsy. Methods: We conducted a retrospective review of 267 consecutive patients from 2015 to 2017 who had abdominal ultrasounds and a subsequent random liver biopsy within one month. The HRI was calculated and compared with the percent steatosis as assessed by histology. Results: An HRI of ≤1.17 corresponds with >95% positive predictive value of ≤5% steatosis. Between HRI values 1.18 and 1.39, performance of steatosis prediction is mixed. However, for values <1.37 there is an increased likelihood of steatosis ≤5% and likewise the opposite for values >1.37. An HRI of ≥1.4 corresponds with >95% positive predictive value of ≥10% steatosis. Conclusion: HRI is an accurate noninvasive tool to quantify degree of steatosis and guide who should undergo random liver biopsy, potentially significantly reducing the total number of necessary liver biopsies.

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