A prospective comparison of three ultrasound-based techniques in quantitative diagnosis of hepatic steatosis in NAFLD

Yuli Zhu; Haohao Yin; Da Zhou; Qiannan Zhao; Kun Wang; Yunling Fan; Kailing Chen; Hong Han; Huixiong Xu

doi:10.1007/s00261-023-04078-7

A prospective comparison of three ultrasound-based techniques in quantitative diagnosis of hepatic steatosis in NAFLD

Abdom Radiol (NY). 2024 Jan;49(1):81-92. doi: 10.1007/s00261-023-04078-7. Epub 2023 Nov 11.

Authors

Yuli Zhu^#¹, Haohao Yin^#^{1

2

3}, Da Zhou^#⁴, Qiannan Zhao¹, Kun Wang¹, Yunling Fan¹, Kailing Chen¹, Hong Han⁵, Huixiong Xu⁶

Affiliations

¹ Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
² Shanghai Institute of Medical Imaging, Fudan University, Shanghai, 200032, China.
³ Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China.
⁴ Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁵ Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China. han.hong@zs-hospital.sh.cn.
⁶ Department of Ultrasound, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China. xu.huixiong@zs-hospital.sh.cn.

^# Contributed equally.

PMID: 37950767
DOI: 10.1007/s00261-023-04078-7

Abstract

Purpose: To investigate the correlation between different ultrasound attenuation-based techniques and to compare their diagnostic performances using proton magnetic resonance spectroscopy (¹H-MRS) as a reference standard.

Methods: Participants who had clinical suspicion of nonalcoholic fatty liver disease (NAFLD) were prospectively recruited. Each subject had ultrasound with attenuation imaging (ATI) or quantitative ultrasound including tissue attenuation imaging (TAI) and tissue scatter-distribution imaging (TSI), and controlled-attenuation parameter (CAP) and ¹H-MRS if available. The technical success rates, intra-observer repeatabilities of attenuation and backscattering coefficient were evaluated. ATI, TAI and CAP were three attenuation-based techniques. Spearman coefficient was used to test correlations among them and ¹H-MRS. In addition, the diagnostic performances of these parameters for detecting ≥ 5% or 10% hepatic steatosis were evaluated.

Results: 130 participants had ultrasound scanning. Among them, 67 had CAP and 48 had ¹H-MRS. The technical success rates were all 100%. The intra-observer repeatabilities of them were also excellent (ICCs > 0.90) and AC-ATI correlated well with AC-TAI (r = 0.752). AC-ATI, AC-TAI showed moderate correlation with CAP, (r_ATI = 0.623, 95% CI 0.446-0.752, P < 0.001; r_TAI = 0.573, 95% CI 0.377-0.720, P < 0.001). For correlation with ¹H-MRS, ATI and TAI performed better than CAP(r_ATI = 0.587; r_TAI = 0.712; r _CAP = 0.485). The AUCs of ATI, TAI, TSI and CAP for detecting ≥ 5% hepatic steatosis were 0.883, 0.862, 0.870 and 0.868, respectively. The AUC improved to 0.907 when TAI and TSI were combined (P < 0.05). When detecting ≥ 10% hepatic steatosis, the AUCs were 0.855, 0.702, 0.822 and 0.838, respectively.

Conclusion: Different ultrasound attenuation-based techniques were well correlated and exhibited good diagnostic performances in quantitative diagnosis of hepatic steatosis, however, the threshold values were different. Combinations of multiple parameters may improve the diagnostic performance in detecting hepatic steatosis.

Trial registration: The study has been registered online ( https://www.chictr.org.cn ; unique identifier: ChiCTR2300069459).

Keywords: Attenuation coefficient; Hepatic steatosis; Nonalcoholic fatty liver disease; Quantitative ultrasound.

MeSH terms

Elasticity Imaging Techniques* / methods
Humans
Liver / diagnostic imaging
Liver / pathology
Magnetic Resonance Imaging / methods
Non-alcoholic Fatty Liver Disease* / diagnostic imaging
Non-alcoholic Fatty Liver Disease* / pathology
Proton Magnetic Resonance Spectroscopy
Ultrasonography / methods

Abstract

MeSH terms

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