Development of liver surface nodularity quantification program and its clinical application in nonalcoholic fatty liver disease

Jong-Hyun Ryu,Chang-Won Jeong,Tae-Hoon Kim,Ji Eon Kim

doi:10.1038/s41598-019-46442-y

Jong-Hyun Ryu, Chang-Won Jeong + Show 2 more

Open Access

https://doi.org/10.1038/s41598-019-46442-y

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Journal: Scientific Reports	Publication Date: Jul 10, 2019
Citations: 14	License type: open-access

Affiliation: Wonkwang University Medical Center

Abstract

The liver morphological changes in relation to fibrosis stage in nonalcoholic fatty liver disease (NAFLD) have not yet been clearly understood. This study was to develop a liver surface nodularity (LSN) quantification program and to compare the fibrosis grades in simple steatosis (SS) and nonalcoholic steatohepatitis (NASH). Thirty subjects (7 normal controls [NC], 12 SS and 11 NASH) were studied. LSN quantification procedure was bias correction, boundary detection, segmentation and LSN measurement. LSN scores among three groups and fibrosis grades compared using Kruskal–Wallis H test. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristics (ROC) curve. Mean LSN scores were NC 1.30 ± 0.09, SS 1.54 ± 0.21 and NASH 1.59 ± 0.23 (p = 0.008). Mean LSN scores according to fibrosis grade (F) were F0 1.30 ± 0.09, F1 1.45 ± 0.17 and F2&F3 1.67 ± 0.20 (p = 0.001). The mean LSN score in F2&F3 is significantly higher than that in F1 (p = 0.019). The AUROC curve to distinguish F1 and F2&F3 was 0.788 (95% CI 0.595–0.981, p = 0.019) at a cut-off LSN score greater than 1.48, and its diagnostic accuracy had 0.833 sensitivity and 0.727 specificity. This study developed LSN program and its clinical application demonstrated that the quantitative LSN scores can help to differentially diagnose fibrosis stage in NAFLD.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is clinically ‘silent liver disease’ such as chronic liver disease and most patients with nonalcoholic fatty liver disease (NAFLD) are asymptomatic until development of cirrhosis and hepatic decompensation[1]
Imaging plays a promising role in assessing fibrosis and cirrhosis, with several methods being employed in clinical practice already, ranging from evaluation of liver morphology to elastography[9,10,11,12]
The use of quantitative liver surface nodularity (LSN) to stage liver fibrosis has been applied to CT18,19 and MRI20,21 with different levels of diagnostic accuracy

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is clinically ‘silent liver disease’ such as chronic liver disease and most patients with NAFLD are asymptomatic until development of cirrhosis and hepatic decompensation[1]. Liver biopsy has been regarded as the reference standard for diagnosing hepatic inflammation, fibrosis and cirrhosis in NAFLD This method has well-known weaknesses with the procedure include the invasive approach, sampling errors, inability to assess the severity of cirrhosis, and complications such as pain, bleeding, infection and rarely death[4,5]. In the NAFLD patients with an initial diagnosis of early stage (compensated) fibrosis or cirrhosis, there are currently no validated non-invasive methods for predicting hepatic decompensation. There is an unmet need for widely applicable non-invasive methods to diagnose cirrhosis and advanced liver fibrosis and to predict future risk of hepatic decompensation and death.

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