Abstract
To establish a versatile means for screening and management of nonalcoholic steatohepatitis (NASH), shear wave velocity was measured in 20 normal controls and 138 consecutive nonalcoholic fatty liver disease (NAFLD) cases. Referencing biochemical properties in 679 healthy volunteers, a formula to distinguish NASH suspects was established and validated in another cohort of 138 histologically proven NAFLD cases. NASH and simple steatosis (SS) suspects were selected based on a plot of shear wave velocity against age. A formula consisting of five factors (γ-glutamyl transpeptidase, alkaline phosphatase, platelet counts, body mass index, and presence/absence of type 2 diabetes mellitus) distinguished NASH suspects from SS suspects with area under the receiver operating characteristic curve values of 86% and 84% in the development and validation cohorts. Among 25 NAFLD cases in which shear wave velocity was repeatedly measured, 8 and 9 cases revealed an increase or decrease, respectively, of shear wave velocity in the entire liver, and the corresponding change in shear wave velocity was primarily observed in the right lobe or the left lateral segment, respectively. These results suggest that the new formula and sequential shear wave velocity measurements at each segment enable high throughput screening of NASH suspects and noninvasive assessment of pathophysiological alleviation/aggravation in cases of NASH.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is pandemic worldwide [1]
Within the broad spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is the most severe form because of its propensity to progress toward fibrosis of the liver, cirrhosis, and eventually hepatocellular carcinoma [2]
Fibrosis stages were histologically evaluated in 28 virtual touch tissue quantification (VTTQ)+ cases, and VTTQ values for F0 were obtained from Normal, for which no histological evaluation was performed
Summary
Nonalcoholic fatty liver disease (NAFLD) is pandemic worldwide [1]. Within the broad spectrum of NAFLD, nonalcoholic steatohepatitis (NASH) is the most severe form because of its propensity to progress toward fibrosis of the liver, cirrhosis, and eventually hepatocellular carcinoma [2]. A histological evaluation in a biopsy specimen is currently the gold standard to confirm the presence of chronic necroinflammation and to evaluate the pathophysiological extent in NAFLD [3]. It is impractical to conduct liver biopsies in a large population with NAFLD for the diagnosis of NASH and to repeat liver biopsies through the long clinical course of the disease. In the United States and other western countries, the prevalence of NAFLD is estimated to be as high as 30% [4]. There is an urgent need to establish an efficient and practical method to identify NASH suspects in routine medical checkups and to encourage those patients to visit a hospital
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