Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. This study aimed to evaluate the performance of four ultrasound-based techniques for the non-invasive multiparametric (MPUS) assessment of liver fibrosis (LF), steatosis (HS), and inflammation in patients with NAFLD. We included 215 consecutive adult patients with NAFLD (mean age: 54.9 ± 11.7; 54.5% were male), in whom LF, HS, and viscosity were evaluated in the same session using four new ultrasound-based techniques embedded on the Aixplorer MACH 30 system: ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave UltraSound (SSp.PLUS), Attenuation Plane-wave UltraSound (Att.PLUS), and Viscosity Plane-wave UltraSound (Vi.PLUS). Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan) were considered as control. All elastographic measurements were performed according to guidelines. Valid liver stiffness measurements (LSM) were obtained in 98.6% of patients by TE, in 95.8% of patients by 2D-SWE.PLUS/Vi.PLUS, and in 98.1% of patients by Att.PLUS/SSp.PLUS, respectively. Therefore, 204 subjects were included in the final analysis. A strong correlation between LSMs by 2D-SWE.PLUS and TE (r = 0.89) was found. The best 2D-SWE.PLUS cut-off value for the presence of significant fibrosis (F ≥ 2) was 7 kPa. Regarding steatosis, SSp.PLUS correlated better than Att.PLUS with CAP values: (r = −0.74) vs. (r = 0.45). The best SSp.PLUS cut-off value for predicting the presence of significant steatosis was 1524 m/s. The multivariate regression analysis showed that Vi.PLUS values were associated with BMI and LSM by 2D-SWE.PLUS. In conclusion, MPUS was useful for assessing fibrosis, steatosis, and inflammation in a single examination in patients with NAFLD.
Highlights
Non-alcoholic fatty liver disease (NAFLD) was defined as a pathological entity in 1980.It was described as an excessive fat infiltration of the liver in the absence of significant alcohol consumption or other causes of liver disease
Ultrasound-based measurements were performed in all patients, in the same session, using ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave Ultrasound (SSp.PLUS), Attenuation Plane-wave Ultrasound (Att.PLUS), Viscosity Plane-wave Ultrasound (Vi.PLUS) from Aixplorer (Supersonic Imagine, Aix-en-Provence, France), and using Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan, EchoSens, Paris, France)
A total of 215 patients with NAFLD were enrolled in the study and underwent multiparametric measurements
Summary
Non-alcoholic fatty liver disease (NAFLD) was defined as a pathological entity in 1980. It was described as an excessive fat infiltration of the liver in the absence of significant alcohol consumption or other causes of liver disease. NAFLD is the most common chronic liver disease worldwide with an estimated global prevalence of 25%. It became a significant health and economic burden of modern society [1]. The term “metabolicassociated fatty liver disease” (MAFLD) was suggested as a more appropriate substitute for NAFLD [2,3]
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