Assessment Of Hepatic Steatosis Research Articles

Quantitative Evaluation of Hepatic Steatosis Using Normalized Local Variance in a Rat Model: Comparison with Histopathology as the Reference Standard.

ObjectiveTo evaluate the diagnostic performance of the normalized local variance (NLV) ultrasound technique in the assessment of hepatic steatosis, and to identify the factors that influence the NLV value using histopathological examination as the reference standard.Materials and MethodsForty male Sprague-Dawley rats were fed a methionine-choline-deficient diet for variable periods (0, 2, 4, 6, 8, 10, or 12 days or 2, 3, or 4 weeks; four rats per group). At the end of each diet duration, magnetic resonance spectroscopy (MRS) and NLV examination were performed. Thereafter, the rats were sacrificed and their livers were histopathologically evaluated. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic capability of the NLV value in the detection of varying degrees of hepatic steatosis. Univariate and multivariate linear regressions were used to determine the factors associated with the NLV value.ResultsThe areas under the ROC curve for the detection of mild, moderate, and severe hepatic steatosis were 0.953, 0.896, and 0.735, respectively. The NLV value showed comparable diagnostic performance to that of MRS in the detection of ≥ mild or ≥ moderate hepatic steatosis. Multivariate linear regression analysis revealed that the degree of hepatic steatosis was the only significant factor affecting the NLV value (p < 0.001).ConclusionThe NLV value of ultrasound demonstrated satisfactory diagnostic performance in the assessment of varying degrees of hepatic steatosis. The degree of hepatic steatosis was the only significant factor that affected the NLV value.

Assessing hepatic steatosis on ultrasound imaging using deep learning

Purpose To develop a deep learning algorithm which can assess hepatic steatosis Materials and Methods All abdominal ultrasounds from a tertiary centre from January 2013 - November 2017 were reviewed. Studies with known focal hepatobiliary pathology were excluded. Of the 1509 candidate studies, 505 were considered suitable for inclusion. From each study, four ultrasound images of the right lobe of the liver were chosen, two transverse and two longitudinal. Two radiologists and one radiology fellow reviewed each panel of four images and assigned a number of 1 (normal) - 7(severe steatosis). Subsequently, a consensus was agreed upon by all three radiologists, which was used as the gold standard. 2020 images were divided by patients into training, validation and testing sets in a ratio of 8:1:1. Images were scaled to 256 × 256. A modified Densenet model pre-trained upon ImageNet was trained and validated. Quadratic weighted Cohen's Kappa was chosen as the evaluation metric. Results The most common category was two (normal-mild steatosis), with 159 (32%) studies. 17 (3%) were in the least common category which was category seven (severe steatosis). The radiologists achieved a quadratic weighted Cohen's Kappa of 0.82 - 0.95 and the Densenet model achieved a quadratic weighted Cohen's Kappa of 0.87. The most commonly misclassified category amongst the radiologists was three (mild) whilst the most commonly misclassified categories for the Densenet model were tied at three and four (mild, mild-moderate). Conclusions The deep learning algorithm performs similarly to subspecialty trained radiologists in the assessment of hepatic steatosis on ultrasound.

Controlled attenuation parameter does not predict hepatic decompensation in patients with advanced chronic liver disease.

Background & AimsAssessment of hepatic steatosis by transient elastography (TE)‐based controlled attenuation parameter (CAP) might predict hepatic decompensation. Therefore, we aimed to evaluate the prognostic value of CAP in patients with compensated advanced chronic liver disease (cACLD) and decompensated cirrhosis (DC).MethodsA total of 430 patients who underwent TE (liver stiffness ≥10 kPa) and CAP measurements were included in this retrospective analysis. Half of patients (n = 189) underwent simultaneous HVPG measurement. In cACLD patients, first hepatic decompensation was defined by new onset of ascites, hepatic encephalopathy or variceal bleeding. In patients with DC, the following events were considered as further hepatic decompensation: requirement of paracentesis, admission for/development of grade 3/4 hepatic encephalopathy, variceal (re‐)bleeding or liver‐related death.ResultsFirst hepatic decompensation occurred in 25 of 292 (9%) cACLD patients, while 46 of 138 (33%) DC patients developed further hepatic decompensation during a median follow‐up of 22 and 12 months respectively. CAP was not predictive of first (cACLD; per 10 dB/m; hazard ratio [HR]: 0.97, 95% confidence interval [95% CI]: 0.91‐1.03, P = 0.321) or further hepatic decompensation (DC; HR: 0.99, 95% CI: 0.94‐1.03, P = 0.554) in adjusted analysis. Using the well‐established CAP cut‐off of ≥248 dB/m for hepatic steatosis, the incidence of first (cACLD; P = 0.065) and further hepatic decompensation (DC; P = 0.578) was similar in patients with hepatic steatosis or without. Serum albumin levels (per mg/dL; HR: 0.83, 95% CI: 0.77‐0.89, P < 0.001) and MELD‐Na (per point; HR: 1.15, 95% CI: 1.04‐1.28, P = 0.006) in cACLD and MELD‐Na (per point; HR: 1.12, 95% CI: 1.05‐1.19, P < 0.0001) in DC patients were the only parameters independently associated with first and further hepatic decompensation, respectively.ConclusionControlled attenuation parameter does not predict the development of first (cACLD)/further (DC) hepatic decompensation, while serum albumin levels and MELD‐Na are of prognostic value.

Liver intravoxel incoherent motion diffusion-weighted imaging for the assessment of hepatic steatosis and fibrosis in children.

AIMTo evaluate the correlation between intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters and the degree of hepatic steatosis and fibrosis in children.METHODSThis retrospective study was approved by the institutional review board. The children (≤ 18 years) who underwent liver IVIM DWI with 8 b-values under the suspicion of hepatic steatosis or fibrosis from February 2013 to November 2016 were included. Subjects were divided into normal, fatty liver (FAT), and fibrotic liver (FIB) groups. The slow diffusion coefficient (D), fast diffusion coefficient (D*), perfusion fraction (f), and apparent diffusion coefficient (ADC) were measured. MR proton density fat fraction (PDFF), MR elastography (MRE), and IVIM values were compared.RESULTSA total of 123 children (median age of 12 years old, range: 6-18 years) were included, with 8 in the normal group, 93 in the FAT group, and 22 in the FIB group. The D* values were lower in the FIB group compared with those of the normal (P = 0.015) and FAT (P = 0.003) groups. The f values were lower in the FIB group compared with the FAT group (P = 0.001). In multivariate analyses, PDFF value was positively correlated with f value (β = 3.194, P < 0.001), and MRE value was negatively correlated with D* value (β = -7.031, P = 0.032). The D and ADC values were not influenced by PDFF or MRE value.CONCLUSIONIn liver IVIM DWI with multiple b-values in children, there was a positive correlation between hepatic fat and blood volume, and a negative correlation between hepatic stiffness and endovascular blood flow velocity, while diffusion-related parameters were not affected.

Comparison of conventional sonographic signs and magnetic resonance imaging proton density fat fraction for assessment of hepatic steatosis

This study correlated conventional ultrasonography (US) signs with the magnetic resonance imaging (MRI) proton density fat fraction (PDFF) to evaluate the diagnostic performance of US signs (alone or combined) to predict presence and degree of hepatic steatosis (HS). Overall, 182 subjects met the study inclusion criteria between February 2014 and October 2016. Four US signs were evaluated independently by two radiologists. MRI PDFF was defined as the average of 24 non-overlapping regions of interest (ROIs) within eight liver segments obtained by drawing three ROIs within each segment. The latter acted as the reference standard to evaluate diagnostic accuracy of the US signs and their combinations. Diagnostic performance of US for HS was assessed using receiver operating characteristic (ROC) curve analyses. There was a strongly positive correlation between some combinations of US signs and PDFF (σ = 0.780, p < 0.001). The sensitivity, specificity, PPV, and NPV were 96.6%, 74.8%, 64.8%, and 97.9%, respectively, determined using abnormal hepatorenal echoes to detect grade 1 or higher HS (area under the ROC curve = 0.875). The sensitivity and NPV for detecting HS with US were good and US may be considered a suitable screening tool for exclusion of HS.

Feasibility of balanced steady-state free precession sequence at 1.5T for the evaluation of hepatic steatosis in obese children and adolescents.

To determine the feasibility of balanced steady-state free precession (b-SSFP) imaging for measuring hepatic steatosis in obese children and adolescents, using proton magnetic resonance spectroscopy (1H MRS) as reference standard. 182 obese Chinese paediatric patients underwent conventional T1-weighted dual echo MRI, 1H MRS and b-SSFP imaging for non-invasive assessment of hepatic steatosis. There was a strong positive correlation between liver fat fraction (FF) on T1-weighted dual echo MRI and 1H MRS-determined liver fat content (LFC) (r = 0.964, p < .001), and a strong negative correlation between the ratio of liver signal intensity (SI) to spleen SI (L/S) on b-SSFP and LFC (r = -0.896, p < .001). ROC curve analysis based on a diagnostic threshold of 1H MRS-determined LFC >50 mg/g (>5 % by wet weight) showed areas under the curves for FF and L/S at 0.989 (0.976-1.000) and 0.926 (0.888-0.964), respectively. Optimal FF and L/S cut-off values identified patients with hepatic steatosis with 97.9 % and 86.5 % sensitivity and 93.4 % and 93.4 % specificity, respectively. Following further validation, b-SSFP at 1.5T has potential as a feasible technique for evaluation of hepatic steatosis in obese paediatric patients with limited breath-holding capacity. • L/S on b-SSFP images closely correlated with 1 H MRS-determined LFC. • b-SSFP has high diagnostic accuracy for hepatic steatosis in obese children. • 100% of obese paediatric subjects are imaged successfully using b-SSFP sequence. • b-SSFP has potential to evaluate hepatic steatosis in children with poor breath-hold.

Hepatic Steatosis Assessment with Ultrasound Small-Window Entropy Imaging

Nonalcoholic fatty liver disease is a type of hepatic steatosis that is not only associated with critical metabolic risk factors but can also result in advanced liver diseases. Ultrasound parametric imaging, which is based on statistical models, assesses fatty liver changes, using quantitative visualization of hepatic-steatosis–caused variations in the statistical properties of backscattered signals. One constraint with using statistical models in ultrasound imaging is that ultrasound data must conform to the distribution employed. Small-window entropy imaging was recently proposed as a non–model-based parametric imaging technique with physical meanings of backscattered statistics. In this study, we explored the feasibility of using small-window entropy imaging in the assessment of fatty liver disease and evaluated its performance through comparisons with parametric imaging based on the Nakagami distribution model (currently the most frequently used statistical model). Liver donors (n = 53) and patients (n = 142) were recruited to evaluate hepatic fat fractions (HFFs), using magnetic resonance spectroscopy and to evaluate the stages of fatty liver disease (normal, mild, moderate and severe), using liver biopsy with histopathology. Livers were scanned using a 3-MHz ultrasound to construct B-mode, small-window entropy and Nakagami images to correlate with HFF analyses and fatty liver stages. The diagnostic values of the imaging methods were evaluated using receiver operating characteristic curves. The results demonstrated that the entropy value obtained using small-window entropy imaging correlated well with log10(HFF), with a correlation coefficient r = 0.74, which was higher than those obtained for the B-scan and Nakagami images. Moreover, small-window entropy imaging also resulted in the highest area under the receiver operating characteristic curve (0.80 for stages equal to or more severe than mild; 0.90 for equal to or more severe than moderate; 0.89 for severe), which indicated that non–model-based entropy imaging—using the small-window technique—performs more favorably than other techniques in fatty liver assessment.

Controlled Attenuation Parameter for Assessment of Hepatic Steatosis in Indian Patients

The gold standard method for measurement of hepatic steatosis is liver histology. Controlled Attenuation Parameter (CAP) can measure hepatic steatosis non-invasively. We aimed to assess the accuracy of CAP for detection of hepatic steatosis. A total of 462 patients (May 2012-January 2017)-89 non-alcoholic fatty liver disease, 182 chronic hepatitis B, 88 chronic hepatitis C and 103 patients with other etiologies who underwent simultaneous liver biopsy and CAP estimation using Transient Elastography (TE) were included. Steatosis was graded as S0: steatosis in 0-5% of hepatocytes, S1: 6-33%, S2: 34-66% and S3: 67-100%. Receiver Operating Characteristic (ROC) curves were plotted to evaluate the accuracy of CAP in detecting hepatic steatosis. Predictors of CAP were assessed by multivariate linear regression model. The mean age±SD was 33.8±11.6 years; 296 (64.1%) were males. On liver histology, steatosis grades S0, S1, S2 and S3 were seen in 331 (71.6%), 74 (16.0%), 39 (8.4%) and 18 (3.9%), respectively. The median CAP (IQR) values for S0, S1, S2, and S3 steatosis were 206 (176-252) dB/m, 295 (257-331) dB/m, 320 (296-356) dB/m, and 349 (306-363) dB/m, respectively. For estimation of ≥S1, ≥S2, and ≥S3 using CAP, AUROC were 0.879, 0.893, and 0.883, respectively. In multivariate analysis, only BMI (OR 1.18; CI, 1.11-1.26, P<0.001) and grade of hepatic steatosis (grade 1, OR, 3.94; 95% CI, 1.58-9.84, P=0.003; grade 2, OR 42.04; 95% CI, 4.97-355.31, P=0.001 and grade 3, OR 35.83; 95% CI 4.31-297.61, P=0.001) independently predicted CAP. CAP detects hepatic steatosis with good accuracy in Indian patients with various etiologies.

MEASUREMENT OF CONTROLLED ATTENUATION PARAMETER: A SURROGATE MARKER OF HEPATIC STEATOSIS IN PATIENTS OF NONALCOHOLIC FATTY LIVER DISEASE ON LIFESTYLE MODIFICATION - A PROSPECTIVE FOLLOW-UP STUDY.

Liver biopsy is a gold standard method for hepatic steatosis assessment. However, liver biopsy is an invasive and painful procedure and can cause severe complications therefore it cannot be frequently used in case of follow-up of patients. Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). To evaluate hepatic steatosis, transient elastography with controlled attenuation parameter (CAP) measurement is an option now days. Aim of this study is to evaluate role of measurement of controlled attenuation parameter, a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification. In this study, initially 37 participants were included who were followed up after 6 months with transient elastography, blood biochemical tests and anthropometric measurements. The results were analyzed by Multivariate linear regression analysis and paired samples t-test (Dependent t-test) with 95% confidence interval. Correlation is calculated by Pearson correlation coefficients. Mean CAP value for assessing hepatic steatosis during 1st consultation (278.57±49.13 dB/m) was significantly improved (P=0.03) after 6 months of lifestyle modification (252.91±62.02 dB/m). Only fasting blood sugar (P=0.008), weight (P=0.000), body mass index (BMI) (P=0.000) showed significant positive correlation with CAP. Only BMI (P=0.034) and weight (P=0.035) were the independent predictor of CAP value in NAFLD patients. Lifestyle modification improves the hepatic steatosis, and CAP can be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. There is no relation between CAP and Fibroscan score in NAFLD patients. Only BMI and weight can predict CAP value independently.

Ultrasound parametric imaging of hepatic steatosis using the homodyned-K distribution: An animal study

Hepatic steatosis is an abnormal state where excess lipid mass is accumulated in hepatocyte vesicles. Backscattered ultrasound signals received from the liver contain useful information regarding the degree of steatosis in the liver. The homodyned-K (HK) distribution has been demonstrated as a general model for ultrasound backscattering. The estimator based on the first three integer moments (denoted as “FTM”) of the intensity has potential for practical applications because of its simplicity and low computational complexity. This study explored the diagnostic performance of HK parametric imaging based on the FTM method in the assessment of hepatic steatosis. Phantom experiments were initially conducted using the sliding window technique to determine an appropriate window size length (WSL) for HK parametric imaging. Subsequently, hepatic steatosis was induced in male Wistar rats fed a methionine- and choline-deficient (MCD) diet for 0 (i.e., normal control), 1, 2, 4, 6, and 8 weeks (n = 36; six rats in each group). After completing the scheduled MCD diet, ultrasound B-mode and HK imaging of the rat livers were performed in vivo and histopathological examinations were conducted to score the degree of hepatic steatosis. HK parameters μ (related to scatterer number density) and k (related to scatterer periodicity) were expressed as functions of the steatosis stage in terms of the median and interquartile range (IQR). Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance levels of the μ and k parameters. The results showed that an appropriate WSL for HK parametric imaging is seven times the pulse length of the transducer. The median value of the μ parameter increased monotonically from 0.194 (IQR: 0.18–0.23) to 0.893 (IQR: 0.64–1.04) as the steatosis stage increased. Concurrently, the median value of the k parameter increased from 0.279 (IQR: 0.26–0.31) to 0.5 (IQR: 0.41–0.54) in the early stages (normal to mild) and decreased to 0.39 (IQR: 0.29–0.45) in the advanced stages (moderate to severe). The areas under the ROC curves obtained using (μ, k) were (0.947, 0.804), (0.914, 0.575), and (0.813, 0.604) for the steatosis stages of ≥mild, ≥moderate, and ≥severe, respectively. The current findings suggest that ultrasound HK parametric imaging based on FTM estimation has great potential for future clinical diagnoses of hepatic steatosis.

Performance Evaluations on Using Entropy of Ultrasound Log-Compressed Envelope Images for Hepatic Steatosis Assessment: An In Vivo Animal Study.

Ultrasound B-mode imaging based on log-compressed envelope data has been widely applied to examine hepatic steatosis. Modeling raw backscattered signals returned from the liver parenchyma by using statistical distributions can provide additional information to assist in hepatic steatosis diagnosis. Since raw data are not always available in modern ultrasound systems, information entropy, which is a widely known nonmodel-based approach, may allow ultrasound backscattering analysis using B-scan for assessing hepatic steatosis. In this study, we explored the feasibility of using ultrasound entropy imaging constructed using log-compressed backscattered envelopes for assessing hepatic steatosis. Different stages of hepatic steatosis were induced in male Wistar rats fed with a methionine- and choline-deficient diet for 0 (i.e., normal control) and 1, 1.5, and 2 weeks (n = 48; 12 rats in each group). In vivo scanning of rat livers was performed using a commercial ultrasound machine (Model 3000, Terason, Burlington, MA, USA) equipped with a 7-MHz linear array transducer (Model 10L5, Terason) for ultrasound B-mode and entropy imaging based on uncompressed (HE image) and log-compressed envelopes (HB image), which were subsequently compared with histopathological examinations. Receiver operating characteristic (ROC) curve analysis and areas under the ROC curves (AUC) were used to assess diagnostic performance levels. The results showed that ultrasound entropy imaging can be used to assess hepatic steatosis. The AUCs obtained from HE imaging for diagnosing different steatosis stages were 0.93 (≥mild), 0.89 (≥moderate), and 0.89 (≥severe), respectively. HB imaging produced AUCs ranging from 0.74 (≥mild) to 0.84 (≥severe) as long as a higher number of bins was used to reconstruct the signal histogram for estimating entropy. The results indicated that entropy use enables ultrasound parametric imaging based on log-compressed envelope signals with great potential for diagnosing hepatic steatosis.

Discordance in steatosis classification between liver biopsy and transient elastography for high controlled attenuation parameter (CAP) values.

The controlled attenuation parameter (CAP) measured by transient elastography allows for the noninvasive assessment of hepatic steatosis. However, discrepant results between CAP values and histological evaluation have been reported in particular with high CAP values. We therefore investigated the diagnostic validity of high CAP measurements. Forty patients with liver disease and CAP measurements > 300 dB/m that underwent ultrasound-guided or minilaparoscopic liver biopsy were retrospectively enrolled. CAP values were compared with the respective histological and macroscopic evaluation and correlated with clinical parameters. CAP values > 300 dB/m had an 87.5 % specificity for detection of hepatic steatosis but failed to discriminate between steatosis grade S1 - S3. Discordant results, defined as a discrepancy of at least 2 steatosis grades between transient elastography and liver biopsy, were observed in 40 % of cases. The interquartile range (IQR) of CAP was confirmed as a predictor of discrepant findings. Macroscopic evaluation as part of minilaparoscopy detected hepatic steatosis in 74 % of patients with histological grade S2 - S3 in contrast to only 10 % classified as histological grade S0 - S1. High CAP measurements need to be interpreted with care and with regard to clinical parameters, in particular when high IQR values are registered.

Utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients

BackgroundControlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored. ObjectivesTo assess the utility of CAP for assessment of hepatic steatosis in morbidly obese individuals and evaluate the effect of bariatric surgery on hepatic steatosis and fibrosis. SettingA tertiary care academic hospital. MethodsBaseline details of anthropometric data, laboratory parameters, FibroScan (XL probe), and liver biopsy were collected. Follow-up liver biopsy was done at 1 year. ResultsOf the 124 patients screened, 76 patients were included; mean body mass index was 45.2 ± 7.1 kg/m2. FibroScan success rate was 87.9%. The median liver stiffness measurement (LSM) and CAP were 7.0 (5.0–9.5) kPa and 326.5 (301–360.5) dB/m, respectively. On liver histopathology, severe steatosis and nonalcoholic steatohepatitis were present in 5.3% and 15.8%; significant fibrosis (≥stage 2) and cirrhosis in 39.5% and 2.6%, respectively. Area under receiver operator characteristic curve of LSM for prediction of significant fibrosis (F2–4 versus F0–1) and advanced fibrosis (F3–4 versus F0–2) was .65 (95% confidence interval [CI]: .52–.77) and .83 (95% CI: .72–.94), respectively. The area under receiver operator characteristic curve of CAP for differentiating moderate hepatic steatosis (S2–3 versus S0–1) and severe hepatic steatosis (S3 versus S0–2) was .74 (95% CI: .62–.86) and .82 (95% CI: .73–.91), respectively. At 1-year follow-up, 32 patients underwent liver biopsy. In these patients, there was significant improvement in hepatic steatosis (P = .001), lobular inflammation (P = .033), ballooning (P<.001), and fibrosis (P = .003). Nonalcoholic steatohepatitis was resolved in 3 of 4 (75%) patients. LSM and CAP significantly declined. ConclusionsLSM and CAP are feasible and accurate at diagnosing advanced fibrosis and severe hepatic steatosis in morbidly obese individuals. Bariatric surgery is associated with significant improvement in LSM, CAP, steatohepatitis, and fibrosis.

Gender difference in the impact of gynoid and android fat masses on the progression of hepatic steatosis in Japanese patients with type 2 diabetes

BackgroundIncreased visceral adiposity is strongly associated with non-alcoholic fatty liver disease (NAFLD). However, little attention has been paid to the association between the change in subcutaneous adipose mass and the progression of non-alcoholic fatty liver disease (NAFLD). We aimed to investigate whether increased subcutaneous adipose tissue (gynoid fat mass) could be protective against the progression of NAFLD in Japanese patients with type 2 diabetes.MethodsThis is a retrospective observational study of 294 Japanese patients with type 2 diabetes (65 ± 10 years old, 40% female). Liver attenuation index (LAI) measured by abdominal computed tomography was used for the assessment of hepatic steatosis. Both gynoid (kg) and android (kg) fat masses were measured by the whole body dual-energy X-ray absorptiometry. One-year changes in LAI, gynoid, and android fat masses were evaluated in both male and female patients. Linear regression analysis with a stepwise procedure was used for the statistical analyses to investigate the association of the changes in gynoid and android fat masses with the change in LAI.ResultsLAI levels at baseline were 1.15 ± 0.31 and 1.10 ± 0.34 in female and male patients (p = 0.455). The change in gynoid fat mass was significantly and positively associated with the change in LAI in both univariate (standardized β 0.331, p = 0.049) and multivariate (standardized β 0.360, p = 0.016) models in the female patients. However, no significant association was observed in males. In contrast, the increase in android fat mass was significantly associated with the reduced LAI in both genders in the multivariate models (standardized β −0.651, p < 0.001 in females and standardized β −0.519, p = 0.042 in males).ConclusionsThis study provides evidence that increased gynoid fat mass may be protective against the progression of NAFLD in female Japanese patients with type 2 diabetes.

Epidemiological Profile and Clinical Characteristics of Patients With Hepatitis B Infection

Background and Aim: To describe the demographic and clinical characteristics of patients with hepatitis B. To assess correlation of non invasive methods for assessment of hepatic steatosis (HS) and fibrosis in patients with chronic hepatitis B (CHB). Methods: An observational prospective study of patients referred to the outpatient clinic for evaluation of Hepatitis B. Demographic, laboratory data, clinical presentation, non invasive assessment of fibrosis using fibrosis index based on 4 factor (FIB-4), aspartate aminotransferase to platelet ratio (APRI) and Fibroscan (FS) (502 Echosens) E score. Assessment of hepatic steatosis (HS) using USG and Controlled attenuation parameter (CAP) at time of referral. Results: 175 patients (Male 70% N = 122, Female 30%, N = 53), mean age 41.5 years (range 17–77 years), 6.85% (N = 12/175) had acute hepatitis B infection, leaving 163 patients with CHB. HbeAg was negative in 86.5% (N = 116/134), HBV DNA viral load < 2000 IU/ml in 60% (N = 54/90) and 75% (N = 122/163) had normal transaminases. Presence of concomitant HS identified in 61.5% using CAP score (N = 80/130, S1 = 17, S2 = 33, S3 = 30) mean CAP score 284. On USG, HS detected in 37.8% (N = 101/161). Correlation of fibrosis score using APRI, FIB 4 and FB are tabulated. 13.5% (N = 22/163) patients presented with decompensated cirrhosis (ascites, portal hypertension) and 4.3% (N = 7/163) had hepatocellular carcinoma. Conclusion: There was a male preponderance seen. USG alone will miss HS in significant proportion of patients with CHB. The degree of agreement on stage of fibrosis using non invasive markers of fibrosis was good in patients with F4. Presence of HS may influence the degree of fibrosis (Table 1).Table 1Correlation of Degree of Fibrosis Using Noninvasive Markers.FIB-4 (N = 161)APRI (N = 161)Fibroscan (N = 130)Fibroscan (no steatosis N = 50)Fibroscan (steatosis N = 80F0–F1118136803050F2–F3289341222F415161679 Open table in a new tab The author has none to declare.

Evaluation of Hepatic Steatosis by Using Acoustic Structure Quantification US in a Rat Model: Comparison with Pathologic Examination and MR Spectroscopy.

Purpose To determine factors that significantly affect the focal disturbance (FD) ratio calculated with an acoustic structure quantification (ASQ) technique in a dietary-induced fatty liver disease rat model and to assess the diagnostic performance of the FD ratio in the assessment of hepatic steatosis by using histopathologic examination as a standard of reference. Materials and Methods Twenty-eight male F344 rats were fed a methionine-choline-deficient diet with a variable duration (3.5 days [half week] or 1, 2, 3, 4, 5, or 6 weeks; four rats in each group). A control group of four rats was maintained on a standard diet. At the end of each diet period, ASQ ultrasonography (US) and magnetic resonance (MR) spectroscopy were performed. Then, the rat was sacrificed and histopathologic examination of the liver was performed. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of the FD ratio in the evaluation of the degree of hepatic steatosis. The Spearman correlation coefficient was calculated to assess the correlation between the ordinal values, and multivariate linear regression analysis was used to identify significant determinant factors for the FD ratio. Results The diagnostic performance of the FD ratio in the assessment of the degree of hepatic steatosis (area under the receiver operating characteristic curve: 1.000 for 5%-33% steatosis, 0.981 for >33% to 66% steatosis, and 0.965 for >66% steatosis) was excellent and was comparable to that of MR spectroscopy. There was a strong negative linear correlation between the FD ratio and the estimated fat fraction at MR spectroscopy (Spearman ρ, -0.903; P < .001). Multivariate linear regression analysis showed that the degree of hepatic steatosis (P < .001) and fibrosis stage (P = .022) were significant factors affecting the FD ratio. Conclusion The FD ratio may potentially provide good diagnostic performance in the assessment of the degree of hepatic steatosis, with a strong negative linear correlation with the estimated fat fraction at MR spectroscopy. The degree of steatosis and stage of fibrosis at histopathologic examination were significant factors that affected the FD ratio. © RSNA, 2017 Online supplemental material is available for this article.

Primary non-function is frequently associated with fatty liver allografts and high mortality after re-transplantation.

The shortage of liver donations demands the use of suboptimal grafts with steatosis being a frequent finding. Although ≤30% macrovesicular steatosis is considered to be safe the risk for primary non-function (PNF) and outcome after re-transplantation (re-OLT) is unknown. Among 1205 orthotopic liver transplantations performed at our institution the frequency, survival and reason of re-OLT were evaluated. PNF (group A) cases and those with initial transplant function but subsequent need for re-OLT (group B) were analysed. Histopathology and clinical judgement determined the cause of PNF and included an assessment of hepatic steatosis. Additionally, survival of fatty liver allografts (group C) not requiring re-OLT was considered in Kaplan-Meier and multivariate regression analysis. A total of 77 high urgency re-OLTs were identified and included 39 PNF cases. Nearly 70% of PNF cases were due to primary fatty liver allografts. The 3-month in-hospital mortality for PNF cases after re-OLT was 46% and the mean survival after re-OLT was 0.5 years as compared to 5.2 and 5.1 years for group B, C, respectively, (P<.008). In multivariate Cox regression analysis only hepatic steatosis was associated with an inferior survival (HR 4.272, P=.002). The MELD score, donor BMI, age, cold ischaemic time, ICU stay, serum sodium and transaminases did not influence overall survival. Our study highlights fatty liver allografts to be a major cause for PNF with excessive mortality after re-transplantation. The findings demand the development of new methods to predict risk for PNF of fatty liver allografts.

Robust sound speed estimation for ultrasound-based hepatic steatosis assessment

Hepatic steatosis is a common condition, the prevalence of which is increasing along with non-alcoholic fatty liver disease (NAFLD). Currently, the most accurate noninvasive imaging method for diagnosing and quantifying hepatic steatosis is MRI, which estimates the proton-density fat fraction (PDFF) as a measure of fractional fat content. However, MRI suffers several limitations including cost, contra-indications and poor availability. Although conventional ultrasound is widely used by radiologists for hepatic steatosis assessment, it remains qualitative and operator dependent. Interestingly, the speed of sound within soft tissues is known to vary slightly from muscle (1.575 mm · µs−1) to fat (1.450 mm · µs−1). Building upon this fact, steatosis could affect liver sound speed when the fat content increases. The main objectives of this study are to propose a robust method for sound speed estimation (SSE) locally in the liver and to assess its accuracy for steatosis detection and staging. This technique was first validated on two phantoms and SSE was assessed with a precision of 0.006 and 0.003 mm · µs−1 respectively for the two phantoms. Then a preliminary clinical trial (N = 17 patients) was performed. SSE results was found to be highly correlated with MRI proton density fat fraction (R2 = 0.69) and biopsy (AUROC = 0.952) results. This new method based on the assessment of spatio-temporal properties of the local speckle noise for SSE provides an efficient way to diagnose and stage hepatic steatosis.

1140 - Comparison of Proton Magnetic Resonance Spectroscopy of Lipid Composition with Liver Biopsy for the Assessment of Hepatic Steatosis: A Pilot Study

1140 - Comparison of Proton Magnetic Resonance Spectroscopy of Lipid Composition with Liver Biopsy for the Assessment of Hepatic Steatosis: A Pilot Study

Modern diagnostics of nonalcoholic fatty liver disease: noninvasive research methods

Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as the most common cause of chronic liver disease worldwide. NAFLD represents a wide spectrum of conditions, ranging from simple benign steatosis to nonalcoholic steatohepatitis, which sometimes progresses to cirrhosis and hepatocellular carcinoma. The pivotal issue in the management of patients with NAFLD is the diagnosis of steatohepatitis and fibrosis at an early stage. In this review we present recent data on nonalcoholic fatty liver disease evaluation. Although liver biopsy is regarded as the gold standard for assessment of hepatic steatosis and steatohepatitis, its use has several limitations, including the potential risk of sampling errors, intra- and interobserver variability, invasiveness and the stress it causes to patients, the high cost and the potential for complications. In this review a simple and reliable non-invasive alternative with indicated sensitivity and specificity is described. Non-invasive markers should aim ; in primary care settings, to identify the risk of developing NAFLD among individuals with increased metabolic risk; in secondary and tertiary care settings, to identify those with a worse prognosis, e.g. severe steatohepatitis; monitor disease progression; predict response to therapeutic interventions. Achieving these objectives could reduce the need for liver biopsy. Thus, according to the natural history of NAFLD, all patients with a low risk of developing advanced disease, eventually diagnosed by one of above non-invasive parameters, could be referred to primary care, whereas subjects at high risk of developing advanced disease should be sent to specialists for the evaluation of the degree of fibrosis and the choice of specific management. According to the Clinical Practice Guidelines for the management of NAFLD, ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD, as it provides additional diagnostic information. Whenever imaging tools are not available or feasible (e.g. large epidemiological studies), serum biomarkers and scores are an acceptable alternative for the diagnosis of steatosis. The combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy. At the same time, the identification of advanced fibrosis or cirrhosis by serum biomarkers/scores and/or elastography is less accurate and needs to be confirmed by liver biopsy, according to the clinical context. Аlthough there are a range of controversial issues regarding the use of non-invasive methods for the assessment of NAFLD, these methods are being actively developed, researched and introduced into clinical practice as an equivalent and substitute for liver biopsy.