Liver Attenuation Research Articles

Novel Ultrasound Liver Attenuation Imaging for Detection of Liver Steatosis: Comparison with MRI Based Imaging Methods with Liver Biopsy as A Reference Standard

Novel Ultrasound Liver Attenuation Imaging for Detection of Liver Steatosis: Comparison with MRI Based Imaging Methods with Liver Biopsy as A Reference Standard

Faster rehabilitation weight gain is associated with liver fat in adult survivors of childhood severe acute malnutrition

BackgroundNutritional rehabilitation during severe acute malnutrition (SAM) aims to quickly restore a healthy body weight, but rapid weight gain has been associated with later cardiovascular risk. We hypothesized that faster weight gain during SAM rehabilitation and post-hospitalization is associated with liver fat in adult survivors.MethodJamaican adult survivors of childhood SAM underwent abdominal CT scan to estimate liver fat as mean liver attenuation (MLA) and liver spleen ratio (L/S). Birth weight (BW) and anthropometry measured during, and post-hospitalization were abstracted from admission records.ResultsWe studied 42 marasmus survivors (MRs) and 40 kwashiorkor survivors (KWs). MRs had a lower mean BW (SD) 2.5 (0.8) vs 3.0 (0.7) kg; p=0.01) and were more wasted (p<0.001) and stunted (p=0.03) than KWs on admission to hospital. MRs and KWs had similar rates of rehabilitation weight gain, which was inversely associated with MLA among all survivors of SM (r=-0.246, p=0.029), but only in MRs when assessed by diagnosis (r= -0.449, p=0.004). The association between rehabilitation weight gain and adult liver fat in MRs was not altered by BW, admission wasting or stunting. In KWs, post-hospitalization height gain was inversely associated with MLA (difference = -0.64, 95%CI: -0.64 to -0.13; p=0.006).ConclusionsFaster rehabilitation weight gain is associated with liver fat in adult survivors of childhood severe acute malnutrition. The finding that BW did not influence these outcomes may reflect the timing of the nutritional insult in utero. Target weight gain during nutritional rehabilitation may need to be lowered to optimize long-term outcomes in these children.

A Comparative Study of Ultrasound Attenuation Imaging, Controlled Attenuation Parameters, and Magnetic Resonance Spectroscopy for the Detection of Hepatic Steatosis.

To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis. A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (1 H-MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between 1 H-MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated. The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P=.0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis. ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.

Replacing sedentary time with light activity was associated with less adiposity across several depots in African ancestry men.

The aim of this study was to determine whetherdisplacement of sedentary time with activity was cross-sectionally associated with less adiposity among Black Caribbean men in the Tobago Health Study. Objectively assessed activity was categorized as sedentary (< 1.5 metabolic equivalents; METs), light (≥ 1.5 to < 3.0 METs), or moderate-to-vigorous (≥ 3.0 METs) using the SenseWear Pro armband. Computed tomography scans of the chest, abdomen, liver, and thigh were used to assess subcutaneous and ectopic adipose tissue. The isotemporal substitution framework paired with linear regression was used to examine associations between activity and adiposity adjusting for age, height, total awake time, and multiple comparisons. On average, participants (n=271) were 63 years old with 11.2h/d of sedentary behavior, 4.5h/d of light activity, and 54 min/d of moderate-to-vigorous activity. Replacing sedentary time with light activity was cross-sectionally associated with lower volume and higher density of abdominal and thigh subcutaneous adiposity, visceral adiposity, abdominal and thigh intermuscular adiposity, and pericardial adiposity and higher liver attenuation (p values ≤ 0.0001). Displacement of sedentary time with light activity was associated with less adiposity among this Black Caribbean cohort. Interventions focused on increasing light activity may be easier to maintain than higher intensity interventions and thus may be more successful at reducing adiposity.

PSUN228 Incidence and Predictors of New Onset Diabetes After Transplant (NODAT) in Liver Transplant recipients.

Abstract Background NODAT (New onset Diabetes after Transplant) is associated with multiple complications in liver transplant recipients which has to be diagnosed and treated early to prevent graft failure, cardiovascular morbidity and mortality. With improvement in the care of liver transplant recipients, post-transplant survival has significantly increased. With improved survival, incidence of chronic rejection, Diabetes, Hypertension, Dyslipidemia, etc. complications incidence also increasing. Aims and Objectives To know the incidence and predictors of NODAT. Methodology This was a prospective study of non-Diabetic recipients who underwent Liver Transplantation at Yashoda Hospital, Secunderabad from January 2020 to May 2021. The follow-up duration was 6 months. Total 65 patients were enrolled after excluding recipients who were &amp;lt;18 years of age, were already having diabetes, whose survival was less than 6 months of transplantation and who were not of an Indian origin. All the relevant clinical and biochemical data were collected. Appropriate statistical tests were applied to compare NODAT and Non-diabetes groups (recipients who did not develop diabetes after liver transplantation) to know the predictors of NODAT. Diagnosis of NODAT was be established by the standard ADA guidelines using Fasting blood sugar (FBS), Post prandial blood sugar(PPBS) or HbA1C. Diagnosis of NODAT required the presence of one of the four parameters: (i) fasting blood glucose levels ≥ 126 mg/dL on two occasions OR (ii) Insulin therapy requirement for &amp;gt;= 30 days OR (iii) oral hypoglycemic agent use for ≥ 30 consecutive days OR (iv) HbA1c ≥ 6.5. Transient NODAT was defined as the resolution of hyperglycemia within 6 months of transplantation. Results Total incidence of NODAT in our study was 29.2%. Among them 47.36% were transient NODAT and 52.67% were persistent NODAT. Factors significantly associated with occurrence of NODAT were: Type of Transplant (Living donor liver transplant v/s Deceased donor liver transplant), Presence of Impaired fasting glucose (IFG), presence of post-operative hyperglycemia, lower pre-transplant Magnesium &amp; Immediate post-operative Magnesium level, lower post-operative Albumin, higher trough Tacrolimus level at 3 Months, higher Tacrolimus and steroid dose at 3 months. Factors for which association with NODAT could not be found were: Age, Hepatitis C cirrhosis, alcoholic cirrhosis, pre-transplant BMI, baseline MELD score, pre-transplant FBS, donor age, donor gender, donor BMI, donor FBS &amp; Hba1c, donor CT LAI (Liver Attenuation Index, L-S) value, Steroid dose at discharge, immediate post-op trough Tacrolimus level and use of Everolimus. CONCLUSION: NODAT is the significant entity to be addressed. A robust strategy should be in place for the screening of NODAT. Lower Magnesium levels, presence of pre-transplant IFG and post-operative hyperglycemia give an early opportunity for detection of NODAT. Minimizing Tacrolimus level and steroid dose could be an effective strategy for the prevention of NODAT. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Liver X-ray Attenuation in Patients with Novel Coronavirus Infection (Multislice Computed Tomography Study)

Objective: to analyze the X-ray liver attenuation values in hospitalized patients with novel coronavirus infection (COVID-19) in relation to the time of disease onset, the severity of pulmonary parenchymal involvement, and the disease outcome.Material and methods. Chest computed tomography (CT) findings in 635 patients hospitalized with COVID-19 were analyzed. CT was performed at various times after the disease onset. The attenuation (CT density) values of the visualized liver upper part were measured by selecting the region of interest on CT images. The extent of the affected lung parenchyma was assessed according to the five-step CT0–4 scale, where CT0 corresponds to the absence of viral pneumonia, CT1 – lung parenchyma involvement less than 25%, CT2 – 25–50% lung volume lesion, CT3 – 50–75% lung volume lesion, CT4 – lung parenchyma involvement more than 75%.Results. In patients with CT0, the liver attenuation was significantly higher than in those with CT1, CT2, CT3, and CT4 (p &lt; 0.01). During the first week of the disease, there was a decrease in liver CT density followed by its increase and return to the initial values (p &lt; 0.0005). The dynamics of liver attenuation in the group of patients who died did not differ significantly from those who survived and recovered (p = 0.107). In the early stage of the disease (0–4 days), the liver attenuation in the group of patients who subsequently died turned out to be significantly lower than in the survivors (p &lt; 0.05).Conclusion. The course of COVID-19 is characterized by a transient decrease in liver CT density. The reduction in liver attenuation does not correlate with the volume of the affected lung parenchyma in patients with CT2–4. The dynamics of liver CT density is not associated with the disease outcome. There is a trend towards more pronounced values of liver attenuation decrease in the early stage of the disease in patients who subsequently died, which requires further research.

Liver–Spleen Ratio: Can It Be Used for the Prediction of Coronary Artery Disease?

Considering that ectopic fat accumulation in various organs, especially the heart and liver, is a cardiometabolic risk factor, the need for easily accessible markers of ectopic fat accumulation is inevitable. The main starting point of the study is based on the hypothesis of predicting cardiovascular disease risk through the link that can be established between the liver-spleen ratio, which is one of the strong indicators of hepa- tosteatosis, and epicardial adipose tissue volume. This was a retrospective study. The records of 283 consecutive patients who underwent coronary computed tomography angiography in our Radiology Department were reviewed retrospectively from our hospital's system. All patients' epicardial adipose tissue volume and liver-spleen ratio were calculated using appropriate criteria on non- contrast computed tomography images. Additionally, the Coronary Artery Disease- Reporting and Data System was calculated on contrast computed tomography images. The participating patients were divided into groups according to the liver-spleen ratio and Coronary Artery Disease-Reporting and Data System score. We found that while there was a negative correlation between the liver-spleen ratio and epicardial adipose tissue volume in the hepatosteatosis group, this relationship was not observed in the non-steatosis group. In addition, we observed that the family his- tory of cardiovascular disease and the frequency of cardiovascular disease were higher in the hepatosteatosis group than in the other group, and there was a correlation between cardiovascular disease and the liver-spleen ratio. Also, we found that age and liver- spleen ratio values were found to be independent predictors of coronary artery disease. In our study, we found that the frequency of cardiovascular disease was lower in patients with a high liver-spleen ratio. We also demonstrated in the study that the liver-spleen ratio, which indicates a low level of epicardial adipose tissue volume accumulation, is an independent predictor of cardiovascular disease. In addition, the use of liver-spleen ratio, which is more valuable than liver attenuation in predicting hepatic steatosis, may be more useful in evaluating the risk of hepatosteatosis-related cardio- vascular disease.

May an incidental finding on chest CT be a predictor of access in intensive care unit? Role of hepatic steatosis in patients affected by SARS-CoV-2.

Due to the high prevalence of hepatic steatosis (HS), the aim of the study is to verify the frequency of HS incidentally detected in chest computed tomography (CT) imaging in our population affected by SARS-CoV-2 and to investigate its association with the severity of the infection and outcome in terms of hospitalization. We retrospectively analyzed 500 patients with flu syndrome and clinically suspected of having Sars-CoV-2 infection who underwent unenhanced chest CT and have positive RT-PCR tests for Sars-CoV-2 RNA. Two radiologists both with >5 years of thoracic imaging experience, evaluated the images in consensus, without knowing the RT-PCR results. Liver density was measured by a region of interest (ROI), using a liver attenuation value ≤40 Hounsfield units (HU). On 480 patients, 23.1% (111/480) had an incidental findings of HS on chest CT. The steatosis group, included 83 (74.7%) males and 28 (25.3%) females. Patients with HS were more likely to be hospitalized in the intensive care unit (ICU). On univariate analysis, there is a correlation between probability to be intubate (access in the ICU) and HS: patients with HS are twice as likely to be intubated (OR 2.04, CI 95% 1.11-3.73). Chest CT is an important diagnostic tool for COVID-19 and can provide information about the prognosis of the disease. HS can easily be detected on chest CT taken for the diagnosis of the COVID-19 disease, is an important sign for a poor prognosis and possible predictor of admission in ICU.

S3032 Hiding in Plain Sight: An Atypical Presentation of Metastatic Breast Cancer as Acute Decompensated Cirrhosis

Introduction: Liver is a common site of breast cancer metastases, which are typically identified as hypervascular lesions on imaging. We present a rare case of breast cancer leading to diffuse, intra-sinusoidal, radiographically occult metastases in a patient presenting with new hepatic decompensation. Case Description/Methods: A 65-year-old woman with a remote history of grade IIIa invasive ductal carcinoma of the right breast status post lumpectomy, chemotherapy, and local radiation therapy was referred to liver clinic for 1 month of abdominal pain and newly elevated AST 144 U/L, ALT 143 U/L, total bilirubin 5.2 mg/dL, conjugated bilirubin 3.7 mg/dL, and alkaline phosphatase 652 U/L. She denied use of alcohol, substances, new medications, or supplements. Physical exam did not demonstrate stigmata of chronic liver disease. Work up for infectious, autoimmune, and common infiltrative etiologies of liver disease were negative; several tumor markers were elevated (Table 1). A routine surveillance PET-CT and subsequent MRCP demonstrated diffuse heterogeneous liver attenuation with cirrhotic morphology, splenomegaly, trace ascites, and intrabdominal lymphadenopathy. No discrete masses were seen on either study. The following week the patient was admitted for rapidly progressive failure to thrive, worsening ascites, jaundice, and oliguria. Inpatient labs demonstrated worsening hyperbilirubinemia (total bilirubin 14.8 mg/dL, conjugated bilirubin 12.2 mg/dL), hyponatremia, and AKI. Admission MELD-Na score was 31 and CLIF-C ACLF score was 46. Paracentesis demonstrated SAAG 1.6 with ascites protein 1.8 g/dL confirming Child Pugh Class B Cirrhosis. Transjugular liver biopsy measured hepatic venous pressure gradient 12mmHg and pathology demonstrated metastatic breast carcinoma of the sinusoidal and vascular spaces with background steatosis and non-bridging fibrosis. Despite aggressive treatment with fulvestrant and abemaciclib, she had worsening multiorgan failure. Given her overall poor prognosis, the patient elected to transition to hospice. Discussion: Metastatic breast cancer uncommonly presents with diffuse, intra-sinusoidal metastases that are radiographically occult. This case highlights the importance of maintaining a high index of suspicion for metastatic disease in patients with a history of malignancy presenting with new hepatic decompensation even in absence of typical radiographic findings. In such cases, liver biopsy may be required for a definitive diagnosis. (Table) Table 1. - Work up for etiologies of chronic liver disease Autoimmune markers ANA Positive (1:320, speckled) Anti-mitochondrial Ab < 1:20 dsDNA < =200 Smooth muscle Ab < 20 RNP Ab < 20 SSA Ab 68 (Elevated) SSB Ab < 20 Rheumatoid Factor < 10 Thyroid Peroxidase Ab 135 (Elevated) Beta-2-Glycoprotein IgA/IgG/IgM < 10 Cardiolipin IgA/IgG/IgM < 20 C-ANCAMyeloperoxidase AbP-ANCAProteinase-3 Ab < 1:20< 1:20< 1:20< 1:20 Infectious studies Hep A Ab Nonreactive Hep C Ab Nonreactive Hep B surface Ab < 10 Hep B surface Ag Nonreactive Hep B core Ab Nonreactive MTB-Quantiferon-Gold Negative Other causes of Liver Disease Alpha-1-antitrypsin Negative SPEP/UPEP No monoclonal bands observed Ceruloplasmin Elevated Copper Elevated Ferritin Elevated Tumor Markers AFP 4.2 ng/mL, decreased to < 1.82 ng/mL CEA 84 ng/mL, increased to peak 3042 ng/mL (Elevated) CA 125 930 U/mL CA 19-9 1166 U/mL CA 27.29 7450.1 U/mL (Elevated)

Immune checkpoint inhibitors and their impact on liver enzymes and attenuation

BackgroundImmune related adverse events impacting the liver are common from immune checkpoint inhibitor (ICI) therapy; however, there is little data regarding the subclinical impact of ICIs on liver inflammation. The study aims to determine whether ICI therapy affects liver attenuation and liver enzymes in melanoma patients with and without hepatic steatosis.MethodsA retrospective, cohort study was conducted of patients with advanced melanoma treated with ICI therapy who received serial PET-CT scans at the Vanderbilt University Medical Center (VUMC). Primary outcomes included: liver attenuation measured by PET-CT/non-contrast CT and liver enzymes. Hepatic steatosis was diagnosed by radiologists on clinical imaging.ResultsAmong 839 patients with advanced melanoma treated with ICIs, 81 had serial PET-CT scans approximately 12 months apart and long-term survival; of these 11 patients had pre-existing steatosis/steatohepatitis. Overall, ICI was not associated with significant increases in liver enzymes in all patients; modest decreases in liver enzymes were observed in patients with pre-existing steatosis/steatohepatitis. Similarly, liver attenuation did not change from baseline to post-treatment (58.44 vs 60.60 HU, + 2.17, p = 0.055).ConclusionsICIs may not chronically affect liver enzymes or liver attenuation, a non-invasive measure of liver fat content and inflammation, in the general population or in those with pre-existing steatosis/steatohepatitis.

Liver Attenuation Assessment in Reduced Radiation Chest Computed Tomography.

This study aimed to evaluate the reliability of liver and spleen Hounsfield units (HU) measurements in reduced radiation computed tomography (RRCT) of the chest within the sub-millisievert range. We performed a prospective, institutional review board-approved study of accrued patients who underwent unenhanced normal-dose chest CT (NDCT) and with an average radiation dose of less than 5% of NDCT. In-house artificial intelligence-based denoising methods produced 2 denoised RRCT (dRRCT) series. Hepatic and splenic attenuations were measured on all 4 series: NDCT, RRCT, dRRCT1, and dRRCT2. Statistical analyses assessed the differences between the HU measurements of the liver and spleen in RRCTs and NDCT. As a test case, we assessed the performance of RRCTs for fatty liver detection, considering NDCT to be the reference standard. Wilcoxon test compared liver and spleen attenuation in the 72 patients included in our cohort. The liver attenuation in NDCT (median, 59.38 HU; interquartile range, 55.00-66.06 HU) was significantly different from the attenuation in RRCT, dRRCT1, and dRRCT2 (median, 63.63, 42.00, and 33.67 HU; interquartile range, 56.19-67.19, 37.33-45.83, and 30.33-38.50 HU, respectively), all with a P value <0.01. Six patients (8.3%) were considered to have fatty liver on NDCT. The specificity, sensitivity, and accuracy of fatty liver detection by RRCT were greater than 98.5%, 50%, and 94.3%, respectively. Attenuation measurements were significantly different between NDCT and RRCTs, but may still have diagnostic value in appreciating hepatosteastosis. Abdominal organ attenuation on RRCT protocols may differ from attenuation on NDCT and should be validated when new low-dose protocols are used.

Evaluation of Aortic Distensibility in Patients with Nonalcoholic Fatty Liver Using CT.

Nonalcoholic fatty liver disease has attracted considerable attention with continuously increasing morbidity. To evaluate the aortic distensibility in patients with non-diabetic and hypertension-type Nonalcoholic Fatty Liver Disease (NAFLD) through Dual-Source Computed Tomography (DSCT). 120 patients with NAFLD (experimental group) and 30 healthy subjects (control group) were consecutively enrolled in the study. In the two groups, aortic distensibility was calculated as D = ΔA/(A0 ×Δp). Record fasting insulin, fasting blood glucose, fasting lipid status, age, heart rate, waist circumference, systolic blood pressure, and diastolic blood pressure. Calculate homeostasis model assessment of insulin resistance (HOMA-IR) and Body Mass Index (BMI). A comparative analysis between the two groups was carried out, followed by a correlation analysis between D value and risk factors. D value and liver attenuation of the patients in the NAFLD group were significantly reduced relative to those in the control group (2.24±0.63×10-3 mmHg-1 vs. 3.19±0.86×10-3 mmHg-1, P<0.001 and 41±6HU vs. 53±5HU, P<0.001, respectively) and their fasting blood glucose, fasting insulin, triglyceride, low-density lipoprotein, aspartate aminotransferase, alanine transaminase, HOMA- IR, and BMI were higher than those in the control group. Liver attenuation, HOMA-IR, age, and BMI were significantly correlated with D value in the NAFLD group. The stepwise multiple linear regression analysis indicates that liver attenuation and HOMA-IR were the significant risk factors for D value (β coefficient =0.43, P =0.001, and β coefficient =-0.33, P =0.02, respectively). Patients with NAFLD suffer from a reduction in aortic distensibility, and insulin resistance may play a significant role in the early atherosclerosis stage.

Prevalence of Hepatic Steatosis in Adults Presenting to the Emergency Department Identified by Unenhanced Chest CT

This study aimed to investigate the prevalence of hepatic steatosis in racially diverse adults presenting to the emergency department at a tertiary healthcare system in the United States using attenuation values on unenhanced computed tomography (CT) as the reference standard. The utility of known risk factors for predicting the presence of hepatic steatosis was assessed. Additionally, reporting of hepatic steatosis in original radiology reports was evaluated. For 381 consecutive adults (193 women and 188 men; mean age 55.2 ± 17.2 years), hepatic (left medial, left lateral, right anterior, and right posterior) and splenic (upper, middle, and lower) CT attenuation values (Hounsfield units) were obtained by drawing a 1 cm2 region of interest on unenhanced chest CT obtained in the emergency department for any indication. Multiple attenuation criteria for steatosis, including liver thresholds and liver and spleen attenuation comparison, were applied. Relevant clinical risk factors were recorded and compared against a liver/ spleen attenuation ratio of ≤ 1.1 to include all individuals with steatosis in the analysis. Mean liver attenuation was 59.5 ± 10.4 HU. The prevalence of hepatic steatosis ranged from 5-35.4% depending on the CT attenuation criterion used (5%, liver attenuation ≤ 40 HU; 6.3%, liver attenuation ≤ (spleen attenuation - 10 HU); 16.8%, liver attenuation ≤ spleen attenuation; 34.1%, liver attenuation ≤ (spleen attenuation+5 HU); 35.4%, liver attenuation/ spleen attenuation ≤ 1.1). The prevalence of hepatic steatosis was higher in males compared to females (P=0.01, 42% vs 29%) and age 40-65 years when compared to the rest (P=0.03, 43.5% vs 32.2%), but similar across different racial (P=0.55), ethnic (P=0.78) groups. Overweight status (body mass index >25) and hypertension were sensitive indicator for steatosis (sensitivity=60.7% and 60.5%) but were highly nonspecific (specificity=41.9% and 49.2%). Other clinical risk factors, such as diabetes, dyslipidemia, alcohol overuse, and hepatitis, were more specific (specificity=62.2%-93.9%) but highly insensitive (sensitivity=7.5%-40.3%). 63% (12/19) radiology reports mentioned the presence of moderate-to-severe hepatic steatosis but only 11.1% (15/135) of them mentioned the presence of mild hepatic steatosis. Unenhanced chest CT can be used to assess hepatic steatosis for individuals presenting to the emergency department and provide a non-invasive means for opportunistic screening.

Effect of Nonalcoholic Fatty Liver Disease (NAFLD) on COVID-19: A Single-Center Study of 3983 Patients With Review of Literature.

BackgroundThe presence of metabolic syndrome (MS) is associated with increased disease severity in patients with coronavirus disease 2019 (COVID-19). Non-alcoholic fatty liver disease (NAFLD) associated with or without MS may be related to increased morbidity and mortality in COVID-19, but large Indian studies are lacking. The present study was carried out to assess the impact of NAFLD on the clinical outcomes in patients with COVID-19 infection.MethodsAll patients with COVID-19 hospitalized at a tertiary care hospital in eastern India from April 4 to December 31, 2020, were included in the study. Patients who underwent non-contrast CT (NCCT) chest were evaluated for the presence of hepatic steatosis based on a validated criterion liver attenuation (HU) value lower than the spleen, absolute liver attenuation lower than 40 HU, and liver to spleen attenuation ratio less than 1. Patients were divided into two groups, those with or without fatty liver. Baseline characteristics including age, sex, liver function tests, and outcomes including duration of hospital stay and mortality were compared.ResultsA total of 6003 COVID-19-positive patients were admitted during the study period. Of these patients, 214 children (<18 years) with COVID-19 infection were excluded. One hundred and eight patients with a history of significant ethanol abuse were excluded from the analysis. NCCT scan was not done in 1698 patients. Finally, 3983 patients were included in the study. They were divided into two groups depending on the presence or absence of NAFLD. Of the 3983 patients, 814 (20.4%) had NAFLD. Overall in-hospital mortality among the study group was 6.4%. The mortality rate among patients with NAFLD was 6.7% while that in patients without fatty liver was 6% (P=0.381). Similarly, the mean duration of hospital stay was also comparable between both the groups (10.63±7.2days vs 10.65±6.6 days;P=0.66). Prevalence of NAFLD was similar in survivors and non-survivors; 759 of 2981 patients (25.4%) and 55 of 188 patients 29.2% (P=0.381), respectively. On univariate analysis, male sex, older age, elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) along with low serum albumin and low absolute eosinophil counts (AEC) were associated with higher mortality. However, on multivariate analysis, only older age, male sex, and low albumin levels were associated with higher mortality. Surprisingly, a sub-group analysis showed that females without NAFLD were at a higher risk of mortality than those with fatty liver (4.9% vs 12.3%; P=0.006). Similarly, patients with lower AST levels had higher mortality compared to patients with significantly elevated AST levels (more than two times the upper limit of normal (ULN)), irrespective of the presence of fatty liver.ConclusionsThe prevalence of fatty liver in severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infected patients is similar to the general population in India, the presence of which is not a predictor of severe disease. However, mortality is higher in males and elderly patients.

Levels of abdominal adipose tissue and metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 years: the CARDIA Study

Higher levels of intra-abdominal adipose tissue (IAAT) comprising visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT), and liver fat are posited drivers of obesity-related chronic disease risk. Fast food is hypothesized to contribute to IAAT patterns. We quantified levels of abdominal subcutaneous adipose tissue (SAT), IAAT, and odds of metabolic-associated fatty liver disease (MAFLD) in middle age according to average fast-food intake over the preceding 25 y. We analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants underwent 6 clinical exams and measurements over 25 y with computed tomography-measured VAT, SAT, and IMAT (n=3156), plus MAFLD defined by liver attenuation (≤40 Hounsfield units) and 1metabolic abnormality at year 25 (2010, n=3001, n cases=302). We estimated means of VAT, SAT, IMAT, and liver attenuation at the year 25 exam according to categories of average fast-food intake over the previous 25 y adjusted for sociodemographic and lifestyle factors and logistic regression to estimate the odds ratio of MAFLD at year 25. With higher average fast-food intake over 25 y (categorized as follows: never-1×/mo, >1×-3×/mo, 1-<2×/wk, 2-<3×/wk, ≥3×/wk), there were monotonic higher levels of VAT (98.5, 127.6, 134.5, 142.0, 145.5 cm3), P-trend<0.0001, which were consistent across anthropometrically classified obesity categories. There was a similar pattern with liver fat. There were higher levels of IMAT and SAT with higher fast-food intake (P-trend=0.003, 0.0002, respectively), with amounts leveling off at≥2×/wk. In addition, compared with participants who ate fast food never-1×/mo, there were monotonic higher odds of having MAFLD at year 25 with higher average fast-food intake, with participants who ate fast food≥3×/wk having an OR of MAFLD=5.18 (95% CI: 2.87, 9.37). There were monotonic higher levels of VAT, liver fat, and odds of having MAFLD in middle age according to higher average fast-food intake over the preceding 25 y.

FRI203 - Sex and diagnosis-specific differences in liver elastography and attenuation

FRI203 - Sex and diagnosis-specific differences in liver elastography and attenuation

Individualized Contrast Media Application Based on Body Weight and Contrast Enhancement in Computed Tomography of Livers without Steatosis.

This study analyzes the homogeneity in liver attenuation of a body-weight-based protocol compared to a semi-fixed protocol. Patients undergoing abdominal multiphase computed tomography received 0.500 g of iodine (gI) per kilogram of body weight. Liver attenuation and enhancement were determined using regions of interest on scans in the pre-contrast and portal venous phases. The outcomes were analyzed for interpatient uniformity in weight groups. The subjective image quality was scored using a four-point Likert scale (excellent, good, moderate, and nondiagnostic). A total of 80 patients were included (56.3% male, 64 years, 78.0 kg) and were compared to 80 propensity-score-matched patients (62.5% male, 63 years, 81.7 kg). The liver attenuation values for different weight groups of the TBW-based protocol were not significantly different (p = 0.331): 109.1 ± 13.8 HU (≤70 kg), 104.6 ± 9.70 HU (70–90 kg), and 105.1 ± 11.6 HU (≥90 kg). For the semi-fixed protocol, there was a significant difference between the weight groups (p < 0.001): 121.1 ± 12.1 HU (≤70 kg), 108.9 ± 11.0 HU (70–90 kg), and 105.0 ± 9.8 HU (≥90 kg). For the TBW-based protocol, the enhancement was not significantly different between the weight groups (p = 0.064): 46.2 ± 15.1 HU (≤70 kg), 59.3 ± 6.8 HU (70–90 kg), and 52.1 ± 11.7 HU (≥90 kg). Additionally, for the semi-fixed protocol, the enhancement was not significantly different between the weight groups (p = 0.069): 59.4 ± 11.0 HU (≤70 kg), 53.0 ± 10.3 HU (70–90 kg), and 52.4 ± 7.5 HU (≥90 kg). The mean administered amount of iodine per kilogram was less for the TBW-based protocol compared to the semi-fixed protocol: 0.499 ± 0.012 and 0.528 ± 0.079, respectively (p = 0.002). Of the TBW-based protocol, 17.5% of the scans scored excellent enhancement quality, 76.3% good, and 6.3% moderate. Of the semi-fixed protocol, 70.0% scored excellent quality, 21.3% scored good, and 8.8% scored moderate. In conclusion, the TBW-based protocol increased the interpatient uniformity of liver attenuation but not the enhancement in the portal venous phase compared to the semi-fixed protocol, using an overall lower amount of contrast media and maintaining good subjective image quality.

The H2S Donor Sodium Thiosulfate (Na2S2O3) Does Not Improve Inflammation and Organ Damage After Hemorrhagic Shock in Cardiovascular Healthy Swine.

We previously demonstrated marked lung-protective properties of the H2S donor sodium thiosulfate (Na2S2O3, STS) in a blinded, randomized, controlled, long-term, resuscitated porcine model of swine with coronary artery disease, i.e., with decreased expression of the H2S-producing enzyme cystathionine-γ-lyase (CSE). We confirmed these beneficial effects of STS by attenuation of lung, liver and kidney injury in mice with genetic CSE deletion (CSE-ko) undergoing trauma-and-hemorrhage and subsequent intensive care-based resuscitation. However, we had previously also shown that any possible efficacy of a therapeutic intervention in shock states depends both on the severity of shock as well as on the presence or absence of chronic underlying co-morbidity. Therefore, this prospective, randomized, controlled, blinded experimental study investigated the effects of the STS in cardiovascular healthy swine. After anesthesia and surgical instrumentation, 17 adult Bretoncelles-Meishan-Willebrand pigs were subjected to 3 hours of hemorrhage by removal of 30% of the blood volume and titration of the mean arterial pressure (MAP) ≈ 40 ± 5 mmHg. Afterwards, the animals received standardized resuscitation including re-transfusion of shed blood, fluids, and, if needed, continuous i.v. noradrenaline to maintain MAP at pre-shock values. Animals were randomly allocated to either receive Na2S2O3 or vehicle control starting 2 hours after initiation of shock until 24 hours of resuscitation. The administration of Na2S2O3 did not alter survival during the observation period of 68 hours after the initiation of shock. No differences in cardio-circulatory functions were noted despite a significantly higher cardiac output, which coincided with significantly more pronounced lactic acidosis at 24 hours of resuscitation in the Na2S2O3 group. Parameters of liver, lung, and kidney function and injury were similar in both groups. However, urine output was significantly higher in the Na2S2O3 group at 24 hours of treatment. Taken together, this study reports no beneficial effect of Na2S2O3 in a clinically relevant model of hemorrhagic shock-and-resuscitation in animals without underlying chronic cardiovascular co-morbidity.

Lipoprotein Levels in Early Adulthood and NAFLD in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Objective We evaluated the association of apolipoprotein B (apoB) with low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG) in early adulthood with concordant/discordant associations and midlife NAFLD. Methods Participants from the CARDIA study were included (n = 2,655; baseline mean age: 25.0, 59.1% female, and 48.6% black). NAFLD was defined as liver attenuation ≤40 Hounsfield units after excluding other causes of liver fat. Logistic regression models assessed the odds of Y25 NAFLD among tertiles of apoB, LDL-C, non-HDL-C, and TG and quartiles of the apoB/TG ratio. Discordance/concordance analyses examined the association of apoB with each lipid marker and Y25 NAFLD. Results The Y25 NAFLD prevalence was 10%. The high-tertile TG group (OR 1.87, 95% CI, and 1.30–2.69) and the low- (OR 1.98, 95% CI, and 1.30–3.01) and middle-apoB/TG ratio groups (OR 1.78, 95% CI, and 1.17–2.72) had the greatest odds of midlife NAFLD. Using discordance/concordance analysis, the high-apoB/high-TG group had the highest odds of NAFLD (OR 1.69, 95% CI, and 1.09–2.61) followed by the low-apoB/high-TG group. The high apoB/low TG group had the lowest odds of NAFLD. Conclusions Among the studied lipid markers in early adulthood, TG levels have the strongest and most consistent association with midlife NAFLD.

Fully Automated Abdominal CT Biomarkers for Type 2 Diabetes Using Deep Learning.

Background CT biomarkers both inside and outside the pancreas can potentially be used to diagnose type 2 diabetes mellitus. Previous studies on this topic have shown significant results but were limited by manual methods and small study samples. Purpose To investigate abdominal CT biomarkers for type 2 diabetes mellitus in a large clinical data set using fully automated deep learning. Materials and Methods For external validation, noncontrast abdominal CT images were retrospectively collected from consecutive patients who underwent routine colorectal cancer screening with CT colonography from 2004 to 2016. The pancreas was segmented using a deep learning method that outputs measurements of interest, including CT attenuation, volume, fat content, and pancreas fractal dimension. Additional biomarkers assessed included visceral fat, atherosclerotic plaque, liver and muscle CT attenuation, and muscle volume. Univariable and multivariable analyses were performed, separating patients into groups based on time between type 2 diabetes diagnosis and CT date and including clinical factors such as sex, age, body mass index (BMI), BMI greater than 30 kg/m2, and height. The best set of predictors for type 2 diabetes were determined using multinomial logistic regression. Results A total of 8992 patients (mean age, 57 years ± 8 [SD]; 5009 women) were evaluated in the test set, of whom 572 had type 2 diabetes mellitus. The deep learning model had a mean Dice similarity coefficient for the pancreas of 0.69 ± 0.17, similar to the interobserver Dice similarity coefficient of 0.69 ± 0.09 (P = .92). The univariable analysis showed that patients with diabetes had, on average, lower pancreatic CT attenuation (mean, 18.74 HU ± 16.54 vs 29.99 HU ± 13.41; P < .0001) and greater visceral fat volume (mean, 235.0 mL ± 108.6 vs 130.9 mL ± 96.3; P < .0001) than those without diabetes. Patients with diabetes also showed a progressive decrease in pancreatic attenuation with greater duration of disease. The final multivariable model showed pairwise areas under the receiver operating characteristic curve (AUCs) of 0.81 and 0.85 between patients without and patients with diabetes who were diagnosed 0-2499 days before and after undergoing CT, respectively. In the multivariable analysis, adding clinical data did not improve upon CT-based AUC performance (AUC = 0.67 for the CT-only model vs 0.68 for the CT and clinical model). The best predictors of type 2 diabetes mellitus included intrapancreatic fat percentage, pancreatic fractal dimension, plaque severity between the L1 and L4 vertebra levels, average liver CT attenuation, and BMI. Conclusion The diagnosis of type 2 diabetes mellitus was associated with abdominal CT biomarkers, especially measures of pancreatic CT attenuation and visceral fat. © RSNA, 2022 Online supplemental material is available for this article.