Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2023; 29(22): 3548-3560
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3548
Prospective study comparing hepatic steatosis assessment by magnetic resonance imaging and four ultrasound methods in 105 successive patients
Remi Collin, Benoit Magnin, Constance Gaillard, Carine Nicolas, Armand Abergel, Benjamin Buchard
Remi Collin, Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges 87000, France
Remi Collin, Carine Nicolas, Armand Abergel, Benjamin Buchard, Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
Benoit Magnin, Constance Gaillard, Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
Author contributions: Collin R, Nicolas C, Abergel A and Buchard B conceived and designed the analysis; Collin R, Magnin B, Gaillard C, Nicolas C and Buchard B collected the data; Collin R, Magnin B, Gaillard C, Nicolas C, Abergel A and Buchard B contributed data or analysis tools; Collin R, Magnin B and Buchard B performed the analysis; Collin R and Buchard B wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Clermont-Ferrand University Hospital Institutional Review Board.
Clinical trial registration statement: This study is registered at Clermont-Ferrand University Hospital. The registration identification number is M210401.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Remi Collin, MD, Doctor, Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, Limoges 87000, France. remi.collin@chu-limoges.fr
Received: February 8, 2023
Peer-review started: February 8, 2023
First decision: March 21, 2023
Revised: April 4, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: June 14, 2023
Abstract
BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is becoming a major health problem, resulting in hepatic, metabolic and cardio-vascular morbidity.

AIM

To evaluate new ultrasonographic tools to detect and measure hepatic steatosis.

METHODS

We prospectively included 105 patients referred to our liver unit for NAFLD suspicion or follow-up. They underwent ultrasonographic measurement of liver sound speed estimation (SSE) and attenuation coefficient (AC) using Aixplorer MACH 30 (Supersonic Imagine, France), continuous controlled attenuation parameter (cCAP) using Fibroscan (Echosens, France) and standard liver ultrasound with hepato-renal index (HRI) calculation. Hepatic steatosis was then classified according to magnetic resonance imaging proton density fat fraction (PDFF). Receiver operating curve (ROC) analysis was performed to evaluate the diagnostic performance in the diagnosis of steatosis.

RESULTS

Most patients were overweight or obese (90%) and had metabolic syndrome (70%). One third suffered from diabetes. Steatosis was identified in 85 patients (81%) according to PDFF. Twenty-one patients (20%) had advanced liver disease. SSE, AC, cCAP and HRI correlated with PDFF, with respective Spearman correlation coefficient of -0.39, 0.42, 0.54 and 0.59 (P < 0.01). Area under the receiver operating characteristic curve (AUROC) for detection of steatosis with HRI was 0.91 (0.83-0.99), with the best cut-off value being 1.3 (Se = 83%, Sp = 98%). The optimal cCAP threshold of 275 dB/m, corresponding to the recent EASL-suggested threshold, had a sensitivity of 72% and a specificity of 80%. Corresponding AUROC was 0.79 (0.66-0.92). The diagnostic accuracy of cCAP was more reliable when standard deviation was < 15 dB/m with an AUC of 0.91 (0.83-0.98). An AC threshold of 0.42 dB/cm/MHz had an AUROC was 0.82 (0.70-0.93). SSE performed moderately with an AUROC of 0.73 (0.62-0.84).

CONCLUSION

Among all ultrasonographic tools evaluated in this study, including new-generation tools such as cCAP and SSE, HRI had the best performance. It is also the simplest and most available method as most ultrasound scans are equipped with this module.

Keywords: Non-alcoholic fatty liver disease, Ultrasonography, Steatosis assessment, Magnetic resonance imaging, Controlled attenuation parameter

Core Tip: Among all ultrasonographic tools evaluated in this study, including new-generation systems such as continuous controlled attenuation parameter and sound speed examination, hepato-renal index had the best performance. It is also the simplest and most available method as most ultrasound (US) scans are equipped with this module. The presence of an hyperechogenic liver on US also performed well, confirming that US should remain the first-line screening tool for steatosis.