Grading of Hepatic Steatosis by Ultrasound Quantification
-
Hamidreza Talari
,
Yaser Hamidian
,
Elaheh Askari Moghadam
,
Mohsen Razavizadeh
,
Gholamabbas Moosavi
Abstract
Purpose: Fatty liver is the most common chronic liver disease, and finding the appropriate method for detecting the problem is necessary. The current study aimed to quantity liver steatosis using Computed Tomography (CT), ultrasound images, and Alanine Aminotransferase (ALT) blood test.
Materials and Methods: In this work, 163 Non-Alcoholic Fatty Liver Disease (NAFLD) patients implemented CT and ultrasound images on their abdomen regions. The liver and spleen density were calculated using CT images (as the standard method), and then the patients were divided into mild, and moderate to severe groups. During the sonography, an M-value histogram of the liver and the right kidney was drawn and their ratio (liver/kidney) was considered as a Hepatorenal Index (HRI). Mann-Whitney test was used to evaluate the relationships between HRI and ALT values.
Results: The mean and standard deviation of the liver density in CT scans were obtained as 51 ± 4 HU. The HRI had better performance (Area Under the Curve, AUC: 0.94) than the ALT (AUC: 0.88) in determining liver steatosis. In addition, there was a significant difference between the mild, and moderate to severe groups (P < 0.001) in HRI and ALT values.
Conclusion: Based on the results, HRI is an excellent factor to distinguish between mild, and moderate to severe fatty liver. Notably, HRI is reproducible and operator-independent.
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10- Joeri Lambrecht, Leo A van Grunsven, and Frank Tacke, "Current and emerging pharmacotherapeutic interventions for the treatment of liver fibrosis." Expert Opinion on Pharmacotherapy, Vol. 21 (No. 13), pp. 1637-50, (2020).
11- Daniel Berger, Vishal Desai, and Sujit Janardhan, "Con: liver biopsy remains the gold standard to evaluate fibrosis in patients with nonalcoholic fatty liver disease." Clinical Liver Disease, Vol. 13 (No. 4), p. 114, (2019).
12- Cody J Boyce et al., "Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT." American Journal of Roentgenology, Vol. 194 (No. 3), pp. 623-28, (2010).
13- Mikako Obika and Hirofumi Noguchi, "Diagnosis and evaluation of nonalcoholic fatty liver disease." Experimental diabetes research, Vol. 2012(2011).
14- Yoshihisa Kodama et al., "Comparison of CT methods for determining the fat content of the liver." (2007).
15- Ma Ai Thanda Han, Rola Saouaf, Walid Ayoub, Tsuyoshi Todo, Edward Mena, and Mazen Noureddin, "Magnetic resonance imaging and transient elastography in the management of Nonalcoholic Fatty Liver Disease (NAFLD)." Expert review of clinical pharmacology, Vol. 10 (No. 4), pp. 379-90, (2017).
16- Yingzhen N Zhang et al., "Liver fat imaging—a clinical overview of ultrasound, CT, and MR imaging." The British journal of radiology, Vol. 91 (No. 1089), p. 20170959, (2018).
17- Ali Tarighatnia et al., "Mucin-16 targeted mesoporous nano-system for evaluation of cervical cancer via dual-modal computed tomography and ultrasonography." New Journal of Chemistry, Vol. 45 (No. 40), pp. 18871-80, (2021).
18- Ali Tarighatnia, Mohammad Reza Fouladi, Nader D Nader, Ayuob Aghanejad, and Hossein Ghadiri, "Recent trends of Contrast Agents in Ultrasound Imaging: a review on Classifications and Applications." Materials Advances, (2022).
19- Shira Zelber-Sagi et al., "Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification." World journal of gastroenterology: WJG, Vol. 19 (No. 1), p. 57, (2013).
20- Se Hyung Kim et al., "Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images-initial experience." Radiology-Radiological Society of North America, Vol. 234 (No. 3), pp. 793-803, (2005).
21- N Naumov and L Lukanov, "The echographic histogram--its use in the diagnosis of diffuse liver diseases." Vutreshni Bolesti, Vol. 26 (No. 6), pp. 50-55, (1987).
22- Hiroyuki Osawa and Yasuaki Mori, "Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes." Journal of clinical ultrasound, Vol. 24 (No. 1), pp. 25-29, (1996).
23- Muriel Webb et al., "Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis." AJR Am J Roentgenol, Vol. 192 (No. 2), (2008).
24- Kouki Masuo, Hitoshi Funagi, and Kunihiko Kawai, "The Detection and Grading of the Fatty Liver Based on Histogram Analysis of Ultrasonographic Image and Considering Body Measurements and Laboratory Data." The Showa University Journal of Medical Sciences, Vol. 24 (No. 3), pp. 209-18, (2012).
25- Kaustubh Shiralkar, Stephen Johnson, Edward I Bluth, Richard H Marshall, Adriana Dornelles, and Paul M Gulotta, "Improved method for calculating hepatic steatosis using the hepatorenal index." Journal of Ultrasound in Medicine, Vol. 34 (No. 6), pp. 1051-59, (2015).
26- Lance E Davidson, Jennifer L Kuk, Timothy S Church, and Robert Ross, "Protocol for measurement of liver fat by computed tomography." Journal of applied physiology, Vol. 100 (No. 3), pp. 864-68, (2006).
27- Irfan Zeb, Dong Li, Khurram Nasir, Ronit Katz, Vahid N Larijani, and Matthew J Budoff, "Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis." Academic radiology, Vol. 19 (No. 7), pp. 811-18, (2012).
28- Seong Ho Park et al., "Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment." Radiology, Vol. 239 (No. 1), pp. 105-12, (2006).
29- Chao-Long Chen et al., "Living donor liver transplantation: the Asian perspective." Transplantation, Vol. 97p. S3, (2014).
30- Piyaporn Limanond et al., "Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings." Radiology, Vol. 230 (No. 1), pp. 276-80, (2004).
31- Alessandra Carvalho Goulart et al., "Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)." Sao Paulo Medical Journal, Vol. 133pp. 115-24, (2015).
32- Mustafa Koplay, Mesut Sivri, Hasan Erdogan, and Alaaddin Nayman, "Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease." World journal of hepatology, Vol. 7 (No. 5), p. 769, (2015).
2- G Vernon, A Baranova, and ZM Younossi, "Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults." Alimentary pharmacology & therapeutics, Vol. 34 (No. 3), pp. 274-85, (2011).
3- I Moghaddasifar et al., "Prevalence of non-alcoholic fatty liver disease and its related factors in Iran." International journal of organ transplantation medicine, Vol. 7 (No. 3), p. 149, (2016).
4- Nabil Noureddin, Mazen Noureddin, Amandeep Singh, and Naim Alkhouri, "Progression of nonalcoholic fatty liver disease-associated fibrosis in a large cohort of patients with type 2 diabetes." Digestive Diseases and Sciences, Vol. 67 (No. 4), pp. 1379-88, (2022).
5- Takeki Sato et al., "Severe steatosis and mild colitis are important for the early occurrence of hepatocellular carcinoma." Biochemical and Biophysical Research Communications, Vol. 566pp. 36-44, (2021).
6- Inpyeong Hwang et al., "Hepatic steatosis in living liver donor candidates: preoperative assessment by using breath-hold triple-echo MR imaging and 1H MR spectroscopy." Radiology, Vol. 271 (No. 3), pp. 730-38, (2014).
7- Valeska Ormazabal, Soumyalekshmi Nair, Omar Elfeky, Claudio Aguayo, Carlos Salomon, and Felipe A Zuñiga, "Association between insulin resistance and the development of cardiovascular disease." Cardiovascular diabetology, Vol. 17 (No. 1), pp. 1-14, (2018).
8- Donghee Kim, W Ray Kim, Hwa Jung Kim, and Terry M Therneau, "Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States." Hepatology, Vol. 57 (No. 4), pp. 1357-65, (2013).
9- David A Sass, Parke Chang, and Kapil B Chopra, "Nonalcoholic fatty liver disease: a clinical review." Digestive Diseases and Sciences, Vol. 50 (No. 1), pp. 171-80, (2005).
10- Joeri Lambrecht, Leo A van Grunsven, and Frank Tacke, "Current and emerging pharmacotherapeutic interventions for the treatment of liver fibrosis." Expert Opinion on Pharmacotherapy, Vol. 21 (No. 13), pp. 1637-50, (2020).
11- Daniel Berger, Vishal Desai, and Sujit Janardhan, "Con: liver biopsy remains the gold standard to evaluate fibrosis in patients with nonalcoholic fatty liver disease." Clinical Liver Disease, Vol. 13 (No. 4), p. 114, (2019).
12- Cody J Boyce et al., "Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT." American Journal of Roentgenology, Vol. 194 (No. 3), pp. 623-28, (2010).
13- Mikako Obika and Hirofumi Noguchi, "Diagnosis and evaluation of nonalcoholic fatty liver disease." Experimental diabetes research, Vol. 2012(2011).
14- Yoshihisa Kodama et al., "Comparison of CT methods for determining the fat content of the liver." (2007).
15- Ma Ai Thanda Han, Rola Saouaf, Walid Ayoub, Tsuyoshi Todo, Edward Mena, and Mazen Noureddin, "Magnetic resonance imaging and transient elastography in the management of Nonalcoholic Fatty Liver Disease (NAFLD)." Expert review of clinical pharmacology, Vol. 10 (No. 4), pp. 379-90, (2017).
16- Yingzhen N Zhang et al., "Liver fat imaging—a clinical overview of ultrasound, CT, and MR imaging." The British journal of radiology, Vol. 91 (No. 1089), p. 20170959, (2018).
17- Ali Tarighatnia et al., "Mucin-16 targeted mesoporous nano-system for evaluation of cervical cancer via dual-modal computed tomography and ultrasonography." New Journal of Chemistry, Vol. 45 (No. 40), pp. 18871-80, (2021).
18- Ali Tarighatnia, Mohammad Reza Fouladi, Nader D Nader, Ayuob Aghanejad, and Hossein Ghadiri, "Recent trends of Contrast Agents in Ultrasound Imaging: a review on Classifications and Applications." Materials Advances, (2022).
19- Shira Zelber-Sagi et al., "Comparison of fatty liver index with noninvasive methods for steatosis detection and quantification." World journal of gastroenterology: WJG, Vol. 19 (No. 1), p. 57, (2013).
20- Se Hyung Kim et al., "Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images-initial experience." Radiology-Radiological Society of North America, Vol. 234 (No. 3), pp. 793-803, (2005).
21- N Naumov and L Lukanov, "The echographic histogram--its use in the diagnosis of diffuse liver diseases." Vutreshni Bolesti, Vol. 26 (No. 6), pp. 50-55, (1987).
22- Hiroyuki Osawa and Yasuaki Mori, "Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes." Journal of clinical ultrasound, Vol. 24 (No. 1), pp. 25-29, (1996).
23- Muriel Webb et al., "Diagnostic value of a computerized hepatorenal index for sonographic quantification of liver steatosis." AJR Am J Roentgenol, Vol. 192 (No. 2), (2008).
24- Kouki Masuo, Hitoshi Funagi, and Kunihiko Kawai, "The Detection and Grading of the Fatty Liver Based on Histogram Analysis of Ultrasonographic Image and Considering Body Measurements and Laboratory Data." The Showa University Journal of Medical Sciences, Vol. 24 (No. 3), pp. 209-18, (2012).
25- Kaustubh Shiralkar, Stephen Johnson, Edward I Bluth, Richard H Marshall, Adriana Dornelles, and Paul M Gulotta, "Improved method for calculating hepatic steatosis using the hepatorenal index." Journal of Ultrasound in Medicine, Vol. 34 (No. 6), pp. 1051-59, (2015).
26- Lance E Davidson, Jennifer L Kuk, Timothy S Church, and Robert Ross, "Protocol for measurement of liver fat by computed tomography." Journal of applied physiology, Vol. 100 (No. 3), pp. 864-68, (2006).
27- Irfan Zeb, Dong Li, Khurram Nasir, Ronit Katz, Vahid N Larijani, and Matthew J Budoff, "Computed tomography scans in the evaluation of fatty liver disease in a population based study: the multi-ethnic study of atherosclerosis." Academic radiology, Vol. 19 (No. 7), pp. 811-18, (2012).
28- Seong Ho Park et al., "Macrovesicular hepatic steatosis in living liver donors: use of CT for quantitative and qualitative assessment." Radiology, Vol. 239 (No. 1), pp. 105-12, (2006).
29- Chao-Long Chen et al., "Living donor liver transplantation: the Asian perspective." Transplantation, Vol. 97p. S3, (2014).
30- Piyaporn Limanond et al., "Macrovesicular hepatic steatosis in living related liver donors: correlation between CT and histologic findings." Radiology, Vol. 230 (No. 1), pp. 276-80, (2004).
31- Alessandra Carvalho Goulart et al., "Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)." Sao Paulo Medical Journal, Vol. 133pp. 115-24, (2015).
32- Mustafa Koplay, Mesut Sivri, Hasan Erdogan, and Alaaddin Nayman, "Importance of imaging and recent developments in diagnosis of nonalcoholic fatty liver disease." World journal of hepatology, Vol. 7 (No. 5), p. 769, (2015).
| Files | ||
| Issue | Vol 10 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v10i2.12215 | |
| Keywords | ||
| Liver Steatosis Computed Tomography Ultrasound Hepatorenal Index | ||
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How to Cite
1.
Talari H, Hamidian Y, Askari Moghadam E, Razavizadeh M, Moosavi G. Grading of Hepatic Steatosis by Ultrasound Quantification. Frontiers Biomed Technol. 2023;10(2):112-119.
