Ultrasound-Guided Attenuation Parameter May Replace B-mode Ultrasound in Diagnosing Nonalcoholic Fatty Liver Disease

Bo Jiang, MD; Yiman Du, MD; Xiang Fei, MD; Jianing Zhu, MD; Lianhua Zhu, MD; Qiuyang Li, MD; Yukun Luo, MD, PhD

doi:10.37015/AUDT.2023.220037

ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY >

2023 , Vol. 7 >Issue 3: 260 - 266

DOI: https://doi.org/10.37015/AUDT.2023.220037

Original Research

Ultrasound-Guided Attenuation Parameter May Replace B-mode Ultrasound in Diagnosing Nonalcoholic Fatty Liver Disease

Bo Jiang, MD ,
Yiman Du, MD ,
Xiang Fei, MD ,
Jianing Zhu, MD ,
Lianhua Zhu, MD ,
Qiuyang Li, MD ,
Yukun Luo, MD, PhD

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Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China

First author contact:

¹Bo Jiang and Yiman Du contributed equally to this study.

*Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, China, e-mail: LYK301@163.com.

Received date: 2022-09-17

Revised date: 2023-11-21

Accepted date: 2022-12-30

Online published: 2023-10-09

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Abstract

Objective: To compare the diagnostic sensitivity and consistency of ultrasound-guided attenuation parameter (UGAP) with B-mode ultrasound in nonalcoholic fatty liver disease (NAFLD) patients, and explored their correlation with clinical indicators.
Methods: Patients suspected of NAFLD from July to November 2021 were enrolled in this prospective study. After performing the B-mode ultrasound and UGAP examination, all patients were divided into four groups according to the grade of NAFLD obtained by two modalities, respectively. The diagnostic agreement of the two modalities were evaluated, and the diagnostic sensitivity was compared by the McNemar test. The correlation between clinical indicators and the attenuation coefficient (AC) of UGAP was analyzed by linear regression.
Results: The intraclass correlation coefficient of UGAP was 0.958 (95%CI: 0.943,0.970), while the kappa value of B-mode ultrasound grading was 0.799 (95%CI: 0.686, 0.912). The diagnostic sensitivity of UGAP was higher than that of B-mode ultrasound (99.0% vs. 32%, P < 0.001). BMI and TG can be distinguished in different grades of NAFLD diagnosed by B-mode ultrasound, while BMI, ALT, HDL, and Apo A can be distinguished in different grades of NAFLD diagnosed by UGAP. BMI (r = 0.502, P < 0.001), ALT (r = 0. 396, P < 0.001), TG (r = 0.418, P < 0.001), HDL (r = -0. 359, P < 0.001) and Apo A (r = -0.228, P = 0.020) were linearly correlated with the AC value of UGAP.
Conclusions: Compared with the B-mode ultrasound, UGAP had a higher sensitivity and consistency in diagnosing NAFLD, and correlated well with some laboratory indicators, which may be more valuable in screening and diagnosis of NAFLD.

Key words： Nonalcoholic fatty liver disease; Ultrasonography; Diagnostic imaging

Cite this article

Bo Jiang, MD , Yiman Du, MD , Xiang Fei, MD , Jianing Zhu, MD , Lianhua Zhu, MD , Qiuyang Li, MD , Yukun Luo, MD, PhD . Ultrasound-Guided Attenuation Parameter May Replace B-mode Ultrasound in Diagnosing Nonalcoholic Fatty Liver Disease[J]. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY, 2023 , 7(3) : 260 -266 . DOI: 10.37015/AUDT.2023.220037

References

[1]	Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22:788-793.
[2]	Lazarus JV, Mark HE, Anstee QM, Arab JP, Batterham RL, Castera L, et al. Advancing the global public health agenda for NAFLD: a consensus statement. Nat Rev Gastroenterol Hepatol 2022; 19:60-78.
[3]	Majumdar A, Verbeek J, Tsochatzis EJCoip. Non-alcoholic fatty liver disease: Current therapeutic options. Curr Opin Pharmacol 2021; 61:98-105.
[4]	Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007; 45:846-854.
[5]	Angulo P, Bugianesi E, Bjornsson ES, Charatcharoenwitthaya P, Mills PR, Barrera F, et al. Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2013; 145:782-9.e4.
[6]	Gu J, Liu S, Du S, Zhang Q, Xiao J, Dong Q, et al. Diagnostic value of MRI-PDFF for hepatic steatosis in patients with non-alcoholic fatty liver disease: a meta-analysis. Eur Radiol 2019; 29:3564-3573.
[7]	Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology 2019 ;156(5):1264-81.e4.
[8]	Paige JS, Bernstein GS, Heba E, Costa EAC, Fereirra M, Wolfson T, et al. A pilot comparative study of quantitative ultrasound, conventional ultrasound, and MRI for predicting histology-determined steatosis grade in adult nonalcoholic fatty liver disease. AJR Am J Roentgenol 2017; 208:W168-W177.
[9]	Dasarathy S, Dasarathy J, Khiyami A, Joseph R, Lopez R, McCullough AJ. Validity of real time ultrasound in the diagnosis of hepatic steatosis: a prospective study. J Hepatol 2009; 51:1061-1067.
[10]	van Werven JR, Marsman HA, Nederveen AJ, van Gulik TM, et al. Smits NJ, ten Kate FJ, Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology 2010; 256:159-168.
[11]	Ferraioli G, Kumar V, Ozturk A, Nam K, de Korte CL, Barr RG.US Attenuation for Liver Fat Quantification: An AIUM-RSNA QIBA Pulse-Echo Quantitative Ultrasound Initiative. Radiology 2022: 210736.
[12]	Fujiwara Y, Kuroda H, Abe T, Ishida K, Oguri T, Noguchi S, et al. The B-mode image-guided ultrasound attenuation parameter accurately detects hepatic steatosis in chronic liver disease. Ultrasound Med Biol 2018; 44:2223-2232.
[13]	Imajo K, Toyoda H, Yasuda S, Suzuki Y, Sugimoto K, Kuroda H, et al. Utility of ultrasound-guided attenuation parameter for grading steatosis with reference to MRI-PDFF in a large cohort. Clin Gastroenterol Hepatol 2022; 20:2533-2541.
[14]	Bende F, Sporea I, ?irli R, Baldea V, Laz?r A, Lupu?oru R, et al. Ultrasound-guided Attenuation Parameter (UGAP) for the quantification of liver steatosis using the Controlled Attenuation Parameter (CAP) as the reference method. Med Ultrason 2021;23:7-14.
[15]	Ferraioli G, Soares Monteiro LB,. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol 2019; 25:6053-6062.
[16]	Kuroda H, Fujiwara Y, Abe T, Nagasawa T, Oguri T, Noguchi S, et al. Two-dimensional shear wave elastography and ultrasound-guided attenuation parameter for progressive non-alcoholic steatohepatitis. PloS one 2021; 16:e0249493.
[17]	Papatheodoridi M, Cholongitas E. Diagnosis of Non-alcoholic Fatty Liver Disease (NAFLD): current concepts. Curr Pharm Des 2018; 24:4574-4586.
[18]	Pang Q, Zhang JY, Song SD, Qu K, Xu XS, Liu SS, et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index. World J Gastroenterol 2015; 21:1650-1662.
[19]	Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation 2016; 133:639-649.
[20]	Huang H, Wang J, Xu L, Miao M, Xu C. Association between high-density lipoprotein cholesterol to apolipoprotein A-I ratio and nonalcoholic fatty liver disease: a cross-sectional study. Int J Endocrinol 2021; 2021:6676526.
[21]	Fan N, Peng L, Xia Z, Zhang L, Song Z, Wang Y, et al. Triglycerides to high-density lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease: a cross-sectional study. Lipids Health Dis 2019; 18:39.
[22]	Fukuda Y, Hashimoto Y, Hamaguchi M, Fukuda T, Nakamura N, Ohbora A, et al. Triglycerides to high-density lipoprotein cholesterol ratio is an independent predictor of incident fatty liver; a population-based cohort study. Liver Int 2016; 36:713-720.

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