Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility

Aitharaju, Varun; Silvestri, Annalisa De; Barr, Richard G.

doi:10.1007/s00261-021-03225-2

Cited by 9 publications

(7 citation statements)

References 41 publications

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“…Although a 25-mm SCD cut-off has been used in a prior publication, 13 this is not validated as yet. 32 The current study population with a typical tertiary centre pattern of referral has an expected wide range of indications. There was a significant, though, weak positive correlation between HRI and ATI, and between HRI SG and ATI SG, in the total population.…”

Section: Discussionmentioning

confidence: 99%

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Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis

Srigandan

Zelesco

Abbott

et al. 2022

Australas J Ultrason Med

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Introduction Hepatic steatosis screening is required to assess high‐risk populations, identify those for intervention, monitor response and prevent disease progression and complications. Liver biopsy and magnetic resonance imaging proton density fat fraction are current gold standards, but are limited by biopsy risk factors, patient tolerance and cost. Non‐invasive, cost‐effective, semi‐quantitative and quantitative ultrasound assessment exists. The aim of this study was to assess the correlation between the semi‐quantitative hepatorenal index (HRI) to assess hepatic steatosis using the quantitative attenuation imaging (ATI) as a reference standard, in adults with varied suspected liver pathologies. Methods Data were collected prospectively between April 2019 and March 2020 at a tertiary institution on any patient >18 years referred to US assessment of suspected liver pathology. The only exclusion criteria were absent or invalid HRI or ATI measurements. Three hundred fifty eight patients were included. Results There was a significant weak positive correlation between HRI and ATI (r = 0.351, P < 0.001) and between HRI steatosis grade (SG) and ATI SG (r = 0.329, P < 0.001), using previously established cut‐off values. With ATI as the reference standard, there was no significant correlation between HRI and hepatic steatosis within steatosis grades, nor for no (SG = 0) or any (SG > 0) hepatic steatosis. Conclusions Our study in a typical heterogeneous clinical population suggests the semi‐quantitative HRI is of limited use in hepatic steatosis imaging. As HRI is the objective measure of the subjective brightness (B)‐mode assessment, this imaging feature may not be as reliable as previously thought. Quantitative ATI may be the preferred non‐invasive technique for hepatic steatosis assessment.

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Section: Discussionmentioning

confidence: 99%

“…However, in obese patients (defined as BMI >25 kg/m 2 ) the area under the receiver operating characteristic curve for steatosis diagnosis was quoted as ‘…>0.7 in obese patients, corresponding to moderate diagnostic value…’. Although a 25‐mm SCD cut‐off has been used in a prior publication, 13 this is not validated as yet 32 …”

Section: Discussionmentioning

confidence: 99%

Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis

Srigandan

Zelesco

Abbott

et al. 2022

Australas J Ultrason Med

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“…Ferraioli et al 20 mentioned that an imaging protocol for attenuation imaging (ATI) that consists of 5 consecutive measurements lasts approximately 1 minute. A recent study conducted by Aitharaju et al 21 revealed that multiparametric ultrasound examinations which included a different vendor‐specific liver fat quantification tool (Attenuation imaging, ATI, Canon) can be performed in a short time period (mean time period for the exam was 129.7 ± 62.1 seconds). Furthermore, they reported that the difference in the examination time between the more experienced and less experienced sonographers was statistically significant 21 .…”

Section: Discussionmentioning

confidence: 99%

Interobserver Variability in Ultrasound‐Based Liver Fat Quantification

Şendur

Cerit

Ibrahimkhanli

et al. 2022

J of Ultrasound Medicine

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Objectives-To assess interobserver variability in ultrasound-based quantitative liver fat content measurements and to determine how much time these quantitative ultrasound (QUS) techniques require.Methods-One hundred patients with known or suspected of having nonalcoholic fatty liver disease were included in this prospective study. Two observers who were blinded to each other measurements performed tissue attenuation imaging (TAI) and tissue scatter distribution imaging (TSI) techniques independently. Both observers assessed hepatic steatosis visually and obtained 5 measurements for each QUS technique and the median values of the measurements were recorded. Spearman's correlation test was used to assess the correlation between QUS measurements and visual hepatic stetaosis grades. Intraclass correlation coefficient (ICC) test was used to assess interobserver variability in QUS measurements.Results-The median values of TAI measurements for the observers 1 and 2 were 0.75 and 0.74 dB/cm/MHz, respectively. The median values of TSI measurements for the observers 1 and 2 were 93.53 and 92.58, respectively. The interobserver agreement in TAI (ICC: 0.970) and TSI (ICC: 0.938) measurements were excellent. The mean of the required time period for TAI technique were 55.1 AE 7.8 and 59.9 AE 6.6 seconds for the observers 1 and 2, respectively. The mean of the required time period for TSI technique were 49.1 AE 5.8 and 54.1 AE 5.4 seconds for the observers 1 and 2, respectively. Conclusion-The current study revealed that both TAI and TSI techniques are highly reproducible and can be implemented into daily practice with little additional time requirement.

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“…Quantifying the energy loss while taking the frequency into account can quantify the liver fat content. There are different approaches used to estimate attenuation, which is described elsewhere 12–14 …”

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confidence: 99%

“…There are different approaches used to estimate attenuation, which is described elsewhere. [12][13][14] To improve the clinical use of attenuation imaging, various US vendor systems should provide similar attenuation coefficients (AC) and have similar cut-off values. In this paper, we compare the attenuation coefficient estimate for liver fat fraction from 2 different US systems, one of which has pre-released software.…”

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confidence: 99%

A Pre‐Release Algorithm With a Confidence Map for Estimating the Attenuation Coefficient for Liver Fat Quantification

Barr

Cestone²,

Silvestri

2021

J of Ultrasound Medicine

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Objectives-To compare the estimates of attenuation coefficient (AC) for liver fat quantification between 2 Ultrasound systems and to evaluate the quality measure of a pre-released software.Methods-AC were obtained in 30 participants in this single-center IRBapproved, HIPAA compliant study. Images were obtained on the Philips Epiq Elite system using experimental software and the Canon Medical Systems Aplio i800 with released software. Five AC measurements were taken and the median and IQR/M were calculated. Region of interest placement was based on a confidence map. ROI was at the same depth and size for each system. The concordance was estimated using the Lin's concordance correlation coefficient (CCC), the r Pearson's correlation coefficient, the bias-correction factor (Cb), and the Bland-Altman method.Results-The ACs varied from 0.45 to 1.0 dB/cm/MHz for the Philips system and 0.30 to 0.96 dB/cm/MHz for the Canon system. The CCC (95% CI) was 0.792 (0.666-0.918), Pearson's r was 0.839 with Cb of 0.944, and the mean difference was 0.03 (À0.101; 0.162) suggesting the 2 methods are considered to be in agreement. Based on a Philips confidence map to determine the best location for performing the measurements, a depth of 3.5 to 4.0 cm from the liver capsule was determined, which might be significantly different than that of the Canon system.Conclusions-Estimation of the AC of the 2 systems showed a high agreement, that is, a similar trend. Assessment of the placement of the measurement box based on the quality of the measurement might be different between the 2 systems.

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Assessment of chronic liver disease by multiparametric ultrasound: results from a private practice outpatient facility

Cited by 9 publications

References 41 publications

Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis

Correlation between hepatorenal index and attenuation imaging for assessing hepatic steatosis

Interobserver Variability in Ultrasound‐Based Liver Fat Quantification

A Pre‐Release Algorithm With a Confidence Map for Estimating the Attenuation Coefficient for Liver Fat Quantification

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