Evaluation of the Hepatorenal B-Mode Ratio and the “Controlled Attenuation Parameter” for the Detection and Grading of Steatosis

Abstract

Purpose The aim of this study was to evaluate the hepatorenal index ratio of Supersonic Imagine (B-mode ratio) and the controlled attenuation parameter (CAP) of FibroScan for the noninvasive diagnosis and grading of steatosis. Materials and Methods Two centers prospectively included patients who underwent liver biopsy, B-mode ratio and CAP evaluation all on the same day between June 2017 and July 2019. MRI and histological morphometry were also performed in center 1. Histology (classic semiquantitative score and morphometry) was used as the reference. Results Concerning the B-mode ratio, the AUROCs for ≥ S1, ≥ S2 and ≥ S3 were respectively 0.896 ± 0.20, 0.775 ± 0.30 and 0.729 ± 0.39 with the best cut-off values being 1.22 for ≥ S1 (Se = 76.4 %, Sp = 93.2 %), 1.42 for ≥ S2 (Se = 70.2 %, Sp = 71.2 %) and 1.54 for ≥ S3 (Se = 68.4 %, Sp = 69.8 %). The correlation between the B-mode ratio and morphometry was moderate (Rs = 0.575, p < 0.001) and the correlation between the B-mode ratio and MRI was good (Rs = 0.613, p < 0.001). Concerning the CAP, the AUROCs for ≥ S1, ≥ S2 and ≥ S3 were 0.926 ± 0.18, 0.760 ± 0.30 and 0.701 ± 0.40, respectively, with the best cut-off values being 271 dB/m for ≥ S1 (Se = 84 %, Sp = 88.2 %), 331 dB/m for ≥ S2 (Se = 64.5 %, Sp = 74.7 %) and 355 dB/m for ≥ S3 (Se = 55.3 %, Sp = 75.1 %). The correlation between the CAP and morphometry and between the CAP and MRI was moderate in both cases (Rs = 0.526, p < 0.001 and Rs = 0.397, p < 0.001, respectively). The B-mode ratio was better at ruling in and the CAP was better at ruling out the disease. Conclusion B-mode ratio and CAP show similar and good performance for the diagnosis of steatosis (≥ S1). However, both techniques are limited with respect to differentiating mild to moderate (≥ S2) or severe (≥ S3) steatosis.

Quantitative ultrasound, elastography, and machine learning for assessment of steatosis, inflammation, and fibrosis in chronic liver disease

“…Features that did not perform well as stand-alone features could nonetheless improve classification performance when combined with other features, although this makes physical interpretation of their contribution more difficult to analyze. Our proposed method compares favorably with recent results reported by Moret et al for two state-of-the-art techniques: hepatorenal index ratio with AUCs of 0.90 for S0 vs. S1-3, 0.78 for S0-1 vs. S2-3, and 0.73 for S0-2 vs. S3 and controlled attenuation parameter (CAP) with AUCs of 0.93 for S0 vs. S1-3, 0.76 for S0-1 vs. S2-3, and 0.70 for S0-2 vs. S3 [ 53 ].…”

Cystic fibrosis-related liver disease: Clinical presentations, diagnostic and monitoring approaches in the era of CFTR modulator therapies

“…steatosis [70]. Additional ultrasound tools can be helpful in identifying steatosis, but must be validated in CF in particular, the attenuation coefficient based on the ultrasound attenuation of the echo wave by the steatotic liver (like the controlled attenuation coefficient in transient elastography (TE)) as well as the hepatorenal B-mode ratio, defined as the ratio of the echogenicity of the liver parenchyma to the renal cortex [71,72]. Moreover, MRI can provide non-invasive quantification of steatosis in the entire liver.…”

Hepatorenal Index by B‐Mode Ratio Versus Imaging and Fatty Liver Index to Diagnose Steatosis in Alcohol‐Related and Nonalcoholic Fatty Liver Disease

“…19,21,22 Moret and colleagues recently investigated the HRI by B-mode ratio with a slightly better diagnostic accuracy to diagnose any steatosis (≥S1), but similar results to diagnose higher degrees of steatosis. 22 Unlike previous studies, we did not exclusively look at high-quality images, which could contribute to the lower accuracy in our study. However, to relate the results to clinical practice, we believe that it is important to include all participants regardless of image quality.…”