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

Abstract

Objectives We aimed to evaluate the accuracy of the hepatorenal index by B‐mode ratio to diagnose hepatic steatosis, compared to ultrasound steatosis score, controlled attenuation parameter, and the fatty liver index using histology as the gold standard. Methods We prospectively included participants with alcohol‐related or nonalcoholic fatty liver disease for same‐day noninvasive investigations and liver biopsy. Results We included 137 participants, 72% male, median age 60 years (53–65) and body mass index 32 kg/m2 (28–38). Eighty percent had steatosis (S0/S1/S2/S3 = 20/37/24/19%). B‐mode ratio had moderate diagnostic accuracy for any steatosis (≥S1, area under the receiver operating characteristics curve [AUROC] = 0.79; 95% confidence interval 0.70–0.88), significant steatosis (≥S2, AUROC = 0.76; 0.66–0.85), and severe steatosis (=S3, AUROC = 0.74; 0.62–0.86), independent of disease etiology. The cutoff values to rule‐out and rule‐in any steatosis were 1.09 and 1.45. While B‐mode ratio and controlled attenuation parameter correlated poorly, their diagnostic accuracies were comparable to each other and to ultrasound steatosis scoring. Fatty liver index did not differ from B‐mode ratio in detecting any steatosis but had poor accuracy to detect higher steatosis grades. B‐mode ratio measurements failed in 12% of patients, compared to 1% for ultrasound steatosis scoring and 2% for controlled attenuation parameter. Conclusion The hepatorenal index by B‐mode ratio diagnose steatosis with moderate accuracy in patients with alcohol‐related or nonalcoholic fatty liver disease, comparable to B‐mode ultrasound steatosis scoring and controlled attenuation parameter. However, its clinical use is limited by a high failure rate.

Revisiting the Hepatorenal Index in the Quantification of Hepatic Steatosis: How it is done and the utility

“…Therefore, patients with right renal agenesis, right ectopic kidney, or who have undergone a right nephrectomy are not eligible for this examination. In addition to this limitation, HRI cannot be a reliable measurement for patients with renal conditions such as chronic kidney disease 10 . Patients with renal atrophy would also limit the accuracy of the HRI 7 due to the smaller renal cortex, which poses a more significant limitation for those with a fixed ROI size.…”

“…In addition, the system will often allow the user to change the ROI size with a maximum diameter allowed. 10 There needed to be more discussion about the importance of the ROI size and the impact on the results, but in one article, it was listed as a limitation. Not all patients will have a homogenous or diffuse liver fat distribution, which limits the ability to average all the fat content of the liver even when using multiple ROIs with size limits.…”

Prospective study comparing hepatic steatosis assessment by magnetic resonance imaging and four ultrasound methods in 105 successive patients

“…In our study, HRI performed the best with a cut-off of 1.30. Previously described cut-off for the detection of any grade steatosis may vary in the literature from 1.22 to 1.49, influenced by system settings and different gold standards, and thus limiting HRI reproducibility and applicability[ 21 , 28 , 30 - 32 ].…”

Modern ultrasonic methods of diagnostics of hepatic steatosis

“…Так, в работе M. Kjaergaard et al с помощью ROC-анализа проводилось сравнение диагностической эффективности качественных, количественных (ГРИ, САР) ультразвуковых подходов в оценке стеатоза печени, а также лабораторных индексов (fatty liver index, FLI) (табл. 2) [25]. В данном когортном исследовании приняло участие 137 пациентов с алкогольной и неалкогольной жировой болезнью печени.…”

“…Оптимальное отрезное значение ГРИ для диагностики стеатоза печени (≥ S1) независимо от этиологии равнялось 1,46. ГРИ и САР демонстрировали более высокие значения АUC в оценке умеренного (≥ S2) и тяжелого (= S3) стеатоза в отличие от FLI, что еще раз подчеркивает важность использования количественного ультразвукового подхода в определении тяжести стеатоза печени [25].…”