Relationship Between Greyscale Ultrasound Grading of Hepatic Steatosis and Attenuation Imaging

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed. Method A total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI’s diagnostic capability and cutoff values. Result The correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p < 0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively. Conclusions Attenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.

Validation of attenuation imaging coefficient, shear wave elastography, and dispersion as emerging tools for non-invasive evaluation of liver tissue in children

“…During adolescence, we observed a broad inter-individual variation in ATI values. In late adolescence, mean values of 0.49 [dB/cm/Mhz] were observed corresponding to published data from adult cohorts (0.485–0.60 [dB/cm/Mhz] ( 16 , 21 – 23 , 25 , 27 , 30 , 56 );.…”

“…Studies on ATI measurements of liver parenchyma in adults indicate its ability to detect and quantify steatosis and to differentiate between mild, moderate, and severe grades ( 21 – 27 ). Furthermore, ATI correlates with the results of MRI-PDFF (magnetic resonance imaging proton density fat fraction) and histopathology representing the gold standard for fat measurement in liver parenchyma ( 22 , 26 , 28 , 29 ) and with grayscale grading ( 30 ). In this respect, it also surpasses CAP (controlled attenuation parameter) based on FibroScan® systems ( 30 – 32 ).…”

“…Furthermore, ATI correlates with the results of MRI-PDFF (magnetic resonance imaging proton density fat fraction) and histopathology representing the gold standard for fat measurement in liver parenchyma ( 22 , 26 , 28 , 29 ) and with grayscale grading ( 30 ). In this respect, it also surpasses CAP (controlled attenuation parameter) based on FibroScan® systems ( 30 – 32 ).…”