The B-Mode Image-Guided Ultrasound Attenuation Parameter Accurately Detects Hepatic Steatosis in Chronic Liver Disease

Fujiwara, Yoshitaka; Kuroda, Hidekatsu; Abe, Tamami; Ishida, Kazuyuki; Oguri, Tetsuya; Noguchi, Sachiyo; Sugai, Tamotsu; Kamiyama, Naohisa; Takikawa, Yasuhiro

doi:10.1016/j.ultrasmedbio.2018.06.017

Cited by 112 publications

(111 citation statements)

References 38 publications

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“…Considering the large number of patients at risk, which need to be evaluated, and the search for accurate non-invasive assessment methods, proton density fat fraction (PDFF) by MRI recently became an alternative to liver biopsy for the repetitive quantification of liver steatosis [26,27]. Furthermore, encouraging results of quantification techniques for steatosis implemented on ultrasound systems have been published [28][29][30][31]. Currently, VCTE is one of the reference methods used for liver fibrosis assessment in all liver diseases [14,32], but other ultrasound-based elastography techniques (point SWE or 2D-SWE) and magnetic resonance-elastography (MR-E) are also used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience

Sporea

Mare

Popescu

et al. 2020

JCM

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Background: Type 2 diabetes mellitus (T2DM), obesity, hyperlipidemia, and hypertension are considered risk factors for developing non-alcoholic fatty liver disease (NAFLD). This study aims to assess steatosis and fibrosis severity in a cohort of T2DM patients, using vibration controlled transient elastography (VCTE) and controlled attenuation parameter (CAP). Material and method:We performed a prospective study in which, in each patient, we aimed for 10 valid CAP and liver stiffness measurements (LSM). To discriminate between fibrosis stages, we used the following VCTE cut-offs: F ≥ 2-8.2 kPa, F ≥ 3-9.7 kPa, and F4 -13.6 kPa. To discriminate between steatosis stages, we used the following CAP cut-offs: S1 (mild) -274 dB/m, S2 (moderate) -290dB/m, S3 (severe) -302dB/m. Results: During the study period, we screened 776 patients; 60.3% had severe steatosis, while 19.4% had advanced fibrosis. Female gender, BMI, waist circumference, elevated levels of AST, total cholesterol, triglycerides, blood glucose, and high LSM were associated with severe steatosis (all p-value < 0.05). BMI, waist circumference, elevated levels of AST, HbA1c, and CAP were associated with advanced fibrosis (all p-values < 0.05). Conclusion: Higher BMI (obesity) comprises a higher risk of developing severe steatosis and fibrosis. Individualized screening strategies should be established for NAFLD according to different BMI.

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Section: Discussionmentioning

confidence: 99%

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience

Sporea

Mare

Popescu

et al. 2020

JCM

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“…16 Recently, Fujiwara et al reported that attenuation coefficient measurements obtained with UGAP are superior to CAP-based measurements obtained by TE for diagnosing hepatic steatosis grade in patients with chronic liver disease who underwent liver biopsy. 38 They reported that the area under the receiver operating characteristics curve of UGAP and CAP for detecting grade ≥1 steatosis was 0.90 (95% CI 0.83-0.97) and 0.83 (95% CI 0.74-0.91; P = 0.143), 0.95 (95% CI 0.89-0.99) and 0.84 (95% CI 0.73-0.95; P = 0.013) for detecting grade ≥2 steatosis, and 0.96 (95% CI 0.92-1.00) and 0.82 (95% CI 0.70-0.93; P = 0.001) for detecting grade 3 steatosis, respectively. 38 Therefore, in the near future, UGAP is expected to be widely used as a non-invasive and simple method for quantitative assessment of hepatic fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…38 They reported that the area under the receiver operating characteristics curve of UGAP and CAP for detecting grade ≥1 steatosis was 0.90 (95% CI 0.83-0.97) and 0.83 (95% CI 0.74-0.91; P = 0.143), 0.95 (95% CI 0.89-0.99) and 0.84 (95% CI 0.73-0.95; P = 0.013) for detecting grade ≥2 steatosis, and 0.96 (95% CI 0.92-1.00) and 0.82 (95% CI 0.70-0.93; P = 0.001) for detecting grade 3 steatosis, respectively. 38 Therefore, in the near future, UGAP is expected to be widely used as a non-invasive and simple method for quantitative assessment of hepatic fibrosis. Furthermore, we believe that UGAP could be an alternative evaluation method for PDFF.…”

Section: Discussionmentioning

confidence: 99%

Liver stiffness does not affect ultrasound‐guided attenuation coefficient measurement in the evaluation of hepatic steatosis

Tada

Kumada

Toyoda

et al. 2019

Hepatology Research

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Aim Recently, a new method has been developed to diagnose hepatic steatosis with attenuation coefficients based on the ultrasound‐guided attenuation parameter (UGAP). We investigated whether fibrosis identified by hepatic stiffness measurements based on magnetic resonance elastography (MRE) affects attenuation coefficient measurement using UGAP for the evaluation of hepatic steatosis. Methods A total of 608 patients with chronic liver disease were analyzed. Correlations between magnetic resonance imaging‐determined proton density fat fraction (PDFF) or MRE value and attenuation coefficients were evaluated. In addition, the interaction between hepatic fibrosis and the attenuation coefficient was analyzed. Results The correlation coefficient (r) between PDFF values and attenuation coefficient values was 0.724, indicating a strong relationship. Conversely, the r between MRE values and attenuation coefficient values was −0.187, indicating almost no relationship. In the multiple regression assessment of the effect of PDFF and MRE on the attenuation coefficient based on UGAP, the P‐values for PDFF, MRE, and PDFF × MRE were < 0.001, 0.277, and 0.903, respectively. In patients with non‐alcoholic fatty liver disease (n = 169), the r between PDFF values and attenuation coefficient values was 0.695, indicating a moderate relationship. Conversely, the r between MRE values and attenuation coefficient values was −0.068, indicating almost no relationship. In the multiple regression assessment of the effect of PDFF and MRE on the attenuation coefficient based on UGAP, the P‐values for PDFF, MRE, and PDFF × MRE were <0.001, 0.948, and 0.706, respectively. Conclusion UGAP‐determined attenuation coefficient was weakly affected by liver stiffness, an indicator of hepatic fibrosis.

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“…Ultrasound-guided attenuation parameter (UGAP) from General Electric was recently proposed for steatosis quantification. In a paper published by a Japanese group, UGAP was compared with liver biopsy and CAP in a cohort of 163 patients [24]. In this study, the median value of UGAP in patients with S0, S1, S2 and S3 grade steatosis were 0.485, 0.560, 0.660 and 0.720 respectively (increasing with the severity of steatosis), and in the same time, the AUROCs of UGAP for identifying >S1, >S2 and S3 were 0.900, 0.953 and 0.959, respectively, significantly better than the results obtained with CAP.…”

Section: Ultrasound-guided Attenuation Parameter (Ugap)mentioning

confidence: 99%

Quantification of Liver Steatosis

Sporea¹,

Şirli²,

Popescu³

2020

Ultrasound Elastography

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The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is increasing in the modern world. Fatty infiltration of the liver can be assessed by standard ultrasound, by controlled attenuation parameter (CAP) using the FibroScan device or, more recently, by ultrasound systems that evaluate the attenuation in the liver. Standard ultrasound (US) for steatosis evaluation was used for a long time as a semi-quantitative method for steatosis assessment in the liver. A "bright liver" with "posterior attenuation" is the typical US sign of liver steatosis. Considering the attenuation severity, steatosis is subjectively graded as mild, moderate or severe. Using the kidney/liver ratio, a more accurate evaluation can be made. Controlled attenuation parameter (CAP) was developed by EchoSens, France, and implemented into the FibroScan device. CAP manages an objective assessment of steatosis severity with rather good accuracy. More recently, ultrasound companies such as Hitachi, General Electric and Canon, implemented in their system algorithms which allow an objective assessment of liver steatosis, using the attenuation of the ultrasound beams.

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The B-Mode Image-Guided Ultrasound Attenuation Parameter Accurately Detects Hepatic Steatosis in Chronic Liver Disease

Cited by 112 publications

References 38 publications

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience

Screening for Liver Fibrosis and Steatosis in a Large Cohort of Patients with Type 2 Diabetes Using Vibration Controlled Transient Elastography and Controlled Attenuation Parameter in a Single-Center Real-Life Experience

Liver stiffness does not affect ultrasound‐guided attenuation coefficient measurement in the evaluation of hepatic steatosis

Quantification of Liver Steatosis

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