The use of ultrasound to diagnose hepatic steatosis in type 2 diabetes: Intra- and interobserver variability and comparison with magnetic resonance spectroscopy

Williamson, R.; Perry, Elisa; Glancy, Stephen; Marshall, Ian; Gray, Calum; Nee, Lisa D.; Hayes, Peter; Forbes, Shareen; Frier, B M; Johnston, Geoffrey I.; Lee, A J; Reynolds, Rebecca M.; Price, Jackie F.; Strachan, Mark W. J.; investigators, Edinburgh Type Diabetes Study

doi:10.1016/j.crad.2010.09.021

Cited by 32 publications

(30 citation statements)

References 21 publications

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“…Several studies have been published on the interobserver agreement of CUS for grading steatosis [7, 11, 12]. Our finding that CUS observers were in agreement 53.3% of the time is within range of previous studies reporting 40–64% interobserver agreement [11, 12]; however, our interobserver CUS kappa value of 0.61 was higher than the kappa value range of 0.20–0.54 reported previously [7, 11, 12]. …”

Section: Discussionmentioning

confidence: 99%

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A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease

Paige

Bernstein

Heba

et al. 2017

American Journal of Roentgenology

129

102

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OBJECTIVE The purpose of this study is to explore the diagnostic performance of two investigational quantitative ultrasound (QUS) parameters, attenuation coefficient and backscatter coefficient, in comparison with conventional ultrasound (CUS) and MRI-estimated proton density fat fraction (PDFF) for predicting histology-confirmed steatosis grade in adults with nonalcoholic fatty liver disease (NAFLD). SUBJECTS AND METHODS In this prospectively designed pilot study, 61 adults with histology-confirmed NAFLD were enrolled from September 2012 to February 2014. Subjects underwent QUS, CUS, and MRI examinations within 100 days of clinical-care liver biopsy. QUS parameters (attenuation coefficient and backscatter coefficient) were estimated using a reference phantom technique by two analysts independently. Three-point ordinal CUS scores intended to predict steatosis grade (1, 2, or 3) were generated independently by two radiologists on the basis of QUS features. PDFF was estimated using an advanced chemical shift–based MRI technique. Using histologic examination as the reference standard, ROC analysis was performed. Optimal attenuation coefficient, backscatter coefficient, and PDFF cutoff thresholds were identified, and the accuracy of attenuation coefficient, backscatter coefficient, PDFF, and CUS to predict steatosis grade was determined. Interobserver agreement for attenuation coefficient, backscatter coefficient, and CUS was analyzed. RESULTS CUS had 51.7% grading accuracy. The raw and cross-validated steatosis grading accuracies were 61.7% and 55.0%, respectively, for attenuation coefficient, 68.3% and 68.3% for backscatter coefficient, and 76.7% and 71.3% for MRI-estimated PDFF. Interobserver agreements were 53.3% for CUS (κ = 0.61), 90.0% for attenuation coefficient (κ = 0.87), and 71.7% for backscatter coefficient (κ = 0.82) (p < 0.0001 for all). CONCLUSION Preliminary observations suggest that QUS parameters may be more accurate and provide higher interobserver agreement than CUS for predicting hepatic steatosis grade in patients with NAFLD.

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Section: Discussionmentioning

confidence: 99%

“…Because CUS is assessed using qualitative features, interpretation is subjective, as well as both machine and operator dependent. Because, in part, of these limitations, CUS has limited accuracy [8–10] and high interobserver variability [7, 11, 12] for assessing hepatic steatosis.…”

mentioning

confidence: 99%

A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease

Paige

Bernstein

Heba

et al. 2017

American Journal of Roentgenology

129

102

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“…Kim et al found significant associations between the NFS, APRI and FIB4 with cardiovascular mortality in a general population [42]. Our study used all these, as well as the ELF score, an extracellular matrix-related multi-component panel (HA, P3NP and TIMP-1), validated for use in patients with NAFLD [20], and found no relationship.…”

Section: Discussionmentioning

confidence: 84%

“…All patients underwent a liver ultrasound scan at the 1 year visit. Sonographic grading of hepatic steatosis was performed using standard criteria, as described previously, following validation against proton magnetic resonance spectroscopy [20]. …”

Section: Methodsmentioning

confidence: 99%

γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study

et al. 2015

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Aims/hypothesisWe examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions.Methods1,066 participants with type 2 diabetes aged 60–75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events.ResultsAt baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with γ-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD.Conclusions/interpretationAn independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-015-3575-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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“…Multiple imaging methods like US, CT, MRI, and 1H-MRS have been used to detect and quantify hepatic steatosis non-invasively [11, 14, 24, 36–38]. Non-contrast CT is an easy and widely available method for estimation of IHL content [14–16], with the advantage for IHL quantification in studies obtained for different purposes, such as virtual colonography [14].…”

Section: Discussionmentioning

confidence: 99%

Short- and Long-Term Reproducibility of Intrahepatic Lipid Quantification by 1H-MR Spectroscopy and CT in Obesity

Dichtel

Eajazi²,

Miller³

et al. 2016

Journal of Computer Assisted Tomography

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Objective To assess short- and long-term reproducibility of intrahepatic lipid (IHL) quantification by 1H-MRS and CT. Methods Sixteen obese subjects underwent 1H-MRS using a single-voxel PRESS sequence at 3T and non-contrast single-slice CT of the liver. Measurements were repeated after 6 weeks and 6 months. Clinical parameters (weight, activity, serum lipids) were collected. Short-term (baseline-6-weeks) and long-term (baseline-6-month) reproducibility of IHL was assessed by coefficient of variance (CV), standard deviation (SD), and intraclass correlation coefficient (ICC). Results Short-and long-term reproducibility of 1H-MRS were as follows: CV 5.9–18.8%, SD 0.7–1.9 and ICC 0.998–0.995 (95% CI 0.942–0.999). Short- and long-term reproducibility of CT were as follows: CV 4.4–14.2%, SD 2.4–8.7 and ICC 0.766–0.982 (95% CI 0.271–0.994). There was no significant change in clinical parameters (p>0.3). Conclusions 1H-MRS and CT are reproducible methods for short- and long-term quantification of IHL content. Our results can guide sample size calculations for interventional and longitudinal studies.

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The use of ultrasound to diagnose hepatic steatosis in type 2 diabetes: Intra- and interobserver variability and comparison with magnetic resonance spectroscopy

Cited by 32 publications

References 21 publications

A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease

A Pilot Comparative Study of Quantitative Ultrasound, Conventional Ultrasound, and MRI for Predicting Histology-Determined Steatosis Grade in Adult Nonalcoholic Fatty Liver Disease

γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study

Short- and Long-Term Reproducibility of Intrahepatic Lipid Quantification by 1H-MR Spectroscopy and CT in Obesity

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