Diagnostic performance of ultrasound attenuation imaging for assessing low-grade hepatic steatosis

Jang, Jong Keon; Kim, So Yeon; Yoo, In Woon; Cho, Young Bum; Kang, Hyo Jeong; Lee, Dong Hoon

doi:10.1007/s00330-021-08269-y

Cited by 23 publications

(21 citation statements)

References 42 publications

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“…The diagnostic performance of ATI in a pediatric population in this study was comparable to the values reported in adult populations [ 15 , 16 , 27 , 28 ]. A previous study that included 48 pediatric patients also showed that AC had good diagnostic performance in comparison with a reference standard of MRI-PDFF, with a sensitivity of 0.80 and a specificity of 0.98 using an AC threshold of 0.60 dB/cm/MHz [ 29 ].…”

Section: Discussionsupporting

confidence: 84%

“…grayscale US image, has shown acceptable accuracy in the detection of fatty liver in adult populations [14][15][16]. As ATI enables hepatic fat quantification during a single-sitting US examination, it has a potential role in pediatric populations.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

“…In recent studies, attenuation imaging (ATI), a two-dimensional US-based fat-quantification technique that measures the attenuation coefficient (AC) within a region of interest (ROI) placed on a grayscale US image, has shown acceptable accuracy in the detection of fatty liver in adult populations [ 14 - 16 ]. As ATI enables hepatic fat quantification during a single-sitting US examination, it has a potential role in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

et al. 2022

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To evaluate the accuracy of attenuation imaging (ATI) for assessment of hepatic steatosis in a pediatric population, comparing it with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP). Methods:Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using Spearman's test. The AC cut-off value for discriminating hepatic steatosis corresponding to a CAP value of 241dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of association between AC and CAP. The diagnostic accuracy of AC cut-offs was estimated using imperfect gold standard methodology based on a two-level Bayesian latent class model. Results:Seventy patients (median age [interquartile range], 12.5 years [11.0-14.0]; male:female, 58:12) were included. A moderate-to-good correlation was observed between AC and CAP (ρ=0.646; P<0.001). Multivariable regression analysis affirmed the significant association between AC and CAP (P<0.001). The correlation was not evident in a subgroup of patients with a BMI ≥30kg/m 2 (ρ=−0.202; P=0.551). Linear regression revealed that an AC cut-off of 0.66dB/cm/MHz corresponded to a CAP of 241dB/m. This AC cut-off showed sensitivity of 0.93 (95% CI, 0.85-0.98) and specificity of 0.87 (95% CI, 0.56-1.00). Conclusion:ATI showed acceptable correlation with CAP values in a pediatric population, especially in patients with a BMI <30kg/m 2 . An AC cut-off of 0.66dB/cm/MHz, corresponding to a CAP of 241dB/m, can accurately diagnose liver steatosis.

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Section: Discussionsupporting

confidence: 84%

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

et al. 2022

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“…According to the review by Lewis et al and several subsequently published papers, there are in total 14 studies that have assessed the accuracy of ATI in the quantification of HS compared with the reference methods, as well as their determined cut-offs and AUROC values, which are presented in Table 4 [ 17 , 18 , 19 , 60 , 61 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ]. Several authors have compared ATI with the CAP, but due to its suboptimal performance in quantifying the liver fat content, the latest WFUMB guidelines recommend against using the CAP as the reference standard [ 3 ].…”

Section: Quantitative Ultrasound-based Methodsmentioning

confidence: 99%

Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal

et al. 2022

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The prevalence of the non-alcoholic fatty liver disease has reached major proportions, being estimated to affect one-quarter of the global population. The reference techniques, which include liver biopsy and the magnetic resonance imaging proton density fat fraction, have objective practical and financial limitations to their routine use in the detection and quantification of liver steatosis. Therefore, there has been a rising necessity for the development of new inexpensive, widely applicable and reliable non-invasive diagnostic tools. The controlled attenuation parameter has been considered the point-of-care technique for the assessment of liver steatosis for a long period of time. Recently, many ultrasound (US) system manufacturers have developed proprietary software solutions for the quantification of liver steatosis. Some of these methods have already been extensively tested with very good performance results reported, while others are still under evaluation. This manuscript reviews the currently available US-based methods for diagnosing and grading liver steatosis, including their classification and performance results, with an appraisal of the importance of this armamentarium in daily clinical practice.

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“…ATI calculates the percentage of returned ultrasound energy not absorbed by liver tissue to determine the attenuation by organ tissue. 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)(22)(23)(24)(25)(26)(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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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IntroductionThe number of children with acute and chronic liver disease is rising. Moreover, liver involvement may be limited to subtle changes in organ texture especially in early childhood and some syndromic conditions, such as ciliopathies. Attenuation imaging coefficient (ATI), shear wave elastography (SWE), and dispersion (SWD) are emerging ultrasound technologies providing data about attenuation, elasticity, and viscosity of liver tissue. This additional and qualitative information has been correlated with certain liver pathologies. However, limited data are available for healthy controls and have mainly been raised in adults.MethodsThis prospective monocentric study was conducted at a university hospital with a specialization in pediatric liver disease and transplantation. Between February and July 2021, 129 children aged 0-17.92 years were recruited. Study participants attended outpatient clinics due to minor illnesses excluding liver or cardiac diseases, acute (febrile) infections or other conditions affecting liver tissue and function. ATI, SWE, and SWD measurements were performed on an Aplio i800 (Canon Medical Systems) with an i8CX1 curved transducer by two different investigators with long-standing experience in pediatric ultrasound according to a standardized protocol.ResultsConsidering multiple potential covariates, we derived percentile charts for all 3 devices relying on the Lambda-Mu-Sigma (LMS) approach. 112 children were considered for further analysis, excluding those with abnormal liver function and under-/overweight (BMI SDS<-1.96/> 1.96, respectively). Age range was 0-17.92 years (mean 6.89±0.50SD), 58% were male. The mean duration of the ultrasound examination (basic ultrasound plus SWE, SWD, and ATI) was 6.67±0.22 minutes and it was well tolerated in 83% (n=92) of cases. While ATI was related to age, SWD was found to depend on BMI SDS, and SWE on abdominal wall thickness and sex. ATI correlated with neither SWE nor SWD, but SWE was correlated with SWD.ConclusionsOur study provides norm values and reference charts for ATI, SWE, and SWD considering important covariates including age, sex and, BMI. This may help to implement these promising tools into imaging diagnostics of liver disease and to improve the diagnostic relevance of liver ultrasound. In addition, these noninvasive techniques proved to be time-effective and highly reliable, which make them ideal for application in children.

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Diagnostic performance of ultrasound attenuation imaging for assessing low-grade hepatic steatosis

Cited by 23 publications

References 42 publications

Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

Accuracy of attenuation imaging in the assessment of pediatric hepatic steatosis: correlation with the controlled attenuation parameter

Ultrasound Methods for the Assessment of Liver Steatosis: A Critical Appraisal

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

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