Multiparametric ultrasound imaging for the assessment of normal versus steatotic livers

Basavarajappa, Lokesh; Baek, Jihye; Reddy, Shreya; Song, Jinmei; Tai, Haowei; Rijal, Girdhari; Parker, Kevin J.; Hoyt, Kenneth

doi:10.1038/s41598-021-82153-z

Cited by 37 publications

(18 citation statements)

References 60 publications

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“…Recently, it has been demonstrated that MPUS examinations have the potential to provide a comprehensive estimation of the main components of early-stage NAFLD [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

et al. 2021

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Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. This study aimed to evaluate the performance of four ultrasound-based techniques for the non-invasive multiparametric (MPUS) assessment of liver fibrosis (LF), steatosis (HS), and inflammation in patients with NAFLD. We included 215 consecutive adult patients with NAFLD (mean age: 54.9 ± 11.7; 54.5% were male), in whom LF, HS, and viscosity were evaluated in the same session using four new ultrasound-based techniques embedded on the Aixplorer MACH 30 system: ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave UltraSound (SSp.PLUS), Attenuation Plane-wave UltraSound (Att.PLUS), and Viscosity Plane-wave UltraSound (Vi.PLUS). Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan) were considered as control. All elastographic measurements were performed according to guidelines. Valid liver stiffness measurements (LSM) were obtained in 98.6% of patients by TE, in 95.8% of patients by 2D-SWE.PLUS/Vi.PLUS, and in 98.1% of patients by Att.PLUS/SSp.PLUS, respectively. Therefore, 204 subjects were included in the final analysis. A strong correlation between LSMs by 2D-SWE.PLUS and TE (r = 0.89) was found. The best 2D-SWE.PLUS cut-off value for the presence of significant fibrosis (F ≥ 2) was 7 kPa. Regarding steatosis, SSp.PLUS correlated better than Att.PLUS with CAP values: (r = −0.74) vs. (r = 0.45). The best SSp.PLUS cut-off value for predicting the presence of significant steatosis was 1524 m/s. The multivariate regression analysis showed that Vi.PLUS values were associated with BMI and LSM by 2D-SWE.PLUS. In conclusion, MPUS was useful for assessing fibrosis, steatosis, and inflammation in a single examination in patients with NAFLD.

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“…Recently, it has been demonstrated that MPUS examinations have the potential to provide a comprehensive estimation of the main components of early-stage NAFLD [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

et al. 2021

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“…Unfortunately, 3D data are best appreciated with the assistance of an interactive graphics tool and 3D displays. Furthermore, in many studies, we have more than three measured parameters, including first order statistics, shear wave elastography, and contrast parameters 16,19,20 . In these cases, we cannot directly visualize a higher multidimensional space, and so require a strategy for reducing these.…”

Section: Resultsmentioning

confidence: 99%

“…Alternatively, the M parameters can be directly used for imaging since SVM and inner product apply in a straightforward manner to M ‐dimensional inputs. Examples of multiparametric analysis ( M > 3) utilizing PCA and SVM are found in previous studies 16,19,20 …”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] When extended to subresolvable scattering properties, this enables an assessment of the measured parameters that provide the highest discrimination between groups: for example responders and non-responders to chemotherapy 17 ; normal and abnormal liver conditions. [18][19][20] We propose that the diagnostic value of multiparametric ultrasound measures can be advanced by combining the following concepts:…”

Section: R E S E a R C H A R T I C L E H-scan Trajectories Indicate The Progression Of Specific Diseasesmentioning

confidence: 99%

“…At a higher level of complexity lies the ability to estimate multiple parameters over time 13‐16 . When extended to subresolvable scattering properties, this enables an assessment of the measured parameters that provide the highest discrimination between groups: for example responders and non‐responders to chemotherapy 17 ; normal and abnormal liver conditions 18‐20 …”

Section: Introductionmentioning

confidence: 99%

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H‐scan trajectories indicate the progression of specific diseases

Baek

Parker

2021

Medical Physics

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Purpose The ability of ultrasound to assess pathology is increasing with the development of quantitative parameters. Among these are a set of parameters derived from the recent H‐scan analysis of subresolvable scattering. The emergence of these quantitative measures of tissue/ultrasound interactions now enables a study of the unique trajectories of multiparametric features in multidimensional space, representing the progression of specific diseases over time. We develop the mathematical and visual tools that are effective for classifying, quantifying, and visualizing the steady progression of several diseases from independent studies, all within a uniform framework. Methods After applying the H‐scan analysis of ultrasound echoes, we trained a support vector machine (SVM) to classify the unique trajectories of progressive liver disease from fibrosis, steatosis, and pancreatic ductal adenocarcinoma (PDAC) metastasis. Our approaches include the development of trajectory maps and disease‐specific color imaging stains. Results The multidimensional SVM image classification reached 100% accuracy across the three different studies. Conclusion H‐scan trajectories can be useful to track the progression of multiple classes of diseases, improving diagnosis, staging, and assessing the response to therapy.

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Multiparametric ultrasound imaging for early‐stage steatosis: Comparison with magnetic resonance imaging‐based proton density fat fraction

Baek,

Basavarajappa,

Margolis

et al. 2023

Medical Physics

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BackgroundThe prevalence of liver diseases, especially steatosis, requires a more convenient and noninvasive tool for liver diagnosis, which can be a surrogate for the gold standard biopsy. Magnetic resonance (MR) measurement offers potential, however ultrasound (US) has better accessibility than MR.PurposeThis study aims to suggest a multiparametric US approach which demonstrates better quantification and imaging performance than MR imaging‐based proton density fat fraction (MRI‐PDFF) for hepatic steatosis assessment.MethodsWe investigated early‐stage steatosis to evaluate our approach. An in vivo (within the living) animal study was performed. Fat inclusions were accumulated in the animal livers by feeding a methionine and choline deficient (MCD) diet for 2 weeks. The animals (n = 19) underwent US and MR imaging, and then their livers were excised for histological staining. From the US, MR, and histology images, fat accumulation levels were measured and compared: multiple US parameters; MRI‐PDFF; histology fat percentages. Seven individual US parameters were extracted using B‐mode measurement, Burr distribution estimation, attenuation estimation, H‐scan analysis, and shear wave elastography. Feature selection was performed, and the selected US features were combined, providing quantification of fat accumulation. The combined parameter was used for visualizing the localized probability of fat accumulation level in the liver; This procedure is known as disease‐specific imaging (DSI).ResultsThe combined US parameter can sensitively assess fat accumulation levels, which is highly correlated with histology fat percentage (R = 0.93, p‐value < 0.05) and outperforms the correlation between MRI‐PDFF and histology (R = 0.89, p‐value < 0.05). Although the seven individual US parameters showed lower correlation with histology compared to MRI‐PDFF, the multiparametric analysis enabled US to outperform MR. Furthermore, this approach allowed DSI to detect and display gradual increases in fat accumulation. From the imaging output, we measured the color‐highlighted area representing fatty tissues, and the fat fraction obtained from DSI and histology showed strong agreement (R = 0.93, p‐value < 0.05).ConclusionsWe demonstrated that fat quantification utilizing a combination of multiple US parameters achieved higher performance than MRI‐PDFF; therefore, our multiparametric analysis successfully combined selected features for hepatic steatosis characterization. We anticipate clinical use of our proposed multiparametric US analysis, which could be beneficial in assessing steatosis in humans.

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Multiparametric ultrasound imaging for the assessment of normal versus steatotic livers

Cited by 37 publications

References 60 publications

Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

H‐scan trajectories indicate the progression of specific diseases

Multiparametric ultrasound imaging for early‐stage steatosis: Comparison with magnetic resonance imaging‐based proton density fat fraction

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