Non-invasive imaging biomarkers to assess nonalcoholic fatty liver disease: A review

Trujillo, Michael J.; Chen, Johnson; Rubin, Jonathan M.; Gao, Jing

doi:10.1016/j.clinimag.2021.02.039

Cited by 15 publications

(10 citation statements)

References 75 publications

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“…Past attempts at NAFLD evaluation were limited by the inclusion of non-specific markers as surrogates for steatosis, such as high ALT levels [ 31 ]. On the other hand, NAFLD cohorts based on liver biopsy are generally smaller in size and do not represent an asymptomatic population [ 20 , 32 , 33 ]. Apart from the associated risks and invasiveness, sample error and cost would also limit a large cohort based on biopsy investigation.…”

Section: Discussionmentioning

confidence: 99%

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Correlation between CT Abdominal Anthropometric Measurements and Liver Density in Individuals with Non-Alcoholic Fatty Liver Disease

et al. 2023

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Background: With a growing frequency, nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. NAFLD has a strong correlation with other metabolic disorders, such as obesity, particularly abdominal obesity, even though the underlying causes or risk factors are not entirely understood. This study aims to investigate correlations between abdominal anthropometric measurements and the presence and intensity of liver steatosis as assessed by unenhanced computed tomography (CT). Methods: One hundred and nineteen patients (male/female, 66/53; mean age 54.54 +/− 12.90 years) underwent abdominal non–contrast-enhanced CT. CT images were examined to determine the attenuation of liver parenchyma, subcutaneous fat depth, and waist circumference (WC). Results: Among all patients, WC (r = −0.78, p < 0.0001), infraumbilical subcutaneous fat thicknesses (r = −0.51, p < 0.0001), right paraumbilical subcutaneous fat thicknesses (r = −0.62, p < 0.0001), and left paraumbilical subcutaneous fat thicknesses (r = −0.53, p < 0.0001) had a high inverse correlation with the liver attenuation values. The presence of T2D (OR: 2.40, p = 0.04), WC (OR: 11.45, p < 0.001), right paraumbilical (OR: 10.09, p < 0.001), left paraumbilical (OR: 2.81, p = 0.01), and infraumbilical (OR: 3.06, p = 0.007) were strongly independent predictors of NAFLD risk. Moreover, regarding the laboratory parameters, only the higher value of GGT (OR: 2.84, p = 0.009) is a predictor of NAFLD risk. Conclusions: Our data show that higher baseline values of all abdominal anthropometric measurements are correlated with liver attenuation and act as predictors of NAFLD risk.

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Section: Discussionmentioning

confidence: 99%

“…Ultrasound assessment, in contrast, is operator-dependent [ 34 ]. A variety of improved MR methods that can precisely evaluate hepatic fat content have recently been developed [ 20 , 32 , 33 , 35 ]. However, large-scale implementation would be constrained by availability and cost.…”

Section: Discussionmentioning

confidence: 99%

Correlation between CT Abdominal Anthropometric Measurements and Liver Density in Individuals with Non-Alcoholic Fatty Liver Disease

et al. 2023

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“…It is not surprising to observe poor reliability in measuring the L/K ratio in the study. Technical challenges in measuring the L/K ratio include, but are not limited to, the anisotropic nature of the kidney cortex (angle‐dependent scattering of signal), anatomic variation (anatomically low kidneys may create greater distance between the liver and kidney), and variation of the image depth of ROI for measuring the L/K ratio between scan sessions and different operators 25 …”

Section: Discussionmentioning

confidence: 99%

“…Technical challenges in measuring the L/K ratio include, but are not limited to, the anisotropic nature of the kidney cortex (angledependent scattering of signal), anatomic variation (anatomically low kidneys may create greater distance between the liver and kidney), and variation of the image depth of ROI for measuring the L/K ratio between scan sessions and different operators. 25 The reliability of measuring multiple ultrasound parameters of the liver is critically important in screening and monitoring the progression for NAFLD. Some considerable factors may help to improve intra-observer and inter-observer reliability in performing multiparametric ultrasound measurements.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Performing Multiparametric Ultrasound in Adult Livers

Gao

Lee

Trujillo

2021

J of Ultrasound Medicine

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Purpose The aim of the study was to test inter‐observer and intra‐observer reliability of measuring multiparametric ultrasound in adult livers. Methods We prospectively measured shear wave velocity (SWV, m/s), shear wave dispersion slope (SWD, m/s/kHz), attenuation coefficient (ATI, dB/cm/MHz), normalized local variance (NLV), and echo intensity ratio of liver to kidney (L/K ratio) in 21 adults who underwent liver magnetic resonance imaging‐proton density fat fraction (MRI‐PDFF). Intraclass correlation coefficient and 95% Bland–Altman limits of agreement (95% LOA) were used to analyze intra‐ and inter‐observer reproducibility. Results Based on liver MRI‐PDFF, 21 participants (8 men and 13 women, mean age 55 years) were divided into group 1 (11 normal livers, MRI‐PDFF <5%) and group 2 (10 steatotic livers, MRI‐PDFF ≥5%). ICCs for intra‐observer repeatability and inter‐observer reproducibility in measuring multiple ultrasound parameters in both normal and steatotic livers were above 0.75. However, 95% confidence interval for measuring SWD in all livers and L/K ratio in normal livers was 0.38–0.90 and 0.47–0.91, respectively. Differences in SWV, SWD, ATI, NLV, L/K ratio, and MRI‐PDFF between participants with and without hepatic steatosis were significant (p < .05), whereas serum biomarkers and body mass index were not (p > .05), based on a two‐tailed t‐test. Conclusions The results suggest that the repeatability and reproducibility for measuring liver SWV, ATI, and NLV are moderate to excellent, while those for SWD and L/K ratio are poor. Standardized machine settings, scanning protocols, and operator training are suggested in performing multiparametric ultrasound of the liver.

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“…Recently, the use of quantitative ultrasound biomarkers, including attenuation coefficient (AC), backscatter coefficient, and ultrasound elastography has been incorporated into the evaluation of tissue ultrasound characteristics and mechanical properties associated with hepatic steatosis (Dioguardi et al 2020;Lee et al 2021;Trujillo et al 2021). However, pathologic progression in the liver is not limited to the aforementioned tissue characteristic changes based on the mechanism and pathology of NAFLD.…”

Section: Introductionmentioning

confidence: 99%

Superb Microvascular Imaging-Based Vascular Index to Assess Adult Hepatic Steatosis: A Feasibility Study

Gao

King

Chatterji

et al. 2022

Ultrasound in Medicine & Biology

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The aim of the study was to assess the feasibility of using a superb microvascular imaging-based vascular index (SMI-VI) for evaluating adult hepatic steatosis. We prospectively compared liver parenchyma SMI-VI (color pixels/total pixels in the region of interest), portal vein velocity, hepatic artery Doppler parameters (peak systolic velocity, end diastolic velocity, resistive index) and serum lipid and alanine aminotransferase (ALT) levels between 16 normal livers and 34 steatotic livers using magnetic resonance imaging-proton density fat fraction (MRI-PDFF) as the reference. On the basis of a two-tailed t-test, differences in SMI-VI, portal vein velocity, MRI-PDFF and ALT between normal (MRI-PDFF <5%) and steatotic (MRI-PDFF 5%) livers were statistically significant (p < 0.02), whereas hepatic artery Doppler parameters and triglyceride levels were not (p > 0.05). We observed an inverse correlation of SMI-VI with MRI-PDFF (r = À0.88). With 0.19 as the best cutoff value, the area under the receiver operating characteristic curve, sensitivity and specificity of SMI-VI for determining mild (MRI-PDFF 5%) non-alcoholic fatty liver disease (NAFLD) were 0.95, 96% and 94%, respectively. Our results indicate the feasibility of using SMI-VI to assess adult hepatic steatosis. SMI-VI is a potential surrogate marker in the screening for NAFLD.

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Non-invasive imaging biomarkers to assess nonalcoholic fatty liver disease: A review

Cited by 15 publications

References 75 publications

Correlation between CT Abdominal Anthropometric Measurements and Liver Density in Individuals with Non-Alcoholic Fatty Liver Disease

Correlation between CT Abdominal Anthropometric Measurements and Liver Density in Individuals with Non-Alcoholic Fatty Liver Disease

Reliability of Performing Multiparametric Ultrasound in Adult Livers

Superb Microvascular Imaging-Based Vascular Index to Assess Adult Hepatic Steatosis: A Feasibility Study

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