Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort

Burgio, Marco Dioguardi; Ronot, Maxime; Reizine, Edouard; Rautou, Pierre‐Emmanuel; Castéra, Laurent; Paradis, Valérie; Garteiser, Philippe; Beers, Bernard E. Van; Vilgrain, Valérie

doi:10.1007/s00330-019-06480-6

Cited by 79 publications

(48 citation statements)

References 28 publications

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“…Interestingly, in a series of 101 patients scheduled for liver biopsy for mixed etiologies of liver disease, in which ATI‐Pen was used, the same cutoff found in our study for diagnosing any grade of steatosis (S1–S3) was obtained, with sensitivity and specificity of 76% and 86%, respectively 23 . As in the study by Dioguardi Burgio et al, 23 we used the ATI quality factor recommended by the manufacturer: ie, an R 2 value of 0.90 or higher.…”

Section: Discussionsupporting

confidence: 73%

“…Attenuation Imaging is a novel technology, and few studies have been published to date 13,18–23 . Interestingly, in a series of 101 patients scheduled for liver biopsy for mixed etiologies of liver disease, in which ATI‐Pen was used, the same cutoff found in our study for diagnosing any grade of steatosis (S1–S3) was obtained, with sensitivity and specificity of 76% and 86%, respectively 23 .…”

Section: Discussionsupporting

confidence: 64%

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Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis

Ferraioli

Maiocchi

Savietto

et al. 2020

J of Ultrasound Medicine

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Objectives The main aim was to assess the performance and cutoff value for the detection of liver steatosis (grade S > 0) with the Attenuation Imaging–Penetration (ATI‐Pen) algorithm available on the Aplio i‐series ultrasound systems (Canon Medical Systems, Otawara, Japan). The magnetic resonance imaging–derived proton density fat fraction (MRI‐PDFF) was used as the reference standard. Secondary aims were to compare the results to those obtained with the previous ATI algorithm (Attenuation Imaging–General [ATI‐Gen]) and with the controlled attenuation parameter (CAP) and to generate a regression equation between ATI‐Pen and ATI‐Gen values. Methods Consecutive adult patients potentially at risk of liver steatosis were prospectively enrolled. Each patient underwent ultrasound quantification of liver steatosis with ATI‐Pen and ATI‐Gen and a CAP assessment with the FibroScan system (Echosens, Paris, France). The MRI‐PDFF evaluation was performed within a week. The correlations between ATI‐Pen, ATI‐Gen, the CAP, and the MRI‐PDFF were analyzed with the Pearson rank correlation coefficient. The diagnostic performance of ATI‐Pen, ATI‐Gen, and the CAP was assessed with receiver operating characteristic curves and an area under the receiver operating characteristic curve (AUROC) analysis. Results Seventy‐two individuals (31 male and 41 female) were enrolled. Correlation coefficients of ATI‐Pen, ATI‐Gen, and the CAP with the MRI‐PDFF were 0.78, 0.83, and 0.58, respectively. The AUROCs of ATI‐Pen, ATI‐Gen, and the CAP for detecting steatosis (S > 0) were 0.90 (95% confidence interval, 0.81–0.96), 0.92 (0.82–0.98), and 0.85 (0.74–0.92), and the cutoffs were greater than 0.69 dB/cm/MHz, greater than 0.62 dB/cm/MHz, and greater than 273 dB/m. The regression equation between ATI‐Pen and ATI‐Gen was ATI‐Pen = 0.88 ATI‐Gen + 0.13. Conclusions Attenuation Imaging is a reliable tool for detecting liver steatosis, showing an excellent correlation with the MRI‐PDFF and high performance with AUROCs of 0.90 or higher.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 64%

Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis

Ferraioli

Maiocchi

Savietto

et al. 2020

J of Ultrasound Medicine

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“…However, FibroScan is not an imaging modality and it requires a dedicated probe. Recently, attenuation imaging (ATI) has been developed as a new ultrasound‐based method for the assessment of hepatic steatosis 22–26 . ATI makes it possible to define the region of interest for attenuation measurement in the liver and to quantitatively assess hepatic steatosis using ultrasound imaging.…”

Section: Introductionmentioning

confidence: 99%

Attenuation imaging based on ultrasound technology for assessment of hepatic steatosis: A comparison with magnetic resonance imaging‐determined proton density fat fraction

Tada

Kumada

Toyoda

et al. 2020

Hepatology Research

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Aim: A new method has recently been developed for diagnosing hepatic steatosis based on attenuation measurement using ultrasound. We investigated the ability of attenuation imaging (ATI) to detect steatosis that was identified by proton density fat fraction (PDFF) on magnetic resonance imaging (MRI) in patients with chronic liver disease. Methods: A total of 119 patients with chronic liver disease (non-B, non-C) were analyzed. The relationship between ATI values and steatosis grades determined by PDFF was evaluated. Additionally, the diagnostic ability of ATI was evaluated using receiver operating characteristic curve analysis, and the correlation between ATI values and PDFF values was determined. Results: The ATI values of steatosis grades 0, 1, 2, and 3 were 0.55, 0.61, 0.74, and 0.84 dB/cm/MHz, respectively (P<0.001). There was a statistically significant trend of higher ATI values with higher steatosis grades (P<0.001). The correlation coefficient (r) between PDFF values and ATI values was 0.70 (95% confidence interval [CI] 0.59-0.78; P<0.001), corresponding to a strong relationship. The diagnostic ability of ATI for steatosis grades ≥1, ≥2, and 3, as determined by PDFF, were 0.81 (95% CI 0.73-0.89), 0.87 (95% CI 0.79-0.96), and 0.94 (95% CI 0.89-0.98), respectively. The r between PDFF values and ATI values was 0.49 (95% CI 0.31-0.63; P<0.001) for patients with mild or no steatosis (grade ≤1), and 0.75 (95% CI 0.57-0.86; P<0.001) for obese patients (body mass index ≥25 kg/m 2). Conclusion: ATI values had an excellent diagnostic ability to detect hepatic steatosis.

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“…Another recent study conducted on 101 patients found out that an AC of > 0.69 dB/cm/MHz showed sensitivity and specificity values of 76%and 86%, respectively, for diagnosing steatosis (S1–S3), and AC > 0.72 dB/cm/MHz had sensitivity and specificity values of 96% and 74%, respectively, for diagnosing steatosis of grade S2–S3. The concomitant presence of advanced fibrosis (F3–F4) did not influenced the AC values[ 49 ]. Hence, the AC is a promising quantitative technique for the noninvasive diagnosis and quantification of liver steatosis.…”

Section: Attenuation Imagingmentioning

confidence: 99%

New frontiers in liver ultrasound: From mono to multi parametricity

Bartolotta¹,

Taibbi²,

Randazzo³

et al. 2021

WJGO

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Modern liver ultrasonography (US) has become a “one-stop shop” able to provide not only anatomic and morphologic but also functional information about vascularity, stiffness and other various liver tissue properties. Modern US techniques allow a quantitative assessment of various liver diseases. US scanning is no more limited to the visualized plane, but three-dimensional, volumetric acquisition and consequent post-processing are also possible. Further, US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations. Effective and safe microbubble-based contrast agents allow a real time, dynamic study of contrast kinetic for the detection and characterization of focal liver lesions. Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies. Microbubbles may also carry and deliver drugs under ultrasound exposure. US plays a crucial role in diagnosing, treating and monitoring focal and diffuse liver disease. On the basis of personal experience and literature data, this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.

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Quantification of hepatic steatosis with ultrasound: promising role of attenuation imaging coefficient in a biopsy-proven cohort

Cited by 79 publications

References 28 publications

Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis

Performance of the Attenuation Imaging Technology in the Detection of Liver Steatosis

Attenuation imaging based on ultrasound technology for assessment of hepatic steatosis: A comparison with magnetic resonance imaging‐determined proton density fat fraction

New frontiers in liver ultrasound: From mono to multi parametricity

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