Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2023; 29(23): 3703-3714
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3703
Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index
Kei Funada, Yumi Kusano, Yoshinori Gyotoku, Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano
Kei Funada, Yumi Kusano, Yoshinori Gyotoku, Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
Author contributions: Funada K, Kusano Y, Gyotoku Y and Shirahashi R conceptualized and designed the study, collected data, carried out the initial analysis, and drafted the initial manuscript; Suda T and Tamano M coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was reviewed and approved by the Dokkyo Medical University Saitama Medical Center Institutional Review Board (approval No. 21057).
Clinical trial registration statement: This study is registered at clinical research support office, Dokkyo Medical University Saitama Medical Center. The registration identification number is 21057.
Informed consent statement: Patients were not required to give informed consent for participation in the present study because the analysis used anonymous clinical data that were obtained after each patient gave informed consent to treatment. For full disclosure, the details of this prospective, observational study were published on the home page of the medical center.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masaya Tamano, PhD, Professor, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi 343-8555, Saitama, Japan. mstamano@dokkyomed.ac.jp
Received: February 8, 2023
Peer-review started: February 8, 2023
First decision: March 7, 2023
Revised: March 14, 2023
Accepted: May 22, 2023
Article in press: May 22, 2023
Published online: June 21, 2023
Abstract
BACKGROUND

Shear wave speed (SWS), shear wave dispersion (SWD), and attenuation imaging (ATI) are new diagnostic parameters for non-alcoholic fatty liver disease. To differentiate between non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver (NAFL), we developed a clinical index we refer to as the “NASH pentagon” consisting of the 3 abovementioned parameters, body mass index (BMI), and Fib-4 index.

AIM

To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.

METHODS

This non-invasive, prospective, observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography, SWD, and ATI were measured. Histological diagnosis based on liver biopsy was performed in 31 patients. The large pentagon group (LP group) and the small pentagon group (SP group), using an area of 100 as the cutoff, were compared; the NASH diagnosis rate was also investigated. In patients with a histologically confirmed diagnosis, receiver-operating characteristic (ROC) curve analyses were performed.

RESULTS

One hundred-seven patients (61 men, 46 women; mean age 55.1 years; mean BMI 26.8 kg/m2) were assessed. The LP group was significantly older (mean age: 60.8 ± 15.2 years vs 46.4 ± 13.2 years; P < 0.0001). Twenty-five patients who underwent liver biopsies were diagnosed with NASH, and 6 were diagnosed with NAFL. On ROC curve analyses, the areas under the ROC curves for SWS, dispersion slope, ATI value, BMI, Fib-4 index, and the area of the NASH pentagon were 0.88000, 0.82000, 0.58730, 0.63000, 0.59333, and 0.93651, respectively; the largest was that for the area of the NASH pentagon.

CONCLUSION

The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.

Keywords: Non-alcoholic fatty liver disease, Non-alcoholic steatohepatitis, Attenuation imaging, Shear wave elastography, Shear wave dispersion, Diagnosis

Core Tip: The non-alcoholic steatohepatitis (NASH) pentagon is a novel clinical index consisting of the five parameters of shear wave speed, dispersion slope, attenuation imaging value, Fib-4 index, and body mass index. It is simple and the calculation of its area is easy. The area of the NASH pentagon is useful for discriminating between patients with NASH and those with non-alcoholic fatty liver.