Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2023; 29(22): 3548-3560
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3548
Prospective study comparing hepatic steatosis assessment by magnetic resonance imaging and four ultrasound methods in 105 successive patients
Remi Collin, Benoit Magnin, Constance Gaillard, Carine Nicolas, Armand Abergel, Benjamin Buchard
Remi Collin, Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges 87000, France
Remi Collin, Carine Nicolas, Armand Abergel, Benjamin Buchard, Department of Hepatology and Gastroenterology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
Benoit Magnin, Constance Gaillard, Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, France
Author contributions: Collin R, Nicolas C, Abergel A and Buchard B conceived and designed the analysis; Collin R, Magnin B, Gaillard C, Nicolas C and Buchard B collected the data; Collin R, Magnin B, Gaillard C, Nicolas C, Abergel A and Buchard B contributed data or analysis tools; Collin R, Magnin B and Buchard B performed the analysis; Collin R and Buchard B wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Clermont-Ferrand University Hospital Institutional Review Board.
Clinical trial registration statement: This study is registered at Clermont-Ferrand University Hospital. The registration identification number is M210401.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
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: Remi Collin, MD, Doctor, Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, 2 Avenue Martin Luther King, Limoges 87000, France. remi.collin@chu-limoges.fr
Received: February 8, 2023
Peer-review started: February 8, 2023
First decision: March 21, 2023
Revised: April 4, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: June 14, 2023
Processing time: 118 Days and 8.7 Hours
ARTICLE HIGHLIGHTS
Research background

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, ranging from simple steatosis to aggressive hepatitis leading to liver fibrosis, cirrhosis and hepatocellular carcinoma.

Research motivation

Diagnose fatty liver disease and assess its severity during follow-up and after treatment is a key in clinical practice. Liver biopsy can deliver this information, but it is an invasive procedure with potentially severe. Therefore, non-invasive techniques were developed to stage steatosis. Ultrasound is the primary imaging modality in the assessment of patients with confirmed or suspected NAFLD.

Research objectives

We wanted to evaluate new ultrasonographic tools to detect and measure hepatic steatosis.

Research methods

One hundred and five patients underwent ultrasonographic measurement of liver sound speed estimation (SSE) and attenuation coefficient (AC) using Aixplorer MACH 30 (Supersonic Imagine, France), continuous Controlled Attenuation Parameter (cCAP) using Fibroscan (Echosens, France) and standard liver ultrasound with hepato-renal index (HRI) calculation. Hepatic steatosis was then classified according to MRI proton density fat fraction (PDFF) as gold standard.

Research results

SSE, AC, cCAP and HRI correlated with PDFF, with respective Spearman correlation coefficient of -0.39, 0.42, 0.54 and 0.59 (P < 0.01). Area under the receiver operating characteristic curve (AUROC) for detection of steatosis with HRI was 0.91 (0.83-0.99), with the best cut-off value being 1.3 (Se = 83%, Sp = 98%). The optimal cCAP threshold of 275 dB/m, corresponding to the recent EASL-suggested threshold, had a sensitivity of 72% and a specificity of 80%. Corresponding AUROC was 0.79 (0.66-0.92). The diagnostic accuracy of cCAP was more reliable when standard deviation was < 15 dB/m with an AUC of 0.91 (0.83-0.98). An AC threshold of 0.42 dB/cm/MHz had an AUROC was 0.82 (0.70-0.93). SSE performed moderately with an AUROC of 0.73 (0.62-0.84).

Research conclusions

HRI had the best performance. It is also the simplest and most available method as most US scans are equipped with this module.

Research perspectives

Measurement quality criteria need to be defined and validated for a wider use of theses techniques. Their improvement could open the way to efficient and easily accessible non-invasive steatosis grading.