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
ARTICLE HIGHLIGHTS
Research background

Non-alcoholic fatty liver disease (NAFLD) is a major problem throughout the world. If non-alcoholic steatohepatitis (NASH) progresses, it can lead to hepatocellular carcinoma. Novel clinical index needs to be developed that can efficiently discriminate NASH patients from non-alcoholic fatty liver (NAFL) patients.

Research motivation

Shear wave speed (SWS), shear wave dispersion (SWD), and attenuation imaging (ATI) are new ultrasound diagnostic parameters for NAFLD. We developed a novel clinical index as the “NASH pentagon” consisting of the 3 abovementioned parameters, body mass index (BMI), and Fib-4 index.

Research objectives

Objective of this study is to prove the utility of NASH pentagon area in the differentiation of NASH and NAFL.

Research methods

Patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 were enrolled. 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 curve analyses were performed.

Research results

The preparation of a NASH pentagon consisting of five parameters, SWS, DS, ATI value, Fib-4 index, and BMI, is simple and the calculation of its area is easy. The LP group with a NASH pentagon area ≥ 100 had 64 patients, and the SP group with an area < 100 had 43 patients. The number of patients diagnosed with NASH was 22 (34.3%) of 64 in the LP group and 3 (7.0%) of 43 in the SP group. The LP group had a significantly higher percentage of NASH patients (P = 0.0042).

Research conclusions

The NASH pentagon is a novel multi-parametric index, and will be useful for identifying NASH patients among NAFLD patients.

Research perspectives

NASH pentagon should be tried in more patients. Besides, the area of NASH pentagon and the details of the histologic diagnosis should be considered.