Ultrasonography.
2024 Mar;43(2):121-131. 10.14366/usg.23194.
Advanced fibrosis leads to overestimation of steatosis with quantitative ultrasound in individuals without hepatic steatosis
- Kumada T
1 - Toyoda H2
- Ogawa S3
- Gotoh T3
- Suzuki Y4
- Imajo K5,6
- Sugimoto K7
- Kakegawa T7
- Kuroda H8
- Yasui Y9
- Tamaki N9
- Kurosaki M9
- Izumi N9
- Akita T10
- Tanaka J10
- Nakajima A5
- Affiliations
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- 1Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan
- 2Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
- 3Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Japan
- 4Department of Gastroenterology, Nayoro City General Hospital, Nayoro, Japan
- 5Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- 6Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
- 7Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
- 8Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
- 9Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino-shi, Japan
- 10Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
- KMID: 2552902
- DOI: http://doi.org/10.14366/usg.23194
Abstract
- Purpose
The effect of hepatic fibrosis stage on quantitative ultrasound based on the attenuation coefficient (AC) for liver lipid quantification is controversial. The objective of this study was to determine how the degree of fibrosis assessed by magnetic resonance (MR) elastography affects AC based on the ultrasound-guided attenuation parameter according to the grade of hepatic steatosis, using magnetic resonance imaging (MRI)–derived proton density fat fraction (MRIderived PDFF) as the reference standard.
Methods
Between February 2020 and April 2021, 982 patients with chronic liver disease who underwent AC and MRI-derived PDFF measurement as well as MR elastography were enrolled. Multiple regression was used to investigate whether AC was affected by the degree of liver stiffness.
Results
AC increased as liver stiffness progressed in 344 patients without hepatic steatosis (P=0.009). In multivariable analysis, AC was positively correlated with skin-capsule distance (P<0.001), MR elastography value (P=0.037), and MRI-derived PDFF (P<0.001) in patients without hepatic steatosis. In 52 of 982 patients (5%), the correlation between AC and MRIderived PDFF fell outside the 95% confidence interval for the regression line slope. Patients with MRI-derived PDFF lower than their AC (n=36) had higher fibrosis-4 scores, albumin-bilirubin scores, and MR elastography values than patients with MRI-derived PDFF greater than their AC (n=16; P=0.018, P=0.001, and P=0.011, respectively).
Conclusion
AC is affected by liver fibrosis (MR elastography value ≥6.7 kPa) only in patients without hepatic steatosis (MRI-derived PDFF <5.2%). These values should be interpreted with caution in patients with advanced liver fibrosis.
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