Ultrasound examination versus Controlled Attenuation Parameter for the detection and quantification of hepatic steatosis

S120

Ultrasound in Medicine & Biology

Ultrasound examination versus Controlled Attenuation Parameter for the detection and quantification of hepatic steatosis Victor B^ aldea, Raluca Lupușoru, Mirela D anil a, Roxana Șirli, Alina Popescu, Camelia Gianina Foncea, Ioan Sporea Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania Introduction and aim: Transient Elastography with Controlled Attenuation Parameter(CAP) was recently introduced as a noninvasive method for quantification of liver steatosis.The aim of this study is to assess the performance of ultrasound(US) compared to CAP for the detection and quantification of liver steatosis. Material and Methods: 323 patients aged 22-83 (54.7 § 13.5), 44% male (142/323), 56% female (181/323) with or without different chronic hepatopathies were included in the study.All patients were assessed by US and CAP using Transient Elastography (FibroScan, EchoSense) during the same session in fasting conditions.US examinations were performed by EFSUMB level 1 qualification practitioners using high tech US systems. We used the following cut-offs for quantifying liver steatosis by CAP: 230-275, 275-300 and > 300 db/m for mild, moderate and severe steatosis(S1,S2,S3) following the recommendations of the manufacturer.US classification of liver steatosis was based on the comparison between liver and renal cortex echogenicity; grade 0 echogenicity equal to the renal cortex, grade 1 increased echogenicity and no posterior attenuation, grade 2 - increased echogenicity and posterior attenuation without obscuring the diaphragmatic outline, grade 3 - echogenic liver with posterior attenuation that obscures the diaphragmatic outline. Results: Based on the cut-off values proposed (CAP) steatosis distribution was 28.8% / 23.2% / 15.8% / 32.2% for S0 / S1 / S2 / S3.By means of US steatosis distribution was 31.6% / 23.5% / 20.4% / 24.5% for S0 / S1 / S2 / S3.Regarding hepatic steatosis US was significantly correlated with CAP score (r = 0.77, p < 0.001).When divided in normal and pathological patients the correlation remained strong (r = 0.83, p < 0.001 respectively r = 0.76, p < 0.001).Using CAP as reference, the area under receiver operating characteristic curves(AUROC) of US to predict S1, S2 and S3 were excellent (0.89, 0.90, respectively 0.93, p < 0.001) Conclusion: US examination is a useful and cheap tool for clinical practice in the screening and quantification of hepatic steatosis, even in the hands of a novice.

Value of viscosity, viscoelasticity and attenuation measurement using shear wave ultrasound elastography Ioan Sporea, Victor B^ aldea, Raluca Lupușoru, Alin Laz ar, Renata Fofiu, Alina Popescu, Roxana Șirli Gastroenterology and Hepatology, University of Medicine and Pharmacy ’’Victor Babes’’, Timisoara, Romania Nonalcoholic Liver Disease (NAFLD) is increasing in frequency in daily practice. Evaluation of such patients needs to assess steatosis, fibrosis and inflammation.A new Ultrasound(US) system from Canon noninvasively evaluates these parameters by measuring shear waves speed (2D-SWE) - related to viscoelasticity and fibrosis; dispersion (DI) - related to viscosity and inflammation, and attenuation parameter (ATI) - related to steatosis. Aim: To evaluate the usefulness of 2D-SWE, DI and ATI measurements obtained using Aplio i800 from Canon, for the noninvasive assessment of liver fibrosis, inflammation, and steatosis using Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) as the reference method. Material and Method: 113 consecutive subjects were included in the study group, mostly NAFLD patients, in whom liver stiffness (LS) and

Volume 45, Number S1, 2019 steatosis were evaluated in the same session by means of 2 elastography techniques: TE with CAP (FibroScan, EchoSens) and 2D-SWE with ATI(Aplio I800, Canon). Reliable LS measurements were defined for TE as the median value of 10 measurements with an interquartile range/median ratio (IQR/M) < 30% and for 2D-SWE the median value of 5 measurements performed in a homogeneous area of liver parenchyma, with an IQR/M < 30%. Dispersion was also assessed with the Aplio system. To discriminate between TE fibrosis stages we used the following cut-offs [1]: F  2: 8.4 kPa and F4: 13.2 kPa and to discriminate between steatosis stages we used the following cut-offs recommended by the manufacturer: S1(mild) 230db/m, S2(moderate) - 275db/m, S3(severe) - 300db/m. Results: Reliable LS measurements were obtained in 99.1% subjects by both 2D-SWE and TE.A very strong positive correlation was found between the LS values obtained by the 2 Methods: r = 0.88, p < 0.0001 and between the attenuation coefficients of steatosis obtained by the 2 methods, r = 0.81, p < 0.0001. The best cut-off value for fibrosis, for F0/1 was  6.2 kPa (AUROC 0.82; Se = 75%; Sp = 85.5%), for F  2 it was 7.9 kPa (AUROC 0.96; Se = 90.4%; Sp = 95.6%), for F4 it was 11.7 kPa (AUROC 0.99; Se = 100%; Sp = 96%). Regarding steatosis, the best cut-off values were: for S1 = 0.64 dB/cm/mHz (AUROC 0.89; Se = 73.6%; Sp = 88.8%), for S2 = 0.79 dB/cm/mHz (AUROC 0.88; Se = 63.4%; Sp = 96.4%), for S3 = 0.86dB/cm/mHz (AUROC 0.95; Se = 45%; Sp = 100%). When we divided the cohort into healthy vs patients with chronic hepatopathies, we found out that the mean DI values in the pathology group were higher than in the healthy group(12.4 § 2.7 vs 11.5 § 1.9, p = 0.03) Conclusion: 2D-SWE and ATI measurements with the new system strongly correlate with TE and CAP results 1 10.1111/apt.14529

Fibrosis and steatosis in type 2 diabetes mellitus patients evaluated with transient elastography and controlled attenuation parameter Ioan Sporea, Ruxandra Mare, Roxana Sirli, Alina Popescu, Silviu Nistorescu, Alexandra Sima, Romulus Timar Victor Babes University of Medicine, Timisoara, Timis, Romania The aim of the study was to assess the severity of liver fibrosis and steatosis in a cohort of type 2 diabetic patients, using non-invasive Methods: Transient Elastography (TE) and Controlled Attenuation Parameter (CAP). Material and Method: The study included 704 type 2 diabetic patients prospectively randomized, evaluated in the same session by means of TE and CAP (FibroScan, EchoSens) to assess both liver fibrosis and steatosis. Reliable liver stiffness measurements (LSM) were defined as the median value of 10 LSM with an IQR/median < 30%. For TE and CAP, M and XL probes were used. A cut-off value of 10.1 kPa [1] was used to define severe fibrosis (F  3). For differentiation between stages of steatosis we used the following cut-off values recommended by the manufacturer: S1 (mild) < 230, S2 (moderate) 275-300 db/m, S3 (severe) > 300 db/m. Results: Out of 704 diabetics screened we excluded those with associated viral hepatitis, those with an AUDIT-C score  8 and those with unreliable LSM. The final analysis included 485 subjects (54.3% women, mean age 60 § 9.5; mean BMI = 31.6 § 6.1 kg/m2) with reliable LSM. 32.1% of patients had obesity grade I, 17.9 % had obesity grade II and 8.9% had obesity grade III (IMC  40 kg/m2). Mild, moderate and severe steatosis by means of CAP was found in 15.6%, 15.6 % and 59.3% cases, respectively. The median CAP values of patients with mild, moderate and severe steatosis were 260 db/m, 287.5 db/m