Ultrasound-based steatosis grading system using 2D-attenuation imaging: An individual patient data meta-analysis with external validation-Reference-Cited by-同舟云学术

Ultrasound-based steatosis grading system using 2D-attenuation imaging: An individual patient data meta-analysis with external validation

Published:2024-04-23 Issue: Volume: Page:
ISSN:0270-9139
Container-title:Hepatology
language:en
Short-container-title:

Author:

Hobeika Christian¹²³^ORCID,Ronot Maxime⁴⁵^ORCID,Guiu Boris⁶^ORCID,Ferraioli Giovanna⁷^ORCID,Iijima Hiroko⁸^ORCID,Tada Toshifumi⁹^ORCID,Lee Dong Ho¹⁰^ORCID,Kuroda Hidekatsu¹¹^ORCID,Lee Young Hwan¹²,Lee Jeong Min¹³^ORCID,Kim So Yeon¹⁴,Cassinotto Christophe⁶^ORCID,Maiocchi Laura¹⁵^ORCID,Raimondi Ambra⁷¹⁵^ORCID,Nishimura Takashi⁸^ORCID,Kumada Takashi¹⁶^ORCID,Kwon Eun Young¹²,Jang Jong Keon¹⁴^ORCID,Correas Jean-Michel¹⁷¹⁸^ORCID,Valla Dominique⁵¹⁹^ORCID,Vilgrain Valérie⁴⁵^ORCID,Dioguardi Burgio Marco⁴⁵^ORCID

Affiliation:

1. Department of HPB Surgery and Liver Transplantation, AP-HP, Hôpital Beaujon, Clichy, France

2. Université Paris Cité, Inserm, CArcinose Péritoine Paris-Technologies, Paris, France

3. Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

4. Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Clichy, France

5. Université Paris Cité, Inserm, Centre de recherche sur l’inflammation, Paris, France

6. Department of Radiology, St-Eloi University Hospital, Montpellier, France

7. Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia, Pavia, Italy

8. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Hyogo, Japan

9. Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan

10. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea

11. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Iwate Medical University, Iwate, Japan

12. Department of Radiology, Wonkwang University School of Medicine and Hospital, Iksan, Korea

13. Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea

14. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

15. Ultrasound Unit, Dipartimento Servizi Diagnostici e per Immagini Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

16. Department of Nursing, Gifu Kyoritsu University, Gifu, Japan

17. AP-HP, Hôpital Necker Enfants Malades, Service d’Imagerie Adulte, Paris, France

18. Sorbonne Université, CNRS, INSERM Laboratoire d’Imagerie Biomédicale, Paris, France

19. Service d’hépatologie, Hôpital Beaujon, Clichy, France

Abstract

Background and Aims: Noninvasive tools assessing steatosis, such as ultrasonography-based 2D-attenuation imaging (ATI), are needed to tackle the worldwide burden of steatotic liver disease. This one-stage individual patient data (IPD) meta-analysis aimed to create an ATI-based steatosis grading system. Approach and Results: A systematic review (EMBASE + MEDLINE, 2018–2022) identified studies, including patients with histologically or magnetic resonance imaging proton-density fat fraction (MRI-PDFF)–verified ATI for grading steatosis (S0 to S3). One-stage IPD meta-analyses were conducted using generalized mixed models with a random study-specific intercept. Created ATI-based steatosis grading system (aS0 to aS3) was externally validated on a prospective cohort of patients with type 2 diabetes and metabolic dysfunction–associated steatotic liver disease (n=174, histologically and MRI-PDFF–verified steatosis). Eleven enrolled studies included 1374 patients, classified into S0, S1, S2, and S3 in 45.4%, 35.0%, 9.3%, and 10.3% of the cases. ATI was correlated with histological steatosis (r = 0.60; 95% CI: 0.52, 0.67; p < 0.001) and MRI-PDFF (r = 0.70; 95% CI: 0.66, 0.73; p < 0.001) but not with liver stiffness (r = 0.03; 95% CI: −0.04, 0.11, p = 0.343). Steatosis grade was an independent factor associated with ATI (coefficient: 0.24; 95% CI: [0.22, 0.26]; p < 0.001). ATI marginal means within S0, S1, S2, and S3 subpopulations were 0.59 (95% CI: [0.58, 0.61]), 0.69 (95% CI [0.67, 0.71]), 0.78 (95% CI: [0.76, 0.81]), and 0.85 (95% CI: [0.83, 0.88]) dB/cm/MHz; all contrasts between grades were significant (p < 0.0001). Three ATI thresholds were calibrated to create a new ATI-based steatosis grading system (aS0 to aS3, cutoffs: 0.66, 0.73, and 0.81 dB/cm/MHz). Its external validation showed Obuchowski measures of 0.84 ± 0.02 and 0.82 ± 0.02 with histologically based and MRI-PDFF–based references. Conclusions: ATI is a reliable, noninvasive marker of steatosis. This validated ATI-based steatosis grading system could be valuable in assessing patients with metabolic dysfunction–associated steatotic liver disease.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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