Comparison between magnetic resonance and ultrasound-derived indicators of hepatic steatosis in a pooled NAFLD cohort

PLoS One. 2021 Apr 1;16(4):e0249491. doi: 10.1371/journal.pone.0249491. eCollection 2021.

Abstract

Background & aims: MRI-based proton density fat fraction (PDFF) and the ultrasound-derived controlled attenuation parameter (CAP) are non-invasive techniques for quantifying liver fat, which can be used to assess steatosis in patients with non-alcoholic fatty liver disease (NAFLD). This study compared both of these techniques to histopathological graded steatosis for the assessment of fat levels in a large pooled NAFLD cohort.

Methods: This retrospective study pooled N = 581 participants from two suspected NAFLD cohorts (mean age (SD) 56 (12.7), 60% females). Steatosis was graded according to NASH-CRN criteria. Liver fat was measured non-invasively using PDFF (with Liver MultiScan's Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation method, LMS-IDEAL, Perspectum, Oxford) and CAP (FibroScan, Echosens, France), and their diagnostic performances were compared.

Results: LMS-IDEAL and CAP detected steatosis grade ≥ 1 with AUROCs of 1.00 (95% CI, 0.99-1.0) and 0.95 (95% CI, 0.91-0.99), respectively. LMS-IDEAL was superior to CAP for detecting steatosis grade ≥ 2 with AUROCs of 0.77 (95% CI, 0.73-0.82] and 0.60 (95% CI, 0.55-0.65), respectively. Similarly, LMS-IDEAL outperformed CAP for detecting steatosis grade ≥ 3 with AUROCs of 0.81 (95% CI, 0.76-0.87) and 0.63 (95% CI, 0.56-0.70), respectively.

Conclusion: LMS-IDEAL was able to diagnose individuals accurately across the spectrum of histological steatosis grades. CAP performed well in identifying individuals with lower levels of fat (steatosis grade ≥1); however, its diagnostic performance was inferior to LMS-IDEAL for higher levels of fat (steatosis grades ≥2 and ≥3).

Trial registration: ClinicalTrials.gov (NCT03551522); https://clinicaltrials.gov/ct2/show/NCT03551522. UMIN Clinical Trials Registry (UMIN000026145); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000026145.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Area Under Curve
  • Female
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease / diagnosis*
  • Non-alcoholic Fatty Liver Disease / pathology
  • ROC Curve
  • Retrospective Studies
  • Severity of Illness Index
  • Ultrasonography*

Associated data

  • ClinicalTrials.gov/NCT03551522
  • UMIN-CTR/UMIN000026145

Grants and funding

The author(s) received no specific funding for the analysis presented in this work. Study 1 was funded by the sponsors and study 2 from Yokohoma City University Hospital. AD, CB, CH, AA and RB are all employees of Perspectum, RB CEO. DK is employed by Texas Digestive Disease Consultants (GI Alliance). Texas Digestive Disease Consultants provided support in the form of salaries for author DK but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.