Evaluation of the Hepatorenal B-Mode Ratio and the “Controlled Attenuation Parameter” for the Detection and Grading of Steatosis

Abstract

Purpose The aim of this study was to evaluate the hepatorenal index ratio of Supersonic Imagine (B-mode ratio) and the controlled attenuation parameter (CAP) of FibroScan for the noninvasive diagnosis and grading of steatosis.

Materials and Methods Two centers prospectively included patients who underwent liver biopsy, B-mode ratio and CAP evaluation all on the same day between June 2017 and July 2019. MRI and histological morphometry were also performed in center 1. Histology (classic semiquantitative score and morphometry) was used as the reference.

Results Concerning the B-mode ratio, the AUROCs for ≥ S1, ≥ S2 and ≥ S3 were respectively 0.896 ± 0.20, 0.775 ± 0.30 and 0.729 ± 0.39 with the best cut-off values being 1.22 for ≥ S1 (Se = 76.4 %, Sp = 93.2 %), 1.42 for ≥ S2 (Se = 70.2 %, Sp = 71.2 %) and 1.54 for ≥ S3 (Se = 68.4 %, Sp = 69.8 %). The correlation between the B-mode ratio and morphometry was moderate (Rs = 0.575, p < 0.001) and the correlation between the B-mode ratio and MRI was good (Rs = 0.613, p < 0.001). Concerning the CAP, the AUROCs for ≥  S1, ≥ S2 and ≥ S3 were 0.926 ± 0.18, 0.760 ± 0.30 and 0.701 ± 0.40, respectively, with the best cut-off values being 271 dB/m for ≥ S1 (Se = 84 %, Sp = 88.2 %), 331 dB/m for ≥ S2 (Se = 64.5 %, Sp = 74.7 %) and 355 dB/m for ≥ S3 (Se = 55.3 %, Sp = 75.1 %). The correlation between the CAP and morphometry and between the CAP and MRI was moderate in both cases (Rs = 0.526, p < 0.001 and Rs = 0.397, p < 0.001, respectively). The B-mode ratio was better at ruling in and the CAP was better at ruling out the disease.

Conclusion B-mode ratio and CAP show similar and good performance for the diagnosis of steatosis (≥ S1). However, both techniques are limited with respect to differentiating mild to moderate (≥ S2) or severe (≥ S3) steatosis.

Zusammenfassung

Ziel Ziel dieser Studie war die Bewertung der hepatorenalen Index-Ratio von Supersonic Imagine (B-Modus-Ratio) und des „controlled attenuation parameter“ (CAP) von FibroScan für die nichtinvasive Diagnose und Einstufung einer Steatose.

Material und Methoden Zwei Zentren schlossen prospektiv Patienten ein, bei denen zwischen Juni 2017 und Juli 2019 am selben Tag eine Leberbiopsie, eine B-Modus-Ratio und eine CAP-Evaluierung durchgeführt wurden. In Zentrum 1 wurden auch eine MRT und eine histologische Morphometrie durchgeführt. Die Histologie (klassischer semiquantitativer Score und Morphometrie) diente als Referenz.

Ergebnisse Hinsichtlich der B-Modus-Ratio lagen die AUROCs für ≥ S1 bei 0,896 ± 0,20, für ≥ S2 bei 0,775 ± 0,30 und ≥ S3 bei 0,729 ± 0,39, wobei die besten Cut-off-Werte 1,22 für ≥ S1 (Se = 76,4 %, Sp = 93,2 %), 1,42 für ≥ S2 (Se = 70,2 %, Sp = 71,2 %) und 1,54 für ≥ S3 (Se = 68,4 %, Sp = 69,8 %) betrugen. Die Korrelation zwischen B-Modus-Ratio und Morphometrie war moderat (Rs = 0,575; p < 0,001) und die Korrelation zwischen B-Modus-Ratio und MRT war gut (Rs = 0,613; p < 0,001). In Bezug auf den CAP lagen die AUROCs für ≥ S1 bei 0,926 ± 0,18, für ≥ S2 bei 0,760 ± 0,30 und für ≥ S3 bei 0,701 ± 0,40, wobei die besten Cut-off-Werte für ≥ S1 bei 271 dB/m (Se = 84 %, Sp = 88,2 %), für ≥ S2 bei 331 dB/m (Se = 64,5 %, Sp = 74,7 %) und für ≥ S3 bei 355 dB/m (Se = 55,3 %, Sp = 75,1 %) lagen. Die Korrelation zwischen CAP und Morphometrie sowie zwischen CAP und MRT war in beiden Fällen moderat (Rs = 0,526; p < 0,001 bzw. Rs = 0,397; p < 0,001). Die B-Modus-Ratio war besser in der Lage, die Erkrankung zu erkennen, und der CAP konnte diese besser ausschließen.

Schlussfolgerung B-Modus-Ratio und CAP zeigen eine ähnliche und gute Leistung bei der Diagnose von Steatose (≥ S1). Beide Methoden sind jedoch hinsichtlich der Differenzierung zwischen leichter bis mittelschwerer Steatose (≥ S2) und schwerer (≥ S3) Steatose begrenzt.

Key words

liver steatosis - diagnosis - grading - B-mode ratio - ultrasound

Publication History

Received: 23 March 2020

Accepted: 03 August 2020

Article published online:
29 September 2020

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