Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery
Abstract
:1. Introduction
2. Material and Methods
2.1. Liver Elastography
2.2. Ultrasound Evaluation of Steatosis
2.3. Liver Biopsy
2.4. Statistical Analysis
3. Results
3.1. The Impact of SLD on Philips IU22 Measurements
3.2. The Impact of SLD on Philips Affiniti 70 Measurements
3.3. Inter-Machine Liver Stiffness Measurement Agreement
3.4. Application of Hamaguchi Score for Steatosis
4. Discussion
Author Contributions
Funding
Conflicts of Interest
Abbreviations
NAFLD | non-alcoholic fatty liver disease |
NAFL | non-alcoholic fatty liver |
NASH | non-alcoholic steatohepatitis |
LD | linear dichroism |
TE | transient elastography |
pSWE | point Shear Wave Elastography |
AWT | abdominal wall thickness |
LSM | liver stiffness measurement |
ElastPQ | Elastography Point Quantification |
HS | Hamaguchi Score |
BMI | body mass index |
EHA | elastography–histology agreement |
ALT | alanine aminotransferase |
AST | aspartate aminotransferase |
GGT | gamma-glutamyl-transferase |
HDL | high density lipoprotein |
LDL | low density lipoprotein |
IQR | interquartile range |
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Characteristic | Value |
---|---|
Age, years | 53 (41; 57) |
Gender, female, n (%) | 174 (62.2 %) |
BMI, kg/m2 | 44 (40; 50) |
Waist Circumference, cm | 135 (121; 146) |
SLD, mm | 32 (26; 40) |
Glycated Hemoglobin, % | 6.3 (± 0.8) |
Fasting Plasma Glucose, mg/dL | 110 (99; 131) |
Fasting Plasma Insulin, mIU/L | 20 (13; 36) |
HOMA-IR Index | 5.10 (3.85; 8.53) |
HOMA-IR Index >2.73, n (%) | 160 (54.7%) |
Previous Diagnosis of Type 2 Diabetes Mellitus, n (%) | 49 (16.4%) |
HDL Cholesterol, mg/dL | 38 (36;43) |
LDL Cholesterol, mg/dL | 171 (151; 199) |
Triglycerides, mg/dL | 143 (110; 210) |
AST, U/L | 26 (21; 32) |
ALT, U/L | 29 (23; 39) |
GGT, U/L | 33 (21; 49) |
ALP, U/L | 75 (64; 102) |
Total Bilirubin, mg/dL | 0.5 (0.34; 0.68) |
Albumin, g/dL | 3.9 (3.7; 4.4) |
Liver Fibrosis (Kleiner), n (%) Score 0 (F0) Score 1 (F1) Score 2 (F2) Score 3 (F3) Score 4 (F4) | 55 (18.4%) 142 (47.5%) 59 (19.7%) 19 (6.4%) 24 (8%) |
Liver Steatosis Grade, n (%) Score 0 Score 1 Score 2 Score 3 | 74 (24.8%) 106 (35.4%) 71 (23.8%) 48 (16%) |
Fibrosis Staging According to Philips IU 22 (n = 183) | ||||
Values | Kleiner F0, n = 24 | Kleiner F1, n = 101 | Kleiner F2, n = 33 | Kleiner F3–4, n = 25 |
Liver Stiffness (kPa), Median (IQR) | 4.1 (3.6;5.3) | 4.34 (3.6;5.5) | 6.6 (4;6.7) | 8.1 (4.9;9.4) |
Correctly Classified by Arbitrary Cut-Off | 15/24 (62.5%) | 25/101 (24.75%) | 18/33 (54.5%) | 14/25 (56%) |
Fibrosis Staging According to Philips Affiniti 70 (n = 125) | ||||
Values | Kleiner F0 n = 45 | Kleiner F1 n = 54 | Kleiner F2 n = 26 | Kleiner F3–4 n = 20 |
Liver Stiffness (kPa), Median (IQR) | 4.5 (3.9;6.20) | 4.6 (4.1;6.10) | 6.5 (4.3;7.2) | 8.6 (6.3;9.3) |
Correctly Classified by Arbitrary Cut-Off | 29/45 (64.4%) | 17/54 (31.5%) | 14/26 (53.8%) | 16/20 (80%) |
Logistic Regression Probability Models | ||
---|---|---|
Impact of Abdominal Wall Stiffness on Elastography–Histology Agreement | ||
Variables | [M1] Philips IU 22 | [M2] Philips Affiniti 70 |
Abdominal Wall Thickness | −0.144 [−0.16;−0.13] | −0.591 [−0.617;−0.564] |
Intercept | 3.99 [3.35;3.63] | 20.86 [18.3;23.4] |
Nagelkerke Pseudo-R2 | 0.266 | 0.894 |
AIC | 207.7 | 38.5 |
BIC | 214.1 | 44.2 |
AUROC | 0.79 [0.72;0.86] | 0.90 [0.85;0.93] |
Hosmer–Lemeshow p-value | 0.09 | 0.15 |
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Giuffrè, M.; Giuricin, M.; Bonazza, D.; Rosso, N.; Giraudi, P.J.; Masutti, F.; Palmucci, S.; Basile, A.; Zanconati, F.; de Manzini, N.; et al. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics 2020, 10, 795. https://doi.org/10.3390/diagnostics10100795
Giuffrè M, Giuricin M, Bonazza D, Rosso N, Giraudi PJ, Masutti F, Palmucci S, Basile A, Zanconati F, de Manzini N, et al. Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery. Diagnostics. 2020; 10(10):795. https://doi.org/10.3390/diagnostics10100795
Chicago/Turabian StyleGiuffrè, Mauro, Michela Giuricin, Deborah Bonazza, Natalia Rosso, Pablo José Giraudi, Flora Masutti, Stefano Palmucci, Antonio Basile, Fabrizio Zanconati, Nicolò de Manzini, and et al. 2020. "Optimization of Point-Shear Wave Elastography by Skin-to-Liver Distance to Assess Liver Fibrosis in Patients Undergoing Bariatric Surgery" Diagnostics 10, no. 10: 795. https://doi.org/10.3390/diagnostics10100795