Quantitative Assessment of Fatty Liver using Ultrasound with Normalized Local Variance Technique

Abstract

Purpose To assess the diagnostic performance of the normalized local variance (NLV) ultrasound technique in the detection of the fatty liver using histopathology as a reference standard.

Materials and Methods We prospectively enrolled 194 consecutive patients with clinical suspicion of diffuse liver disease or history of liver transplantation. Conventional grayscale ultrasound and NLV examinations were performed and immediately followed by liver biopsies. The degrees of fatty liver, necroinflammatory activity, and fibrosis stage were evaluated by histopathological assessment. The diagnostic performance of the NLV values in detecting each grade of fatty liver was determined using receiver operating characteristics analyses, and multivariate linear regression analyses were performed to identify variables significantly associated with the NLV values.

Results The number of patients in each degree of fatty liver and hepatic fibrosis was 118/37/26/13 and 81/68/24/6/14 for none/mild/moderate/severe steatosis and F0 / F1/F2 / F3/F4 fibrosis on histopathological examinations, respectively. The area under the receiver operating characteristics curve and optimal cut-off NLV value for detecting fatty liver of varying degrees were 0.911 and 1.095 for ≥ S1, 0.974 and 1.055 for ≥ S2, and 0.954 and 1.025 for ≥ S3, respectively. Multivariate analyses revealed that not fibrosis or inflammation but rather the degree of steatosis was associated with the NLV value.

Conclusion The NLV value demonstrated excellent diagnostic performance for detecting varying degrees of fatty liver, and the degree of steatosis on histopathological examinations was the only significant factor affecting the NLV value.

Zusammenfassung

Ziel Beurteilung der diagnostischen Leistung der Ultraschalltechnik der normalisierten lokalen Varianz („Normalized Local Variance“, NLV) bei der Diagnose der Fettleber mit der Histopathologie als Referenzstandard.

Material und Methoden Prospektiv nahmen wir 194 konsekutive Patienten mit klinischem Verdacht auf eine diffuse Lebererkrankung oder mit Lebertransplantation als Anamnese auf. Konventionelle Graustufen-Ultraschall- und NLV-Untersuchungen wurden durchgeführt und unmittelbar im Anschluss daran erfolgten Leberbiopsien. Der Grad der Fettleber, die nekroinflammatorische Aktivität und das Fibrosestadium wurden durch die Histopathologie beurteilt. Die diagnostische Leistung der NLV-Werte bei der Diagnose des jeweiligen Verfettungsgrades der Leber wurde mittels ROC-Analysen bestimmt; multivariate lineare Regressionsanalysen wurden durchgeführt, um die Variablen zu identifizieren, die signifikant mit den NLV-Werten assoziiert sind.

Ergebnis Die Anzahl der Patienten bei jedem Grad der Fettleber und Leberfibrose betrug 118/37/26/13 für fehlende/milde/moderate/schwere Steatose und 81/68/24/6/14 für F0-/F1-/F2-/F3-/F4-Fibrose in den histopathologischen Untersuchungen. Die Fläche unter der ROC-Kurve betrug 0,911 für ≥ S1, 0,974 für ≥ S2 und 0,954 für ≥ S3 und der optimale Cut-off des NLV-Werts betrug 1,095 für ≥ S1, 1,055 für ≥ S2 und 1,025 für ≥ S3 für die Diagnose des unterschiedlichen Grades der Fettleber. Multivariate Analysen zeigten, dass nicht eine Fibrose oder Entzündung, sondern vielmehr der Grad der Steatose mit dem NLV-Wert assoziiert war.

Schlussfolgerung Der NLV-Wert zeigte eine ausgezeichnete diagnostische Leistung zum Nachweis der unterschiedlichen Grade der Fettleber. Der Steatosegrad in der Histopathologie war der einzige signifikante Faktor, der den NLV-Wert beeinflusste.

Key words

fatty liver - quantification - pathology - normalized local variance - ultrasound

Publication History

Received: 09 May 2019

Accepted: 28 February 2020

Article published online:
22 April 2020

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