Optimizing the number of valid measurements for the attenuation coefficient to assess hepatic steatosis in MAFLD patients: A study of 139 patients who underwent liver biopsy

Abstract

Purpose We investigated the optimal number of valid measurements (VMs) for the attenuation coefficient (AC) to assess liver steatosis using attenuation imaging (ATI) and explored factors that may affect AC measurement in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

Materials and Methods A total of 139 patients with MAFLD who underwent ATI and liver biopsy were enrolled. Hepatic steatosis was graded as S0–3 according to the SAF scoring system. The AC values from 1, 2, 3, 5, and 7 VMs were compared with the degree of liver steatosis. The correlation between AC values from different VMs was analyzed. The diagnostic performance of AC from different VMs at each steatosis grade was compared. The factors related to AC were identified using linear regression analysis.

Results The mean AC values from 1, 2, 3, 5, and 7 VMs were not significantly different between grades S0–3 (p=n.s. for all). Bland-Altman analysis showed the mean difference in AC values of 3 VMs and 7 VMs was 0.003 dB/cm/MHz, which was smaller compared with 2 VMs, and close to 5 VMs. The intraclass correlation coefficients of AC were all > 0.90 among different VM groups. AC values from different VMs all significantly predicted steatosis grade ≥S1, ≥S2, and S3 without significant statistical differences (p=n.s. for all). The multivariate analysis showed that the hepatic steatosis grade and triglyceride level were factors independently associated with AC.

Conclusion Three valid measurements of AC may be adequate to ensure the accuracy and reproducibility of hepatic steatosis assessment. The degree of liver steatosis and the triglyceride level significantly affected AC values.

Zusammenfassung

Ziel Wir untersuchten die optimale Anzahl gültiger Messungen („valid measurements“, VMs) des Dämpfungskoeffizienten („attenuation coefficient“, AC) zur Beurteilung der Lebersteatose mittels Attenuation-Imaging (ATI) und untersuchten Faktoren, die bei Patienten mit metabolisch-assoziierter Fettlebererkrankung (MAFLD) die AC-Messung beeinflussen können.

Material und Methoden Insgesamt 139 Patienten mit MAFLD, die sich einer ATI und einer Leberbiopsie unterzogen, wurden in die Studie aufgenommen. Die hepatische Steatose wurde nach dem SAF-Score als S0–3 eingestuft. Die AC-Werte von 1, 2, 3, 5 und 7 VMs wurden mit dem Grad der Lebersteatose verglichen. Die Korrelation zwischen den AC-Werten der verschiedenen VMs wurde analysiert. Die diagnostische Leistung des AC aus verschiedenen VMs wurde bei jedem Steatosegrad verglichen. Die Faktoren, die mit dem AC zusammenhängen, wurden mithilfe einer linearen Regressionsanalyse ermittelt.

Ergebnisse Die mittleren AC-Werte von 1, 2, 3, 5 und 7 VMs unterschieden sich nicht signifikant zwischen den Graden S0–3 (p=n.s. für alle). Die Bland-Altman-Analyse zeigte, dass der mittlere Unterschied der AC-Werte von 3 VMs und 7 VMs 0,003 dB/cm/MHz betrug, was im Vergleich zu 2 VMs geringer war und nahe an 5 VMs lag. Die Intraklassen-Korrelationskoeffizienten der AC-Werte waren alle > 0,90 zwischen den verschiedenen VMs-Gruppen. Die AC-Werte der verschiedenen VMs sagten alle signifikant den Steatosegrad ≥S1, ≥S2 und S3 voraus, ohne signifikante statistische Unterschiede (p=n.s. für alle). Die multivariate Analyse zeigte, dass der Grad der Lebersteatose und der Triglyzeridspiegel Faktoren waren, die unabhängig voneinander mit dem AC assoziiert waren.

Schlussfolgerung Drei gültige Messungen des AC können ausreichen, um die Genauigkeit und Reproduzierbarkeit der Bewertung der Lebersteatose zu gewährleisten. Der Grad der Lebersteatose und der Triglyzeridspiegel beeinflussten die AC-Werte signifikant.

Keywords

Metabolic dysfunction-associated fatty liver disease - liver steatosis - attenuation imaging - attenuation coefficient - Metabolic dysfunction-associated steatotic liver disease

Publication History

Received: 22 August 2022

Accepted after revision: 17 August 2023

Article published online:
11 December 2023

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