Funada K, Kusano Y, Gyotoku Y, Shirahashi R, Suda T, Tamano M. Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index. World J Gastroenterol 2023; 29(23): 3703-3714 [PMID: 37398885 DOI: 10.3748/wjg.v29.i23.3703]
Corresponding Author of This Article
Masaya Tamano, PhD, Professor, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi 343-8555, Saitama, Japan. mstamano@dokkyomed.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
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Funada K, Kusano Y, Gyotoku Y, Shirahashi R, Suda T, Tamano M. Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index. World J Gastroenterol 2023; 29(23): 3703-3714 [PMID: 37398885 DOI: 10.3748/wjg.v29.i23.3703]
Kei Funada, Yumi Kusano, Yoshinori Gyotoku, Ryosaku Shirahashi, Toshikuni Suda, Masaya Tamano, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi 343-8555, Saitama, Japan
Author contributions: Funada K, Kusano Y, Gyotoku Y and Shirahashi R conceptualized and designed the study, collected data, carried out the initial analysis, and drafted the initial manuscript; Suda T and Tamano M coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was reviewed and approved by the Dokkyo Medical University Saitama Medical Center Institutional Review Board (approval No. 21057).
Clinical trial registration statement: This study is registered at clinical research support office, Dokkyo Medical University Saitama Medical Center. The registration identification number is 21057.
Informed consent statement: Patients were not required to give informed consent for participation in the present study because the analysis used anonymous clinical data that were obtained after each patient gave informed consent to treatment. For full disclosure, the details of this prospective, observational study were published on the home page of the medical center.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Corresponding author: Masaya Tamano, PhD, Professor, Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi 343-8555, Saitama, Japan. mstamano@dokkyomed.ac.jp
Received: February 8, 2023 Peer-review started: February 8, 2023 First decision: March 7, 2023 Revised: March 14, 2023 Accepted: May 22, 2023 Article in press: May 22, 2023 Published online: June 21, 2023 Processing time: 128 Days and 3.4 Hours
Abstract
BACKGROUND
Shear wave speed (SWS), shear wave dispersion (SWD), and attenuation imaging (ATI) are new diagnostic parameters for non-alcoholic fatty liver disease. To differentiate between non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver (NAFL), we developed a clinical index we refer to as the “NASH pentagon” consisting of the 3 abovementioned parameters, body mass index (BMI), and Fib-4 index.
AIM
To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.
METHODS
This non-invasive, prospective, observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography, SWD, and ATI were measured. Histological diagnosis based on liver biopsy was performed in 31 patients. The large pentagon group (LP group) and the small pentagon group (SP group), using an area of 100 as the cutoff, were compared; the NASH diagnosis rate was also investigated. In patients with a histologically confirmed diagnosis, receiver-operating characteristic (ROC) curve analyses were performed.
RESULTS
One hundred-seven patients (61 men, 46 women; mean age 55.1 years; mean BMI 26.8 kg/m2) were assessed. The LP group was significantly older (mean age: 60.8 ± 15.2 years vs 46.4 ± 13.2 years; P < 0.0001). Twenty-five patients who underwent liver biopsies were diagnosed with NASH, and 6 were diagnosed with NAFL. On ROC curve analyses, the areas under the ROC curves for SWS, dispersion slope, ATI value, BMI, Fib-4 index, and the area of the NASH pentagon were 0.88000, 0.82000, 0.58730, 0.63000, 0.59333, and 0.93651, respectively; the largest was that for the area of the NASH pentagon.
CONCLUSION
The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.
Core Tip: The non-alcoholic steatohepatitis (NASH) pentagon is a novel clinical index consisting of the five parameters of shear wave speed, dispersion slope, attenuation imaging value, Fib-4 index, and body mass index. It is simple and the calculation of its area is easy. The area of the NASH pentagon is useful for discriminating between patients with NASH and those with non-alcoholic fatty liver.
