Novel multi-parametric diagnosis of non-alcoholic fatty liver disease using ultrasonography, body mass index, and Fib-4 index

Figure 1 Non-alcoholic steatohepatitis pentagon. The non-alcoholic steatohepatitis pentagon consists of the five parameters of shear wave speed (SWS), dispersion slope (DS), attenuation imaging value (ATI value), Fib-4 index, and the body mass index (BMI). Based on past reports, the reference values were set as SWS 1.33 m/s, DS 8.5 (m/s)/KHz, ATI value 0.66 (dB/cm)/MHz, BMI 25.0 kg/m², and Fib-4 index 1.3. SWS: Shear wave speed; DS: Dispersion slope; BMI: Body mass index; ATI: Attenuation imaging.

Figure 2 Flowchart of the study. A total of 126 patients who were diagnosed with fatty liver based on abdominal ultrasound and in whom shear wave elastography, shear wave dispersion, and attenuation imaging were measured during the period of this study were entered in the study. Of them, 7 patients with an alcohol intake history of 20 g ethanol/d or more, 3 with hepatitis B, 3 with hepatitis C, and 4 with autoimmune hepatitis or primary biliary cholangitis were excluded. In addition, 1 patient with drug-induced liver injury and 1 patient with cholangitis were excluded, bringing the final number of subjects in this investigation to 107. HBV: Hepatitis B virus; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; PBC: Primary biliary cholangitis; NAFLD: Non-alcoholic fatty liver disease.

Figure 3 Receiver-operating characteristic curve for each parameter. This shows the receiver-operating characteristic (ROC) curve of the 17 patients who underwent liver biopsy during the period of this study. The areas under the ROC curves (AUROCs) of shear wave speed, dispersion slope, attenuation imaging value, body mass index, Fib-4 index, and the area of the non-alcoholic steatohepatitis (NASH) pentagon are 0.88000, 0.82000, 0.58730, 0.63000, 0.59333, and 0.93651, respectively. Of these six parameters, the largest AUROC is that for the area of the NASH pentagon. SWE: Shear wave elastography; SWD: Shear wave dispersion; ATI: Attenuation imaging; BMI: Body mass index; NASH: Non-alcoholic steatohepatitis.