CT Texture Analysis in Nonalcoholic Fatty Liver Disease (NAFLD)

Laura E Dichtel; Azadeh Tabari; Nathaniel D Mercaldo; Kathleen E Corey; Jad Husseini; Stephanie A Osganian; Mark L Chicote; Elizabeth M Rao; Karen K Miller; Miriam A Bredella

doi:10.1016/j.jceh.2023.04.001

CT Texture Analysis in Nonalcoholic Fatty Liver Disease (NAFLD)

J Clin Exp Hepatol. 2023 Sep-Oct;13(5):760-766. doi: 10.1016/j.jceh.2023.04.001. Epub 2023 Apr 13.

Authors

Laura E Dichtel^{1

2}, Azadeh Tabari³, Nathaniel D Mercaldo^{1

3}, Kathleen E Corey^{1

4}, Jad Husseini^{1

3}, Stephanie A Osganian⁴, Mark L Chicote², Elizabeth M Rao², Karen K Miller^{1

2}, Miriam A Bredella^{1

3}

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
³ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
⁴ Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.

PMID: 37693260
PMCID: PMC10483004 (available on 2024-09-01)
DOI: 10.1016/j.jceh.2023.04.001

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease worldwide. There are limited biomarkers that can detect progression from simple steatosis to nonalcoholic steatohepatitis (NASH). The purpose of our study was to utilize CT texture analysis to distinguish steatosis from NASH.

Methods: 16 patients with NAFLD (38% male, median (interquartile range): age 57 (48-64) years, BMI 37.5 (35.0-46.8) kg/m²) underwent liver biopsy and abdominal non-contrast CT. CT texture analysis was performed to quantify gray-level tissue summaries (e.g., entropy, kurtosis, skewness, and attenuation) using commercially available software (TexRad, Cambridge England). Logistic regression analyses were performed to quantify the association between steatosis/NASH status and CT texture. ROC curve analysis was performed to determine sensitivity, specificity, AUC, 95% CIs, and cutoff values of texture parameters to differentiate steatosis from NASH.

Results: By histology, 6/16 (37%) of patients had simple steatosis and 10/16 (63%) had NASH. Patients with NASH had lower entropy (median, interquartile range (IQR): 4.3 (4.1, 4.8) vs. 5.0 (4.9, 5.2), P = 0.013) and lower mean value of positive pixels (MPP) (34.4 (21.8, 52.2) vs. 66.5 (57.0, 70.7), P = 0.009) than those with simple steatosis. Entropy values below 4.73 predict NASH with 100% (95%CI: 67-100%) specificity and 80% (50-100%) sensitivity, AUC: 0.88. MPP values below 54.0 predict NASH with 100% (67-100%) specificity and 100% (50-100%) sensitivity, AUC 0.90.

Conclusion: Our study provides preliminary evidence that CT texture analysis may serve as a novel imaging biomarker for disease activity in NAFLD and the discrimination of steatosis and NASH.

Keywords: computed tomography; nonalcoholic fatty liver disease (NAFLD); nonalcoholic steatohepatitis (NASH); texture analysis.