Reproducibility and accuracy of a pocket-size ultrasound device in assessing liver steatosis

Andrea Costantino; Alessandra Piagnani; Riccardo Caccia; Andrea Sorge; Marco Maggioni; Riccardo Perbellini; Francesca Donato; Roberta D'Ambrosio; Nicole Piazza O Sed; Luca Valenti; Daniele Prati; Maurizio Vecchi; Pietro Lampertico; Mirella Fraquelli

doi:10.1016/j.dld.2023.11.014

Reproducibility and accuracy of a pocket-size ultrasound device in assessing liver steatosis

Dig Liver Dis. 2023 Nov 27:S1590-8658(23)01032-0. doi: 10.1016/j.dld.2023.11.014. Online ahead of print.

Affiliations

¹ Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
² Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
³ Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pathology Unit, Milan, Italy.
⁴ Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy.
⁵ Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.
⁶ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Translational Medicine, Department of Transfusion Medicine and Hematology, Milan, Italy.
⁷ Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Translational Medicine, Department of Transfusion Medicine and Hematology, Milan, Italy.
⁸ Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Hepatology Unit, Milan, Italy; CRC "A. M. and A. Migliavacca" Center for Liver Disease, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
⁹ Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy. Electronic address: mfraquelli@yahoo.it.

PMID: 38016894
DOI: 10.1016/j.dld.2023.11.014

Abstract

Background: This diagnostic prospective study compared the feasibility and diagnostic accuracy of Pocket-size Ultrasound Devices (PUDs) against standard ultrasound (US) in detecting liver steatosis using the controlled attenuation parameter (CAP) and liver biopsy as reference standards.

Materials and methods: Consecutive patients with chronic liver diseases were assessed for the presence of steatosis using PUD and US. A CAP cut-off value >275 dB/m was applied to establish ≥S1. A 26-patient subgroup underwent liver biopsy. PUD reproducibility was evaluated using Cohen's k statistic. Diagnostic accuracy of PUD and US was given as Sensibility (Sn), Specificity (Sp), Positive and Negative Predictive Values (PPV, NPV), positive and negative Likelihood Ratio (LR+, LR-).

Results: 81 consecutive patients (69% males) with multiple etiologies were enroled. PUD inter-observer agreement was good (k 0.77, 95%CI 0.62-0.93). PUD and US identified ≥S1 according to CAP values respectively with Sn 0.87, Sp 0.61, PPV 0.49, NPV 0.91, LR+ 2.04, LR- 0.07, AUROC 0.74 and Sn 0.96, Sp 0.54, PPV 0.47, NPV 0.97, LR+ 2.10, LR- 0.07, AUROC 0.75.

Conclusions: PUD shows good reproducibility and diagnostic accuracy in ruling liver steatosis out, representing a useful point-of-care tool to avail of hepatologists interested in excluding NAFLD, but with basic US skills.

Keywords: Controlled-attenuation parameter; Liver biopsy; Non-alcoholic fatty liver disease; Pocket size ultrasound devices; Steatosis; Ultrasound; Vibration-controlled transient elastography.