Ultrasound Detection of Liver Fibrosis in Individuals with Hepatic Steatosis Using the Homodyned K Distribution

Yu-Wei Tsai; Zhuhuang Zhou; Cihun-Siyong Alex Gong; Dar-In Tai; Anca Cristea; Yu-Ching Lin; Ya-Chun Tang; Po-Hsiang Tsui

doi:10.1016/j.ultrasmedbio.2020.09.021

Ultrasound Detection of Liver Fibrosis in Individuals with Hepatic Steatosis Using the Homodyned K Distribution

Ultrasound Med Biol. 2021 Jan;47(1):84-94. doi: 10.1016/j.ultrasmedbio.2020.09.021. Epub 2020 Oct 24.

Authors

Yu-Wei Tsai¹, Zhuhuang Zhou², Cihun-Siyong Alex Gong³, Dar-In Tai⁴, Anca Cristea⁵, Yu-Ching Lin⁶, Ya-Chun Tang⁷, Po-Hsiang Tsui⁸

Affiliations

¹ Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
² College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China.
³ Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁴ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway.
⁶ Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, at Keelung and Chang Gung University, Taiwan.
⁷ Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁸ Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. Electronic address: tsuiph@mail.cgu.edu.tw.

PMID: 33109381
DOI: 10.1016/j.ultrasmedbio.2020.09.021

Abstract

Acoustic structure quantification (ASQ) based on the analysis of ultrasound backscattered statistics has been reported to detect liver fibrosis without significant hepatic steatosis. This study proposed using ultrasound parametric imaging based on the parameter α of the homodyned K (HK) distribution for staging liver fibrosis in patients with significant hepatic steatosis. Raw ultrasound image data were acquired from patients (n = 237) to construct B-mode and HK α parametric images, which were compared with the focal disturbance (FD) ratio obtained from ASQ on the basis of histologic evidence (METAVIR fibrosis score and hepatic steatosis severity). The data were divided into group I (n = 173; normal to mild hepatic steatosis) and group II (n = 64; with moderate to severe hepatic steatosis) for statistical analysis through one-way analysis of variance and receiver operating characteristic (ROC) curve analysis. The results showed that the HK α parameter monotonically decreased as the liver fibrosis stage increased (p < .05); concurrently, the FD ratio increased (p < .05). For group I, the areas under the ROC (AUROCs) obtained using the FD ratio and the α parameter (AUROC_FD and AUROC_α) were, respectively, 0.56 and 0.55, 0.68 and 0.68, 0.64 and 0.64 and 0.62 and 0.62 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. The values of AUROC_FD and AUROC_α for group II were, respectively, 0.88 and 0.91, 0.81 and 0.81, 0.77 and 0.76 and 0.78 and 0.73 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. As opposed to previous studies, ASQ was found to fail in characterizing liver fibrosis in group I; however, it was workable for identifying liver fibrosis in patients with significant hepatic steatosis (group II). Compared with ASQ, HK imaging provided improved diagnostic performance in the early detection of liver fibrosis coexisting with moderate to severe hepatic steatosis. Ultrasound HK imaging is recommended as a strategy to evaluate early fibrosis risk in patients with significant hepatic steatosis.

Keywords: Acoustic structure quantification; Hepatic steatosis; Homodyned K distribution; Liver fibrosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Fatty Liver / complications*
Female
Humans
Liver Cirrhosis / complications*
Liver Cirrhosis / diagnostic imaging*
Male
Middle Aged
Prospective Studies
Ultrasonography / methods
Young Adult