Abstract
Liver stiffness (LS) is a tissue characteristic that reflects a combination of fibrosis stage, liver perfusion and inflammation, and is modulated by several technical confounders of the measurement technique. Liver steatosis results from metabolic alterations associated with diabetes mellitus and obesity. It is defined by the presence of lipid droplets within the hepatocytes which alter ultrasound propagation and physical tissue properties. This chapter focuses on the potential modulation of LS by steatosis and discusses noninvasive ultrasound-based methods of steatosis quantification as potential modifiers of LS interpretation. In summary, steatosis-induced modulation of liver stiffness remains a topic of ongoing debate. Although no specific recommendation can be given, most studies indicate a reduced diagnostic precision of LSM in patients with severe steatosis and obesity, which especially impairs the positive predictive value of LSM for ruling in advanced fibrosis. In some cohorts, steatosis is not at all or even slightly negatively correlated with LS. There are individual case observations, in the absence of inflammation, where a decrease of steatosis/CAP during alcohol detoxification leads to a slight elevation of LS. Future studies should prospectively analyze the effect of steatosis on LS in further detail.
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References
EASL-EASD-EASO Clinical EASL. Practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–402.
Bedossa P, Biopsy PK. Noninvasive methods to assess progression of nonalcoholic fatty liver disease. Gastroenterology. 2016;150(8):1811–22.e4.
Dyson JK, McPherson S, Anstee QM. Non-alcoholic fatty liver disease: non-invasive investigation and risk stratification. J Clin Pathol. 2013;66(12):1033–45.
Hirche TO, Ignee A, Hirche H, Schneider A, Dietrich CF. Evaluation of hepatic steatosis by ultrasound in patients with chronic hepatitis C virus infection. Liver Int. 2007;27(6):748–57.
Nightingale K, Rouze N, Rosenzweig S, Wang M, Abdelmalek M, Guy C, et al. Derivation and analysis of viscoelastic properties in human liver: impact of frequency on fibrosis and steatosis staging. IEEE Trans Ultrason Ferroelectr Freq Control. 2015;62(1):165–75.
Shen F, Zheng RD, Shi JP, Mi YQ, Chen GF, Hu X, et al. Impact of skin capsular distance on the performance of controlled attenuation parameter in patients with chronic liver disease. Liver Int. 2015;35(11):2392–400.
Mueller S. Does pressure cause liver cirrhosis? The sinusoidal pressure hypothesis. World J Gastroenterol. 2016;22(48):10482.
Mueller S, Nahon P, Rausch V, Peccerella T, Silva I, Yagmur E, et al. Caspase-cleaved keratin-18 fragments increase during alcohol withdrawal and predict liver-related death in patients with alcoholic liver disease. Hepatology. 2017;66(1):96–107.
Rausch V, Peccerella T, Lackner C, Yagmur E, Seitz HK, Longerich T, et al. Primary liver injury and delayed resolution of liver stiffness after alcohol detoxification in heavy drinkers with the PNPLA3 variant I148M. World J Hepatol. 2016;8(35):1547–56.
Ballestri S, Nascimbeni F, Lugari S, Lonardo A, Francica G. A critical appraisal of the use of ultrasound in hepatic steatosis. Expert Rev Gastroenterol Hepatol. 2019;13(7):667–81.
Piscaglia F, Salvatore V, Mulazzani L, Cantisani V, Schiavone C. Ultrasound shear wave elastography for liver disease. a critical appraisal of the many actors on the stage. Eur J Ultrasound. 2016;37(01):1–5.
Berzigotti A. Getting closer to a point-of-care diagnostic assessment in patients with chronic liver disease: controlled attenuation parameter for steatosis. J Hepatol. 2014;60(5):910–2.
Karlas T, Petroff D, Wiegand J. Collaboration, not competition: the role of magnetic resonance, transient elastography, and liver biopsy in the diagnosis of nonalcoholic fatty liver disease. Gastroenterology. 2017;152(3):479–81.
Sasso M, Beaugrand M, de Ledinghen V, Douvin C, Marcellin P, Poupon R, et al. Controlled attenuation parameter (CAP): a Novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010;36(11):1825–35.
Karlas T, Petroff D, Sasso M, Fan JG, Mi YQ, de Ledinghen V, et al. Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis. J Hepatol. 2017;66(5):1022–30.
Tada T, Iijima H, Kobayashi N, Yoshida M, Nishimura T, Kumada T, et al. Usefulness of attenuation imaging with an ultrasound scanner for the evaluation of hepatic steatosis. Ultrasound Med Biol. 2019;45(10):2679–87.
Karlas T. Estimating steatosis and fibrosis: Comparison of acoustic structure quantification with established techniques. World J Gastroenterol. 2015;21(16):4894.
Keller J, Kaltenbach TEM, Haenle MM, Oeztuerk S, Graeter T, Mason RA, et al. Comparison of Acoustic Structure Quantification (ASQ), shearwave elastography and histology in patients with diffuse hepatopathies. BMC Med Imaging. 2015;15(1).
Liu J, Ren W, Ai H, Dun G, Ji Y, Zhang Y, et al. Acoustic structure quantification versus point shear wave speed measurement for the assessment of liver fibrosis in viral hepatitis B. Ultrasound Med Biol. 2018;44(6):1177–86.
Mueller S. Personal observation. 2019.
Poynard T, Pham T, Perazzo H, Munteanu M, Luckina E, Elaribi D, et al. Real-time shear wave versus transient elastography for predicting fibrosis: applicability, and impact of inflammation and steatosis. A non-invasive comparison. PLoS One. 2016;11(10):e0163276.
Boursier J, Zarski JP, de Ledinghen V, Rousselet MC, Sturm N, Lebail B, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57(3):1182–91.
Macaluso FS, Maida M, Cammà C, Cabibbo G, Cabibi D, Alduino R, et al. Steatosis affects the performance of liver stiffness measurement for fibrosis assessment in patients with genotype 1 chronic hepatitis C. J Hepatol. 2014;61(3):523–9.
Petta S, Maida M, Macaluso FS, Di Marco V, Camma C, Cabibi D, et al. The severity of steatosis influences liver stiffness measurement in patients with nonalcoholic fatty liver disease. Hepatology. 2015;62(4):1101–10.
Karlas T, Dietrich A, Peter V, Wittekind C, Lichtinghagen R, Garnov N, et al. Evaluation of transient elastography, acoustic radiation force impulse imaging (ARFI), and enhanced liver function (ELF) score for detection of fibrosis in morbidly obese patients. PLoS One. 2015;10(11):e0141649.
Harris N, Nadebaum D, Christie M, Gorelik A, Nicoll A, Sood S, et al. Acoustic radiation force impulse accuracy and the impact of hepatic steatosis on liver fibrosis staging. J Med Imaging Radiat Oncol. 2016;60(5):587–92.
Conti F, Serra C, Vukotic R, Fiorini E, Felicani C, Mazzotta E, et al. Accuracy of elastography point quantification and steatosis influence on assessing liver fibrosis in patients with chronic hepatitis C. Liver Int. 2016;37(2):187–95.
Petta S, Wong VW, Camma C, Hiriart JB, Wong GL, Marra F, et al. Improved noninvasive prediction of liver fibrosis by liver stiffness measurement in patients with nonalcoholic fatty liver disease accounting for controlled attenuation parameter values. Hepatology. 2017;65(4):1145–55.
Karlas T, Petroff D, Sasso M, Fan JG, Mi YQ, de Ledinghen V, et al. Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement. Aliment Pharmacol Ther. 2018;47(7):989–1000.
Eddowes PJ, Sasso M, Allison M, Tsochatzis E, Anstee QM, Sheridan D, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(6):1717–30.
Shen F, Mi YQ, Xu L, Liu YG, Wang XY, Pan Q, et al. Moderate to severe hepatic steatosis leads to overestimation of liver stiffness measurement in chronic hepatitis B patients without significant fibrosis. Aliment Pharmacol Ther. 2019;50(1):93–102.
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Karlas, T., Mueller, S. (2020). Liver Steatosis (CAP) as Modifier of Liver Stiffness. In: Mueller, S. (eds) Liver Elastography. Springer, Cham. https://doi.org/10.1007/978-3-030-40542-7_39
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DOI: https://doi.org/10.1007/978-3-030-40542-7_39
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