Multiparametric US for Identifying Patient with High-Risk NASH: A Derivation and Validation Study : Multiparametric us for identifying patients with high-risk nash: A derivation and validation study

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Sugimoto, Katsutoshi; Lee, Dong Ho; Lee, Jaeyoung; Yu, Su Jong; Moriyasu, Fuminori; Sakamaki, Kentaro; Oshiro, Hisashi; Takahashi, Hiroshi; Kakegawa, Tatsuya; Tomita, Yusuke; Abe, Masakazu; Yoshimasu, Yu; Takeuchi, Hirohito; Choi, Byung Ihn; Itoi, Takao

Issue Date
Radiological Society of North America
Radiology, Vol.301 No.3, pp.625-634
Background: Nonalcoholic fatty liver disease (NAFLD) is common in the general population but identifying patients with high-risk -nonalcoholic steatohepatitis (NASH) who are candidates for pharmacologic therapy remains a challenge. Purpose: To develop a score to identify patients with high-risk NASH, defined as NASH with an NAFLD activity score (NAS) of 4 or greater and clinically significant fibrosis (stage 2 [F2] or higher). Materials and Methods: This was a cross-sectional secondary analysis of data prospectively collected between April 2017 and March 2019 for a group of patients with NAFLD in Japan (Japan NAFLD, the derivation data set) with contemporaneous two-dimensional shear-wave elastography and biopsy-proven NAFLD (age range, 20-89 years). Three US markers (liver stiffness [LS, measured in kilopascals], attenuation coefficient [AC, measured in decibels per centimeter per megahertz], and dispersion slope [DS, measured in meters per second per kilohertz]) were determined, together with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and the AST-to-ALT ratio. The best-fit multivariate logistic regression model for identifying patients with high-risk NASH was determined. Diagnostic performance was assessed by using the area under the receiver operating characteristic curve (AUC). The findings were validated in an independent data set (Korea NAFLD; age range, 20-78 years). Results: The Japan NAFLD data set included 111 patients (mean age, 53 years. 18 [standard deviation]; 57 men), 84 (76%) with NASH. The Korea NAFLD data set included 102 patients (mean age, 48 years. 18; 43 men), 55 (36%) with NASH. The most predictive model (LAD NASH score) combined LS, AC, and DS. Performance was satisfactory in both the derivation sample (AUC, 0.86; 95% CI: 0.79, 0.93) and the validation sample (AUC, 0.88; 95% CI: 0.80, 0.95). The LAD NASH score showed a positive predictive value of 86.5% and a negative predictive value of 87.5% for high-risk NASH in the derivation sample. Conclusion: A score combining three US markers may be useful for noninvasive identification of patients with high-risk nonalcoholic steatohepatitis for inclusion in clinical trials and pharmacologic therapy. (C) RSNA, 2021
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Journal Papers (저널논문_의학과)
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