A model using ultrasonic biomarkers could help physicians identify patients with nonalcoholic fatty liver disease (NAFLD) who have advanced fibrosis, a study presented November 30 at the RSNA 2023 annual meeting found.
In his presentation, Katsutoshi Sugimoto, MD, PhD, from Tokyo Medical University in Japan discussed the performance of a model he and colleagues developed, which combines multiparametric ultrasound markers. They found that combining normalized local variance with shear-wave speed improves assessment of advanced liver fibrosis.
“The combination…improved the diagnostic performance of identifying [disease] patients compared to shear-wave speed alone, which helps physicians lead to better management and treatment decisions for patients,” Sugimoto said.
Liver fibrosis is a major prognostic factor in NAFLD, making it important to identify patients with advanced fibrosis – also known as metabolic-associated steatohepatitis (MASH). While magnetic resonance elastography shows high performance metrics in fibrosis grades of 2 and above, it has its share of drawbacks. These include its high cost, limited availability, and contraindications.
Sugimoto and colleagues sought to create an accurate model using multiparametric ultrasound to identify NAFLD patients with advanced fibrosis. It tested the model in a prospective study of 65 biopsy-proven NAFLD patients from seven sites.
To develop the model, the team used five ultrasound markers: shear-wave speed, dispersion slope, attenuation coefficient, normalized local variance, and the echo intensity ratio of liver to kidney. These were measured using a 2D shear-wave elastography system (Aplio i800, Canon Medical Systems) immediately before biopsy. Four expert pathologists from one site scored the biopsy specimens.
The researchers found that among the ultrasound markers, shear-wave speed, normalized local variance, and dispersion slope allowed for identification of advanced fibrosis. These included area under the curve (AUC) values of 0.886, 0.805, and 0.79, respectively.
They also found that the most predictive model was the combination of shear-wave speed and normalized local variance with an AUC of 0.908. Additionally, these markers had the highest regression coefficient values in the study, including 2.34 for shear-wave speed and 6.44 for normalized local variance. These indicate a significant association with fibrosis staging.
Finally, the team reported that normalized local variance showed weak correlation with shear-wave speed, suggesting that these markers see different characteristics on liver fibrosis.
Sugimoto said that based on these results, combining shear-wave speed with normalized local variance has the highest potential for identifying NAFLD patients with advanced fibrosis. He added that the model can serve as a noninvasive and accurate tool to assess liver fibrosis.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
