Skip to main content
SpringerLink
Log in

Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery.

Methods

Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis.

Results

The median SWV was 1.57 ± 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 ± 0.90 m/s, 1.55 ± 0.79 m/s and 1.86 ± 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %).

Conclusion

The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity.

Key Points

• Acoustic radiation force impulse imaging provides ultrasonic shear wave velocity measurements.

• SWV measurements were higher in patients with inflammation or fibrosis than NAFLD.

• ARFI differentiates NAFLD from NASH in patients with morbid obesity.

• Results suggest that ARFI can detect NASH in asymptomatic morbidly obese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  2. World Health Organization (2002) World health report 2002. Available via http://www.iotf.org. Accessed 1 Mar 2011

  3. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH (2000) The disease burden associated with overweight and obesity. JAMA 282:1523–1529

    Article  Google Scholar 

  4. National Task Force on the Prevention and Treatment of Obesity (2000) Overweight, obesity, and health risk. Arch Intern Med 160:898–904

    Google Scholar 

  5. McCullogh AJ et al (2005) The epidemiology and risk factors of NASH. In: Farrel GC, George J, de la PM Hall (eds) Fatty liver disease, NASH and related disorders. Blackwell, Malden, pp 23–37

    Google Scholar 

  6. Angulo P (2002) Non alcoholic fatty liver disease. N Engl J Med 346:1221–1231

    Article  PubMed  CAS  Google Scholar 

  7. Nguyen NT, Masoomi H, Laugenour K et al (2011) Predictive factors of mortality in bariatric surgery: data from the Nationwide Inpatient Sample. Surgery 150:347–351

    Article  PubMed  Google Scholar 

  8. McHutchinson J, Poynard T, Afdhal N (2006) Fibrosis as an end point for clinical trials in liver disease: a report of the international fibrosis group. Clin Gastroenterol Hepatol 4:1214–1220

    Article  Google Scholar 

  9. Guzmán-Aroca F, Reus M, Berná-Serna JD et al (2011) Reproducibility of shear-wave velocity measurements by acoustic radiation force impulse imaging in liver: a study in healthy volunteers. J Ultrasound Med 30:975–979

    PubMed  Google Scholar 

  10. Sirli R, Sporea I, Tudora A, Deleanu A, Popescu A (2009) Transient elastographic evaluation of subjects without known hepatic pathology: does age change the liver stiffness? J Gastrointestin Liver Dis 18:57–60

    PubMed  Google Scholar 

  11. Conference NIH (1991) Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Intern Med 115:956–961

    Google Scholar 

  12. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) AUDIT. The alcohol use disorders identification test: guidelines for use in primary care, 2nd edn. WHO, Geneva

  13. Zwiebel WJ (1995) Sonographic diagnosis of diffuse liver disease. Semin Ultrasound CT MR 16:8–15

    Article  PubMed  CAS  Google Scholar 

  14. Charatcharoenwitthaya P, Lindor KD (2007) Role of radiologic modalities in the management of non-alcoholic steatohepatitis. Clin Liver Dis 11:37–54

    Article  PubMed  Google Scholar 

  15. Mazhar SM, Shiehmorteza M, Sirlin CB (2009) Noninvasive assessment of hepatic steatosis. Clin Gastroenterol Hepatol 7:135–140

    Article  PubMed  Google Scholar 

  16. Frutos MD, Luján J, Hernández Q, Valero G, Parrilla P (2007) Clinical pathway for laparoscopic gastric bypass. Obes Surg 17:1584–1587

    Article  PubMed  Google Scholar 

  17. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR (1999) Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 94:2467–2474

    Article  PubMed  CAS  Google Scholar 

  18. Matteoni CA, Younosi ZM, Gramlich T, Bopari N, Liu YC, McCullough AJ (1999) Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116:1413–1419

    Article  PubMed  CAS  Google Scholar 

  19. Cassidy FH, Yokoo T, Aganovic L et al (2009) Fatty liver disease: MR imaging techniques for the detection and quantification of liver steatosis. Radiographics 29:231–260

    Article  PubMed  Google Scholar 

  20. Vizzutti F, Arena U, Nobili V et al (2009) Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease. Ann Hepatol 8:89–94

    PubMed  Google Scholar 

  21. Boursier J, Isselin G, Fouchard-Hubert I et al (2010) Acoustic radiation force impulse: a new ultrasonographic technology for the widespread noninvasive diagnosis of liver fibrosis. Eur J Gastroenterol Hepatol 22:1074–1084

    Article  PubMed  Google Scholar 

  22. Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL (2011) Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 259:749–756

    Article  PubMed  Google Scholar 

  23. Salameh N, Larrat B, Abarca-Quinones J et al (2009) Early detection of steatohepatitis in fatty rat liver by using MR elastography. Radiology 253:90–97

    Article  PubMed  Google Scholar 

  24. Georges PC, Hui JJ, Gombos Z et al (2007) Increased stiffness of the rat liver precedes matrix deposition: implications for fibrosis. Am J Physiol Gastrointest Liver Physiol 293:G1147–G1154

    Article  PubMed  CAS  Google Scholar 

  25. Guzmán-Aroca F, Ayala I, Serrano L et al (2010) Assessment of liver steatosis in chicken by using acoustic radiation force impulse imaging: preliminary results. Eur Radiol 10:2367–2371

    Article  Google Scholar 

  26. Yoneda M, Suzuki K, Kato S et al (2010) Nonalcoholic fatty liver disease: US-based acoustic radiation force impulse elastography. Radiology 256:640–647

    Article  PubMed  Google Scholar 

  27. Regev A, Berho M, Jeffers LJ et al (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618

    Article  PubMed  Google Scholar 

  28. Castéra L, Vergniol J, Foucher J et al (2005) Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 128:343–350

    Article  PubMed  Google Scholar 

  29. Bohte AE, van Werven JR, Bipat S, Stoker J (2011) The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis. Eur Radiol 21:87–97

    Article  PubMed  Google Scholar 

  30. van Werven JR, Marsman HA, Nederveen AJ et al (2010) Assessment of hepatic steatosis in patients undergoing liver resection: comparison of US, CT, T1-weighted dual-echo MR imaging, and point-resolved 1H MR spectroscopy. Radiology 256:159–168

    Article  PubMed  Google Scholar 

  31. van Werven JR, Schreuder TC, Aarts EO et al (2011) Hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery: assessment with open-system 1H-MR spectroscopy. Am J Roentgenol 196:W736–W742

    Article  Google Scholar 

  32. Palmeri ML, Wang MH, Rouze NC et al (2011) Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol 55:666–672

    Article  PubMed  Google Scholar 

  33. Osaki A, Kubota T, Suda T et al (2010) Shear wave velocity is a useful marker for managing nonalcoholic steatohepatitis. World J Gastroenterol 16:2918–2925

    Article  PubMed  Google Scholar 

  34. Weingarten TN, Swain JM, Kendrick ML et al (2011) Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obes Surg 21:1714–2170

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of of Radiology, Virgen de la Arrixaca University Hospital, 30120, El Palmar, Murcia, Spain

    F. Guzmán-Aroca, M. Reus & Juan de Dios Berná-Serna

  2. Department of Surgery, Virgen de la Arrixaca University Hospital, 30120, El Palmar, Murcia, Spain

    M. D. Frutos-Bernal, J. A. Luján-Mompeán & P. Parrilla

  3. Department of Pathology, Virgen de la Arrixaca University Hospital, 30120, El Palmar, Murcia, Spain

    A. Bas

Authors
  1. F. Guzmán-Aroca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. D. Frutos-Bernal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Bas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. A. Luján-Mompeán
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Reus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juan de Dios Berná-Serna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Parrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan de Dios Berná-Serna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guzmán-Aroca, F., Frutos-Bernal, M.D., Bas, A. et al. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging. Eur Radiol 22, 2525–2532 (2012). https://doi.org/10.1007/s00330-012-2505-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-012-2505-3

Keywords

Search

Navigation