Researchers may have developed a new approach to identifying patients at high risk of developing non-alcoholic fatty liver disease (NAFLD).
A team, led by Meghan G. Lubner, MD, Department of Radiation, University of Wisconsin School of Medicine and Public Health, E3 / 311 Center for Clinical Science, evaluated the feasibility of laboratory and CT metrics in identifying what -patients at higher risk of developing NAFLD.
The study included 186 patients with NAFLD confirmed by biopsy who underwent CT within a year of biopsy. The average age of the patient population was 49 years.
87 (47%) patients had nonalcoholic steatohepatitis (NASH) and 112 (60%) had moderate to severe steatosis. There were also a total of 51 patients classified as F0 fibrosis stage, 42 individuals classified as F2, 37 patients as F3, and 33 participants as F4.
In addition, advanced fibrosis at stage 70 (38%) – grade F3 or F4 – was considered a high risk for NAFLD.
Ways
The researchers performed a histopathologic study to diagnose steatosis, inflammation, and fibrosis and classified the presence of any lobular inflammation and hepatocyte balloon as NASH.
Patients with NAFLD and advanced fibrosis – classified as F3 or higher – were classified as high-risk disease. The researchers also reported aspartate transaminase to platelet ratio indices and Fibrosis-4 laboratory scores.
The CT metrics in the study included hepatic attenuation, liver mass size, splenic volume, liver surface nodularity score, and selected tissue characteristics.
In addition, a pair of readers subjectively assessed the presence of NASH and fibrosis.
Conclusions
Overall, FIB-4 score was associated with fibrosis (AUC ROC of 0.75 for indicating high-risk NAFLD), while the individual CT, LSVR and splenic measurement parameters performed best ( AUC of 0.69 for both for the detection of high-risk NAFLD).
Subject reader evaluation was optimal among all parameters (AUCs pf 0.78 for reader 1 and 0.79 for reader 2 for the detection of high-risk NAFLD.
Complementary FIB-4 and subject scores (combined AUC of 0.82 for detection of high-risk NAFLD) and for NASH assessment, FIB-4 was the best (AUC of 0.68), while the AUCs lower than 0.60 for all individual and personal CT features assessments.
“FIB-4 and multiple CT scans may identify patients with high-risk NAFLD (advanced fibrosis or cirrhosis),” the authors wrote. “However, the presence of NASH is not possible for CT.”
Challenges with NAFLD
NAFLD is a condition in which excess fat is stored in the liver. However, this condition usually does not cause symptoms and is usually detected when blood tests identify elevated liver enzymes.
When the fat grows up, it can cause inflammation and damage, causing NASH, which can rupture the liver and cirrhosis.
Non-alcoholic fatty liver disease is often linked to obesity, with the frequency of both diseases becoming increasingly specific. Research shows that NAFLD is found in 40-80% of people with type 2 diabetes and 30-90% of people who are obese.
However, the lack of effective treatments currently available for NAFLD, means that many researchers are using alternative methods for new treatments. There are currently no medications approved by the U.S. Food and Drug Administration (FDA) to treat NAFLD.
The study, “Utility of Multiparametric CT for High-Risk NAFLD Identification,” was published online in the American Journal of Roentgenology.