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Efficacy of B-mode ultrasound-based attenuation for the diagnosis of hepatic steatosis: a systematic review/meta-analysis

  • Review Article–Gastroenterology
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Abstract

The accuracy of attenuation coefficients and B-mode ultrasound for distinguishing between S0 (healthy, < 5% fat) and S1–3 (steatosis ≥ 5%) livers compared to a controlled attenuation parameter is unclear. This meta-analysis aimed to comprehensively assess the diagnostic performance of B-mode ultrasound imaging for evaluating steatosis of ≥ 5%. We searched the PubMed, Embase, and Web of Science databases for studies on the accuracy of B-mode ultrasound for differentiating S0 from S1–3 in adults with chronic liver disease. A bivariate random-effects model was performed to estimate the pooled sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and diagnostic odds ratios (DORs). Subgroup analyses by attenuation coefficient, conventional B-mode ultrasound findings, and B-mode ultrasound findings without semi-quantification methods were performed. Liver steatosis was scored as follows: S0, < 5%; S1, 5–33%; S2, 33–66%; and S3, > 66%. Nineteen studies involving 3240 patients were analyzed. The pooled sensitivity and specificity of B-mode ultrasound for detecting S1 were 0.70 (95% confidence interval [CI], 0.63–0.77) and 0.86 (95% CI 0.82–0.89), respectively. The pooled PLR, NLR, and DOR were 4.90 (95% CI 3.69–6.51), 0.35 (95% CI 0.27– 0.44), and 14.1 (95% CI 8.7–23.0), respectively. The diagnostic accuracy was better in patients with attenuation coefficients (area under the curve [AUC], 0.89; sensitivity, 0.75; specificity, 0.86) than in those with conventional B-mode findings (AUC, 0.80; sensitivity, 0.59; specificity, 0.83). In particular, the diagnostic value was better when the attenuation coefficient guided by B-mode ultrasound was utilized. To screen patients with steatosis of ≥ 5%, attenuation coefficient should be used.

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Funding

This work was supported in part by the Japan Society for the Promotion of Science KAKENHI (Grant Number 21K07701 to M.H., and Grant Number 21K08008 to Y.H.).

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Authors and Affiliations

  1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan

    Masashi Hirooka, Yohei Koizumi, Kotarou Sunago, Yoshiko Nakamura, Takao Watanabe, Osamu Yoshida, Yoshio Tokumoto, Masanori Abe & Yoichi Hiasa

  2. Department of Gastroenterology and Metabology, National Hospital Organization Ehime Medical Center, Tōon, Japan

    Kana Hirooka

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  1. Masashi Hirooka
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  2. Yohei Koizumi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MH, YK, KS, and YN. The first draft of the manuscript was written by MH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Masashi Hirooka.

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Masashi Hirooka, Yohei Koizumi, Kotaro Sunago, Atsushi Yukimoto, Yoshiko Nakamura, Kana Hirooka, Takao Watanabe, Osamu Yoshida, Yoshio Tokumoto, Masanori Abe, and Yoichi Hiasa declare no conflicts of interest.

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Hirooka, M., Koizumi, Y., Sunago, K. et al. Efficacy of B-mode ultrasound-based attenuation for the diagnosis of hepatic steatosis: a systematic review/meta-analysis. J Med Ultrasonics 49, 199–210 (2022). https://doi.org/10.1007/s10396-022-01196-5

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  • DOI: https://doi.org/10.1007/s10396-022-01196-5

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