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The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing in young populations. However, there are inadequate data regarding diagnosis of NAFLD. We aimed to validate three scoring systems against a previous standard of suprailiac skinfold thickness for diagnosing NAFLD in population-based adolescents. Seventeen-year-old adolescents (n = 899), participating in the Raine Study, attended a cross-sectional follow-up. NAFLD was diagnosed using liver ultrasound. Scores for Fatty liver index (FLI), Hepatic Steatosis Index (HSI) and Zhejiang University index (ZJU index) were calculated. Diagnostic accuracy of these diagnostic tests was evaluated through discrimination and calibration. NAFLD was diagnosed 9% in males and 15% in females. The three scoring systems demonstrated better discrimination performance for NAFLD in males (AUC was FLI:0.82, HSI: 0.83 and ZJU index: 0.83) compared to females (AUC was FLI: 0.67, HSI: 0.67 and ZJU index: 0.67). Suprailiac skinfold performed better than the scoring systems (overall AUC: 0.82; male AUC:0.88; female AUC:0.73). FLI had best calibration performance. Suprailiac skinfold thickness was a better predictor of ultrasound-diagnosed NAFLD than the three diagnostic scoring systems investigated. The higher performance characteristics of the algorithmic scoring systems in males compared with females may have implications for use in population assessments. [ABSTRACT FROM AUTHOR]

Hepatic steatosis has been associated with increased risk of coronary artery disease. Individuals with familial hypercholesterolaemia have accelerated but variable progression of coronary artery disease. We investigated whether hepatic steatosis is associated with novel coronary atherosclerosis biomarkers in adults with heterozygous familial hypercholesterolaemia, using comprehensive coronary computed tomographic angiography. We conducted a cross-sectional study of 213 asymptomatic patients with familial hypercholesterolaemia (median age 54.0 years, 59 % female) who underwent coronary computed tomographic angiography for cardiovascular risk assessment in an outpatient clinic. High-risk plaque features, plaque volume and pericoronary adipose tissue attenuation were assessed. From concurrently captured upper abdominal images, severity of hepatic steatosis was computed, as liver minus spleen computed tomography attenuation and stratified into quartiles. Of 213 familial hypercholesterolaemia patients, 59 % had coronary artery calcium, 36 % obstructive coronary artery disease (≥50 % stenosis) and 77 % high-risk plaque features. Increasing hepatic steatosis was associated with higher calcium scores, more high-risk plaque features and presence of obstructive coronary artery disease. Hepatic steatosis was associated with the presence of high-risk plaque features (OR: 1.48; 95 % CI: 1.09–2.00; p = 0.01), particularly in the proximal coronary segments (OR: 1.52; 95 % CI: 1.18–1.96; p = 0.001). Associations persisted on multivariable logistic regression analysis adjusting for cardiometabolic factors, obstructive coronary artery disease and calcium score. Hepatic steatosis was associated with higher plaque volumes (Q4: 499 mm3 vs Q1: 414 mm3, p = 0.02), involving mainly low attenuation and noncalcified plaques (both p = 0.03). No differences in pericoronary adipose tissue attenuation were observed. Hepatic steatosis is associated with multiple indices of advanced coronary atherosclerosis in familial hypercholesterolaemia patients, particularly high-risk plaque features, independent of conventional cardiovascular risk factors and markers. This may involve specific mechanisms related to hepatic steatosis. Clinical trial number: N/A. [Display omitted] • Hepatic fat independently predicts high-risk coronary artery plaque features in FH. • Hepatic fat associates with higher low attenuation and non-calcified plaque volumes. • CT assessment of hepatic fat may add incremental value to CVD risk stratification. [ABSTRACT FROM AUTHOR]

To retrospectively compare the diagnostic accuracy of attenuation imaging (ATI) to detect and grade hepatic steatosis as determined by liver biopsy in a cohort of adult patients with a variety of suspected liver pathologies referred for liver sonography and biopsy. 76 patients met the criteria of having a liver biopsy performed within 4 weeks of an ATI assessment with exclusion of malignancy and prior liver resection. Patients had a median age of 50.5 (range 18-83) years (51 women, 25 men) with median BMI of 28.9 kg/m2 (range 19.2-57.2, IQR 24-33.3). ATI, shear wave elastography (SWE), shear wave dispersion (SWD) and skin to liver capsule distance (SCD) measurements were obtained. Metavir fibrosis and Brunt steatosis grading as well as the presence/absence of inflammation were noted. Controlled attenuation parameter (CAP) values were also recorded, where available. The results were analysed using Spearman correlation coefficient, receiver operator characteristic and multiple logistic model performances to assess correlations, diagnostic performance and discriminate between steatosis grades according to ATI measurement. The distribution of steatosis according to histology was 33/13/23/7 for S0 (<5%), S1(5-33%), S2(33-66%) and S3(>66%). The median ATI value for each biopsy steatosis grade was 0.60 (IQR 0.52-0.65), 0.65 (IQR 0.6-0.71), 0.83 (IQR 0.74-0.90) and 0.90 (IQR 0.82-1.01) dB/cm/MHz for S0, S1, S2 and S3. The AUC of ATI for detection of any steatosis grade (S1-S3) and moderate to severe steatosis (S2-S3) was 0.85 (95% CI, 0.748-0.908) and 0.91 (95% CI, 0.830-0.986) with cutoffs of 0.55 and 0.62 dB/cm/MHz. Logistic regression boundary value of 0.74dB/cm/MHz was able to discriminate between S0-S1 and S2-3 with accuracy, CI and kappa statistic of 0.8889, 0.6529-0.0862 and 0.7534. ATI correlations were SCD (ρ=0.40), BMI (ρ=0.39), CAP (ρ=0.49), SWD (ρ=-0.21) and SWE (ρ=-0.04). There was good correlation between ATI and histological steatosis grade, which was the only significant factor affecting the ATI measurement. The most accurate discrimination was between none to mild (S0-1) and moderate to severe (S2-3) steatosis. [ABSTRACT FROM AUTHOR]

Shear wave elastography (SWE) is an emerging ultrasound-related technology for assessment of liver fibrosis. The usefulness and reliability of SWE is unclear relative to other markers of liver fibrosis. We compared the clinical usefulness of SWE relative to transient elastography (TE), liver ultrasound and other standard biochemical markers of chronic liver disease in patients with varied liver disorders. SWE assessment was performed using a Toshiba Aplio 500 or Canon Aplio i800 machine, concurrently with liver ultrasound on 421 adult patients. Amongst these patients 227 also had liver transient elastography (TE). Patient age, gender, body mass index (BMI), alcohol history, liver disease diagnosis, and laboratory results were recorded. Associations between SWE, TE and patient factors were sought. Suspected significant liver fibrosis was defined by liver stiffness measurement interpretation of ≥ F2 equivalent using Metavir staging. Patients were predominantly male (67.5%). Males and females were matched as regards age and BMI. The indications for SWE included nonalcoholic fatty liver disease (10%), chronic hepatitis B (22%), chronic hepatitis C (38%), alcohol-related liver disease (18%) and others (12%). 23%The mean (standard deviation) age was 53 (14) years, body mass index 27.7 (6.3) kg/m2, ultrasound-measured skin to liver capsule distance 20.0 (7.3)mm, serum ALT 39(27) U/L and AST 48(32) U/L. The median (IQR) liver stiffness was 9.9 (6.4-20.0) kPa with SWE and 9.2 (5.8-20.9) kPa with TE. Patients with suspected significant liver fibrosis determined by SWE, compared with patients not suspected of having significant fibrosis, were significantly older, had higher BMI, skin to liver capsule distance, TE liver stiffness measurement, alcohol consumption, and blood based assessments AST (but not ALT), AST/ALT ratio, AST to platelet ratio index (APRI), Fibrosis-4 index (FIB-4), Hepascore and NAFLD fibrosis score (NFS), but lower platelet count and serum albumin (p < 0.05 for all). There was a strong correlation between SWE and TE liver stiffness measurement (r = 0.77, p < 001). The strength of correlation between SWE and TE varied by aetiology of liver disease; alcohol (r = 0.6, p = 0.005), hepatitis B (r = 0.5, p < 0.001), hepatitis C (r = 0.73, p < 0.001), NAFLD (r = 0.87, p < 0.001). Using multiple logistic regression analysis, independent predictors of significant liver fibrosis using either SWE or TE were FIB-4, BMI and male sex (after adjusting for other covariates). SWE was found to be a useful test for suspected liver fibrosis in various liver disorders, and results were found to correlate with TE liver stiffness measurement plus clinically relevant anthropometric and laboratory parameters. [ABSTRACT FROM AUTHOR]