A Comparison of the Sensitivity and Specificity of Ultrasound Elastography Compared to Liver Ultrasound, ALT, and AST in the Detection of Fatty Liver and Fibrosis in Patients with Metabolic Syndrome and Type 2 Diabetes Mellitus
Abstract
Objective. This study aims to determine whether ultrasound elastography (fibroscan) is more sensitive and specific in detecting fatty liver and fibrosis as compared to ultrasound and elevated serum aminotransferase levels in patients with type 2 diabetes mellitus and metabolic syndrome.
Methodology. All elastography results from January to December, 2013 were reviewed. A total of 102 patients met the inclusion/exclusion criteria. The sensitivity and specificity of elastograph, ultrasound, ALT and AST were computed, with fibrosis score as the surrogate gold standard.
Results. Elastography was found to be more sensitive compared to ultrasound for patients with diabetes and metabolic syndrome who have high and moderate probability of fibrosis (100% vs 82.5%, p-value = 0.0036 and 96% vs 76.4%, p-value = 0.0036, respectively). The elastograph is also more specific compared to ultrasound (86.49% vs 32.43%, p-value = 0.0000) for detecting fatty liver and fibrosis. Only elastography was found to be significantly associated with the surrogate gold standard used in this study.
Conclusion. Elastograph (fibroscan) is more sensitive and specific than ultrasound in detecting fatty liver in the presence of severe and moderate probability for fibrosis. Ultrasound, ALT and AST showed no correlation with fibrosis score.Downloads
References
Kelley DE, McKolanis TM, Hegazi RAF, Kuller LH and Kalhan SC. Fatty liver in type 2 diabetes mellitus: relation to regional adiposity, fatty acids, and insulin resistance. Am J Physiol Endocrinol Metab. 2003;285: E906–E916.
Marchesini G, et al. Nonalcoholic fatty liver disease a feature of the metabolic syndrome. Diabetes 50.8 2001: 1844-1850.
Wieckowska A and Feldstein AE. Diagnosis of nonalcoholic fatty liver disease: Invasive versus noninvasive. Seminars in Liver Disease. 2008; 28(4):386–395.
Garcia-Compean DK, et al. Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management. World Journal of Gastroenterology. 2009; 42-56.
Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: A longitudinal study of 103 patients with sequential liver biopsies. Journal of Hepatology. 2005; 42:132–138.
Myers RP, et al. Noninvasive diagnosis of nonalcoholic fatty liver disease. Annals of Hepatology 2009; 8(1): S25-S33
Adams LA and Angulo P. Recent concepts in non‐alcoholic fatty liver disease. Diabetic Medicine. 2005; 22(9): 1129-1133.
Poynard T, et al. The diagnostic value of biomarkers for the prediction of liver steatosis. Comp Hepatology. 2005; 4:10
Erbey JR, Silberman C, Lydick E. Prevalence of abnormal serum alanine amino transferase level in obese patients and patients with type 2 diabetes. American Journal of Medicine, 2000 November; 109(7)588-590.
Yin-Yan L, Xue-Mei W, et al. Ultrasonic elastography in clinical quantitative assessment of fatty liver. World Journal of Gastroenterology. 2010; 12-25.
Angulo P, et al. The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD. Journal of Hepatology. 2007; 45(4): 846-54
Consensus worldwide definition of metabolic syndrome. http//:www.idf.org/webdata/docs/IDF_Meta_def_final.pdf. Accessed September 10, 2012.
Foucher J, et al. Diagnosis of cirrhosis by transient elastography (fibroscan): A prospective study. GUT. 2006; 124-156.
Somaye K, et al. Non-alcoholic fatty liver disease and correlation of serum alanine aminotransferase level with histopathologic findings. Hepatitis Monthly. 2011; 11(6): 452-458
Paschos P, Paletas K. Non-alcoholic fatty liver disease and metabolic syndrome. Hippokratia. 2009; 13(1): 9-19.
Prati D, Taioli E, Zanella E. Updated definitions of healthy ranges for serum alanine transferase levels. Ann. Med. Int. 2002; 137:1-1.
Smith BW, Adams LA. Nonalcoholic fatty liver disease and diabetes mellitus: Pathogenesis and treatment. Nature Reviews Endocrinology. 2011; 7(8):456-465.
Levinthal G and Tavill A. Liver disease and diabetes mellitus. Clinical Diabetes. 2010; 498-532.
Oikawa S, Fon Tracer K, Rozman D. Nonalcoholic fatty liver disease: Focus on lipoprotein and lipid deregulation. Journal of Lipids. 2011; 28(4):339-350.
Demir M, Lang S, Schlattjan M, Drebber U, Wedemeyer I, et al. NIKEI: A new inexpensive and non-invasive scoring system to exclude advanced fibrosis in patients with NAFLD. PLoS ONE 8(3): 2013: e58360. doi:10.1371/journal.pone.0058360
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
