The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study

• Published in: European journal of radiology 2021-03, Vol.136, p.109516-109516, Article 109516
• Main Authors: Niriella, Madunil Anuk, Ediriweera, Dileepa Senajith, Kasturiratne, Anuradhani, Gunasekara, Deepa, De Silva, Shamila Thivanshi, Dassanayaka, Anuradha Supun, De Silva, Arjuna Priyadarshin, Kato, Norihiro, Pathmeswaran, Arunasalam, Wickramasinghe, Ananda Rajitha, de Silva, Hithanadura Janaka
• Format: Article
• Language: English
• Subjects: Cardiovascular events; Cohort Studies; Fatty liver; Humans; NAFLD; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Non-alcoholic Fatty Liver Disease - epidemiology; Outcomes; Prospective Studies; Risk Factors; Ultrasonography; Ultrasound criteria
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2020.109516

•We assessed the clinical utility of using increase of hepatic echogenicity alone (intermediate) compared to using additional criteria (moderate-severe) for the diagnosis of fatty liver.•After seven years of follow-up, the odds of having new-onset metabolic traits and cardiovascular events were significantly higher compared to controls only in moderate-severe non-alcoholic fatty liver disease (NAFLD).•However, both intermediate and moderate-severe NAFLD were both associated with higher prevalent adverse metabolic traits compared to controls, thereby identifying individuals that need medical intervention.•We therefore recommend the approach of staging or grading rather than using stringent US criteria for diagnosis of fatty liver in NAFLD. Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying