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Session: Ultrasound
Session starts: Thursday 26 January, 10:30
Presentation starts: 11:30
Room: Room 559

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Gert Weijers (Radboudumc)
Eric Tjwa (Radboudumc)
Chris de Korte (Radboudumc)

Abstract:
Purpose Test if the Calibrated Ultrasound (CAUS) predictive performance increases in the detection and staging of hepatic steatosis, when using a novel quantitative histology method for staging the liver fat content instead of traditional histological steatosis staging (NALFD Activity score, further called NAS). Background and methods Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder in developed countries with a global prevalence of approximately 25%. Liver biopsy still is the gold standard for staging steatosis, however are invasive and prone to misclassification by qualitative scoring. CAUS is able to detect and classify steatosis accurately compared to classical steatosis scoring (Weijers et al., Radiology, 2022). CAUS’ Residual Attenuation Coefficient (RAC), which is a depth independent relative attenuation measure, showed the highest predictive value. To test the effect of possible histological misclassification we compared CAUS to a novel and quantitative method for automatic interpretation of digitized HE stains (Munsterman et al,. Cytometry B, 2019) Results In this study retrospectively 214 consecutive patients were enrolled from which 195 patient with a successful liver biopsy and 2D ultrasound examinations could be included. HE stains were digitized and quantitatively analyzed by determining the fat area percentage (QNAS, %). Area under the ROC (AUROC) were performed to assess the predictive performance of steatosis grading. Highest correlation to QNAS was found for CAUS’ RAC parameter (R=0.77, p<.001). Boosted performances of CAUS to QNAS (AUROC mild; moderate; severe steatosis respectively: 0.99; 0.96; 0.95) were found compared to traditional histological staging (AUROC: 0.97; 0.93; 0.93). Conclusion CAUS is able to classify HS accurately using calibrated 2D ultrasound images. The use of quantitative instead of qualitative histology boosted the predictive performance, which indicate that HS misclassification by pathologist partly might be overcome.