Liver Stiffness Evaluation by ARFI imaging in Type 2 Diabetes Mellitus Patients

Nguyễn Thị Hồng Anh, MDNguyễn Thiện Hùng, MDMEDIC CENTER VIETNAM

Introduction

The prevalence of metabolic syndrome is increasing while the age of its onset is decreasing

Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases worldwide.

Fatty infiltration of the liver is quite frequent in patients with obesity, DM and metabolic syndrome.

Bi-directional, causal link between NAFLD and DM.

A percentage of NAFLD will develop nonalcoholic steatohepatitis (NASH), which can progress to liver cirrhosis.

Accurate assessment of the degree of liver fibrosis is important for estimating prognosis and deciding on an appropriate course of treatment for cases of chronic liver disease with various etiologies.

Because of the inherent limitations of liver biopsy, there is a great need for noninvasive and reliable tests that accurately estimate the degree of liver fibrosis. Ultrasound elastography is considered a non-invasive, convenient, and precise technique to grade the degree of liver fibrosis by measuring liver stiffness.

Background & Aims The aim of this small observed study

was to evaluate a population of OPD diabetic patients regarding the severity of liver steatosis and liver fibrosis by ARFI imaging.

Materials and method Descriptive cross-section statistics Assess liver steatosis (B mode

transabdominal US)and liver fibrosis (ARFI imaging)

Inclusive criteria: DM patients > 18 yrs

Exclusive criteria Consumption beer / alcohol >20g/day HBV, HCV Drug induced hepatitis Autoimmune hepatitis

Staging liver steatosis and fibrosis

Steatosis severity:semi-quantitative scale/ B mode S0 = no steatosis S1 = mild steatosis S2 = moderate steatosis S3 = severe steatosis

Stages of liver fibrosis (ARFI technique) F0 = 0,99 - 1,16 m/s F1 = 1,16 - 1,25 m/s F2 = 1,25 - 1,32 m/s F3 = 1,32 - 1,56 m/s F4 = 1,56 - 4,15 m/s

FATTY INFILTRATION B-mode

Results

45 type 2 diabetic patients (19 M, 26F).

Age=30-74. Duration of acquired DM= first onset -

20 years. 2 obese patients (4,4%), 11 over

weight patients (24,44%)

Results Significant fibrosis

(F2-F3): 31.1% (14 cases) patients with or without steatosis.

Severe fibrosis (F4): 17.77% (8 cases) with steatosis.

100% severe steatosis (S3) are significant /severe fibrosis.

6,66% (3 cases) significant fibrosis (F2-F3) without steatosis: long time DM (7-15 y)

S0 S1 S2 S3 Total

F0 2 2 2 0 6

F1 3 11 3 0 17

F2 1 3 1 1 6

F3 2 3 2 1 8

F4 0 4 1 3 8

Total 8 23 9 5 45

Discussion 1 Lower percentage of Vietnamese over

weight / obese DM patients compared to western-american

(2/45 obese +11/45 over weight #28,88%) Lower percentage of male DM patient (19/45

#42,22%) because of inclusive criteria (non alcohol and negative HBV, HCV)

Liver steatosis diagnosed by ultrasound is very frequently found in type 2 DM patients (38/45#84,44%), a significance of them having moderate/severe steatosis (S2=9, S3=5; 14/38 #36,84%)

Discussion 2 A significant liver stiffness increase was

found in more than 40% of DM patients and was not correspondence with steatosis severity. Fibrosis seems to depend on acquired DM duration.

But severe steatosis (S3) was concerned with significant /severe fibrosis.

ARFI technique is a fast, useful and valuable tool, as comparable as transient elastography in diabetic liver stiffness assessment.

Discussion 3 The best accuracy for ARFI in NAFLD

patients occurred when distinguishing between patients with no or moderate fibrosis (F0 to F2) and those with severe fibrosis or cirrhosis (F3-F4).

The interference by obesity on the ARFI technique was less conspicuous.

Conclusions1. A significant liver stiffness increase was

found in more than 40% of DM patients. 2. Liver stiffness assessment in type 2

diabetic patients should be performed systematically to identify those with significant liver fibrosis.

3. ARFI technique is comparable with TE in liver stiffness assessment.

References

1. Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound-proven Steatosis -Ioan Sporea1, Ruxandra Mare1, Raluca Lupușoru1, Alexandra Sima2, Roxana Șirli1, Alina Popescu1, Romulus Timar2, J Gastrointestin Liver Dis, June 2016 Vol. 25 No 2: 167-174.

2. Liver Stiffness in Nonalcoholic Fatty Liver Disease:A Comparison of Supersonic Shear Imaging,FibroScan, and ARFI With Liver Biopsy. HEPATOLOGY, Month 2015

3. Principles and clinical application of ultrasound elastography for diffuse liver disease-Woo Kyoung Jeong1, Hyo K. Lim1, Hyoung-Ki Lee2, Jae Moon Jo2, Yongsoo Kim3. Ultrasonography 33(3), July 2014

Thanks for attention !