A Prospective Evaluation of Transient Elastography in Non-Alcoholic Fatty Liver Disease - BMI and Subcutaneous Fat Thickness Do Not Affect Accuracy
Bibliographic record
Abstract
Purpose: Transient elastography (TE) has emerged as an important non-invasive technique of evaluating hepatic fibrosis. However, recent data suggest that greater hepatic steatosis may downgrade TE values relative to the degree of hepatic fibrosis on biopsy in nonalcoholic fatty liver disease (NAFLD) patients. This prospective study evaluates the relationship between TE values and hepatic steatosis as measured on magnetic resonance imaging (MRI) of the liver. Other variables which may affect TE accuracy in NAFLD were also investigated, including higher patient body mass index (BMI) and greater subcutaneous fat overlying the liver. Methods: All adult patients at a tertiary care centre in London, Canada, who met diagnostic criteria for NAFLD were invited to participate in this study. All patients underwent liver biopsy, TE and had anthropomorphic measurements, liver transaminases and measures of metabolic dysfunction measured. Liver biopsies were read by a single, blinded pathologist and scored according to the validated nonalcoholic steatohepatitis activity score (NAS). The FibroScan 502 system (Echosens) was used to conduct TE measurements for all study patients. Subcutaneous fat and hepatic steatosis measured as hepatic fat fraction was measured using Magnetic Resonance Imaging with Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL-MRI), a computer-based quantification method separating fat and water signals in MRI images allowing accurate, validated and reproducible measurement of subcutaneous fat thickness. Linear regression analysis was used to evaluate the correlation between BMI and TE values; subcutaneous fat thickness and TE values; and degree of fibrosis on liver biopsy and TE values. Results: Linear regression demonstrated a positive correlation between TE values and the degree of fibrosis on liver biopsy (P<0.001). There was no correlation between subcutaneous fat thickness and TE values (P=0.699), between BMI and TE values (P=0.883), between subcutaneous fat thickness and liver fibrosis score (p=0.183), nor between BMI and liver fibrosis score (p=0.057). There was no correlation between hepatic fat fraction and TE values (p=0.152), nor hepatic fat fraction and liver fibrosis score (p=0.0118). Conclusion: This study demonstrates that TE correlates well with the degree of hepatic fibrosis on liver biopsy in NAFLD patients, and suggests that common anthropomorphic features of such patients such as increased hepatic steatosis, increased BMI, and peri-hepatic subcutaneous fat does not adversely affect the reliability of TE. This finding supports the continued use of this important diagnostic modality in a population that is becoming increasingly prevalent.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".