Ultrasound to detect nonalcoholic steatohepatitis in obese people

Because of a sedentary lifestyle and fast food, nearly eight million overweight French people are at risk of developing fatty liver disease, according to the Inserm. This disease (called non-alcoholic fatty liver disease, or NASH for these acronyms) can lead to cirrhosis or liver cancer. It is becoming more and more common due to the increasing obesity worldwide. So much so that it should become the main reason for liver transplantation in the near future. Currently, the most reliable way to detect excessive fatty liver is organ biopsy, but non-invasive devices can avoid this interference in the near future. These devices, of which there are few references, use ultrasound to assess the stiffness of the liver and thus estimate the level of fibrosis and steatosis (excess fat) in this organ, to reveal its condition. According to a study published in October 2021, it is almost as accurate as a biopsy in detecting these fatty livers, even in people with morbid obesity (BMI greater than 40 kg/m2).2).

What is fatty liver disease?

A diet that is too fatty or sweet leads to a buildup of fat within the liver cells that make up the liver (steatosis). They grow and deform, which can lead to their destruction. This cell death results in a scarring process that leads to an accumulation of fibrous tissue in the liver. This fibrosis will then lead to hardening of the liver, which can be detected by analyzing the speed with which waves propagate in this tissue: the more rigid it is, the greater the fibrosis, and therefore the faster the waves propagate. (Liver stiffness is a sign of cell destruction that is hindering the proper functioning of the organ.)

Researchers at the University of Vienna (Austria) tested the FibroScan (made by the French company Echosens, see box) on 170 obese patients with an average body mass index (BMI) of 44.4 kg/m2. These findings were then confirmed by biopsies. The ultrasound machine was able to predict liver stiffness, and thus the level of fibrosis and steatosis, in 90% of the subjects, but its predictions became inaccurate in those with a BMI greater than 44.4 kg/m2 (Obesity begins at 30, and morbid obesity begins at 40.) For those with weight below this BMI, the prediction of nonalcoholic fatty liver disease (NASH) was 83% accurate.

Ultrasound vs. biopsy

A biopsy is a surgical procedure that, like any surgical procedure, carries a risk of infection and bleeding. On the other hand, devices such as FibroScan are as minimally invasive as ultrasound examinations of pregnant women: ultrasound waves emitted on the surface of the skin make it possible to study the interior of the liver. Thus, this technique is safer and easier than biopsy. This study shows that the use of ultrasound devices, which have already been commercialized and used by professionals, can facilitate the diagnosis of nonalcoholic fatty liver disease. Further evaluations are needed to confirm the accuracy of detecting fatty liver in people with a very high BMI, especially those at high risk of developing cirrhosis or hepatocellular carcinoma.

Science and the future He was talking about her… 20 years ago!
Since 2001 Science and the future It echoed the development of the French device FibroScan (here, founder Laurent Sandrin and technical director of Echosens, with a medical ultrasound device. A publication that led to his meeting with designer Olivier Jeanjean.”With him, we designed the look of the device while we were developing the electronic boards. In July 2003, it was completed.”

Pictured above, Laurent Sandrine and his prototype. 20 years later, same with FibroScan today.

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