Nonalcoholic fatty liver disease: scintigraphy in the diagnosis of steatohepatitis

Silva, Alessandro D'Avila da; Mattos, Ângelo Zambam de; Tovo, Cristiane Valle; Daros, Larissa Faraco; Anselmi, Osvaldo Estrela; Coral, Gabriela Perdomo; Mattos, Angelo Alves de

doi:10.1590/1806-9282.20210718

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Original Article • Rev. Assoc. Med. Bras. 67 (11) • Nov 2021 • https://doi.org/10.1590/1806-9282.20210718 copy

Nonalcoholic fatty liver disease: scintigraphy in the diagnosis of steatohepatitis

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Nonalcoholic fatty liver disease is the most prevalent cause of chronic liver disease worldwide. Nonalcoholic steatohepatitis is associated with increased mortality rates due to the liver and cardiovascular diseases. The gold standard for discriminating nonalcoholic fatty liver disease activity and staging is the anatomopathological examination, which is an invasive method. In this regard, noninvasive methods, such as scintigraphy, have been under investigation. This study investigated the role of scintigraphy in the diagnosis of nonalcoholic steatohepatitis in obese patients with nonalcoholic fatty liver disease undergoing bariatric surgery.

METHODS:

Patients undergoing bariatric surgery and liver biopsy were prospectively included. ^99mTc-phytate scintigraphy was performed to assess liver/spleen, spleen/heart, and liver/heart uptake ratios, while ^99mTc-isonitrile scintigraphy assessed liver/heart ratio. To evaluate the presence of nonalcoholic steatohepatitis, the results of ^99mTc-phytate scintigraphy and ^99mTc-isonitrile scintigraphy were compared with the anatomopathological examination.

RESULTS:

Sixty-one patients with nonalcoholic fatty liver disease were allocated into two groups, namely, nonalcoholic steatohepatitis (n=49) and non-nonalcoholic steatohepatitis (n=12). The results of scintigraphic images obtained after the infusion of radiopharmaceutical ^99mTc-phytate in liver/spleen, spleen/heart, liver/heart ratios and ^99mTc-isonitrile liver/heart ratio presented no difference between groups with and without nonalcoholic steatohepatitis with an accuracy of 47.5, 37.7, 50.8, and 52.5%, respectively.

CONCLUSION:

Scintigraphy was not proven to be a useful method to differentiate patients with and without nonalcoholic steatohepatitis.

KEYWORDS:
Non-alcoholic fatty liver disease; Nonalcoholic steatohepatitis; Diagnosis; Radionuclide imaging

	All-cases (n=61)	Without NASH (n=12)	With NASH (n=49)	p-value
Age^* * Data presented as mean±SD; (years)	39.4±9.1	36.1±8.4	40.2±9.2	0.159^a a Mann-Whitney U test.
Female^ Data presented as number of patients (% of all patients).	49 (80.3)	9 (7.5)	40 (81.6)	0.689^a a Mann-Whitney U test.
BMI^* * Data presented as mean±SD; (kg/m²)	42.5±5.5	44.5±3.0	42.1±5.7	0.050^a a Mann-Whitney U test.
ALT^* * Data presented as mean±SD; (U/L)	36.3±21.2	24.6±10.3	39.1±22.0	0.009^a a Mann-Whitney U test.
AST^* * Data presented as mean±SD; (U/L)	26.4±11.1	22.3±6.3	27.4±1.8	0.167^a a Mann-Whitney U test.
Bilirubin^* * Data presented as mean±SD; (mg/dL)	0.4±0.3	0.4±0.3	0.4±0.3	0.956^a a Mann-Whitney U test.
Triglycerides^* * Data presented as mean±SD; (mg/dL)	177.3±160.8	105.6±34.8	198.9±74.5	0.011^a a Mann-Whitney U test.
TC^* * Data presented as mean±SD; (mg/dL)	193.9±38.6	174.8±30.4	198.5±39.3	0.059^a a Mann-Whitney U test.
HDL^* * Data presented as mean±SD; (mg/dL)	47.1±10.4	53.6±11.2	45.6±9.7	0.038^a a Mann-Whitney U test.
LDL^* * Data presented as mean±SD; (mg/dL)	114±29	100±26	117±28	0.106^a a Mann-Whitney U test.
Glucose^* * Data presented as mean±SD; (mg/dL)	104.5±33.0	87.2±8.8	108.8±35.3	0.004^a a Mann-Whitney U test.
Insulin^* * Data presented as mean±SD; (U/L)	20.7±9.1	16.8±5.8	21.7±9.5	0.037^a a Mann-Whitney U test.
HOMA-IR^* * Data presented as mean±SD;	5.5±3.3	3.8±1.5	6.0±3.5	0.013^a a Mann-Whitney U test.
Platelets^* * Data presented as mean±SD; (mm³)	274573±67274	272000±68747	275204±67616	0.949^a a Mann-Whitney U test.
Ferritin^* * Data presented as mean±SD; (ng/mL)	240.9±226.6	214.6±157.2	247.3±241.5	0.986^a a Mann-Whitney U test.
Albumin^* * Data presented as mean±SD; (g/dL)	4.2±0.3	4.2±0.3	4.2±0.3	0.964^a a Mann-Whitney U test.
Hypertension^ Data presented as number of patients (% of all patients).	28 (45.9)	3 (25.0)	25 (51.0)	0.122^b b Fisher's exact test.
Diabetes^ Data presented as number of patients (% of all patients).	14 (23.0)	1 (8.3)	13 (26.5)	0.264^b b Fisher's exact test.
Dyslipidemia^ Data presented as number of patients (% of all patients).	12 (19.7)	0 (0)	12 (24.5)	0.100^b b Fisher's exact test.

		All-cases (n=61)	Without NASH (n=12)	With NASH (n=49)	p-value
^99mTc-phytate liver/spleen
	Mean±SD	5.73±2.60	7.43±4.46	5.32±1.73	0.095
	Median	5.35	7.05	5.31
	(min–max)	2.67–19.49	3.8–19.49	2.67–10.59
^99mTc-phytate spleen/heart
	Mean±SD	2.25±0.65	2.03±0.62	2.30±0.65	0.207
	Median	2.17	1.99	2.26
	(min–max)	1.01–4.23	1.01–3.33	1.30–4.23
^99mTc-phytate liver/heart
	Mean±SD	11.90±3.08	13.21±3.89	11.58±2.80	0.179
	Median	11.85	12.84	11.56
	(min–max)	6.10–19.84	6.81–19.84	6.10–17.96
^99m Tc-MIBIliver/heart
	Mean±SD	2.08±0.71	2.32±0.84	2.02±0.67	0.171
	Median	1.92	2.19	1.92
	(min–max)	1.11–4.31	1.51–4.31	1.11–4.26

	Sensitivity (%)	Specificity (%)	PVV (%)	NPV (%)	Accuracy (%)
^99mTc-phytateliver/spleen≤5	44.9	58.3	81.5	20.6	47.5
^99mTc-phytatespleen/heart≤2	34.7	50.0	73.9	15.8	37.7
^99mTc-phytateliver/heart≤11.5	46.9	66.7	85.2	23.5	50.8
^99mTc-methoxy-isobutyl isonitrileliver/heart≤1.9	49	66.7	85.7	24.2	52.5

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[1] *Corresponding author: cristianev@ufcspa.edu.br