title: Diagnostic accuracy of a noninvasive hepatic ultrasound score for non-alcoholic fatty liver disease (NAFLD) in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: OBJECTIVE
  Noninvasive strategies for evaluating non-alcoholic fatty liver disease (NAFLD) have been investigated over the last few decades. Our aim was to evaluate the diagnostic accuracy of a new hepatic ultrasound score for NAFLD in the ELSA-Brasil study.
  
  
  METHODS
  Diagnostic accuracy study conducted in the ELSA center, in the hospital of a public university.
  
  
  METHODS
  Among the 15,105 participants of the ELSA study who were evaluated for NAFLD, 195 individuals were included in this sub-study. Hepatic ultrasound was performed (deep beam attenuation, hepatorenal index and anteroposterior diameter of the right hepatic lobe) and compared with the hepatic steatosis findings from 64-channel high-resolution computed tomography (CT). We also evaluated two clinical indices relating to NAFLD: the fatty liver index (FLI) and the hepatic steatosis index (HSI).
  
  
  RESULTS
  Among the 195 participants, the NAFLD frequency was 34.4%. High body mass index, high waist circumference, diabetes and hypertriglyceridemia were associated with high hepatic attenuation and large anteroposterior diameter of the right hepatic lobe, but not with the hepatorenal index. The hepatic ultrasound score, based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe, presented the best performance for NAFLD screening at the cutoff point ≥ 1 point; sensitivity: 85.1%; specificity: 73.4%; accuracy: 79.3%; and area under the curve (AUC 0.85; 95% confidence interval, CI: 0.78-0.91)]. FLI and HSI presented lower performance (AUC 0.76; 95% CI: 0.69-0.83) than CT.
  
  
  CONCLUSIONS
  The hepatic ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe has good reproducibility and accuracy for NAFLD screening.
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Alessandra Carvalho
authors.initials: AC
authors.lastname: Goulart
authors.affiliation: Radiology Department, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brasil.
authors.forename: Ilka Regina Souza de
authors.initials: IR
authors.lastname: Oliveira
authors.affiliation: Institute of Mathematics and Statistics, Universidade de São Paulo (USP), São Paulo, Brasil.
authors.forename: Airlane Pereira
authors.initials: AP
authors.lastname: Alencar
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Maira Solange Camara dos
authors.initials: MS
authors.lastname: Santos
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Itamar Souza
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Radiology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Brenda Margatho Ramos
authors.initials: BM
authors.lastname: Martines
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Danilo Peron
authors.initials: DP
authors.lastname: Meireles
authors.affiliation: Radiology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: João Augusto dos Santos
authors.initials: JA
authors.lastname: Martines
authors.affiliation: University Hospital, University of Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Misciagna
authors.affiliation: Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Isabela Martins
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Department of Internal Medicine and Head, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brasil.
authors.forename: Paulo Andrade
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D048909:Diabetes Complications; D005234:Fatty Liver / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography; D055105:Waist Circumference / Q000502:physiology
chemical_list: D002784:Cholesterol