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
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
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.
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
45 type 2 diabetic patients (19 M, 26F).
Duration of acquired DM= first onset -20 years.
2 obese patients (4,4%), 11 over weight
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
6,66% (3 cases) significant
fibrosis (F2-F3) without
steatosis: long time DM (7-
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
Lower percentage ofVietnamese 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
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.
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
The interference by obesity on theARFI
technique was less conspicuous.
1. 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
3. ARFI technique is comparable withTE in liver
1. Liver Stiffness Evaluation byTransient Elastography inType 2
Diabetes Mellitus Patients with Ultrasound-proven Steatosis
-Ioan Sporea1, Ruxandra Mare1, Raluca Lupușoru1,Alexandra
Sima2, Roxana Șirli1, Alina Popescu1, RomulusTimar2, J
Gastrointestin Liver Dis, June 2016Vol. 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