Kobyliak N. Comparative evaluation of instrumental methods for diagnosis of nonalcoholic steatohepatosis in patients with type 2 diabetes mellitus (Clinical and Experimental Research)

The thesis is devoted to evaluate the comparative effectiveness of instrumental methods for diagnosis of nonalcoholic steatosis in patients with type 2 diabetes and in laboratory animals with experimental obesity. Established that normal values of liver stiffness measured by ShearWave™ Elastography is in the range 4-6 kPa. It is shown that ShearWave™ Elastography can be used as the noninvasive diagnostic marker of nonalcoholic steatosis in patients with type 2 diabetes and in experimental obesity. The diagnostic effectiveness of the method rise with an increasing of fatty infiltration more than 30 % (sensitivity 98 %, specificity 92 %, PPV 97.4 % and NPV 95.8 %). But for differentiation of fatty liver stages ShearWave™ Elastography has a lower diagnostic efficiency. For detection of mild steatosis (fatty infiltration >5-<30 %) the highest diagnostic efficiency are observed for hepato-renal and attenuation indices as are parameters which we used for quantitative assessment of echogenicity change. In patients with type 2 diabetes we diagnosed mild steatosis if the value of hepato-renal index were >1.45 and attenuation index >61.9. But sensitivity and specificity of these indices are high only in cause of diffuse liver damage, which in clinical practice is not always observed. For differentiation of nonalcoholic steatosis stages sufficient diagnostic efficiency has only hepato-renal index as the most sensitive parameter. For mild steatosis its value range from >1.45 to <1.85, for moderate degree >1.85-<2.51 and for severe steatosis >2.51.