비알콜성 지방간 초음파 영상에 GLCM과 인공신경망을 적용한 비알콜성 지방간 질환 분류

김지율,예수영 한국방사선학회 2023 한국방사선학회 논문지 Vol.17 No.5

Non-alcoholic fatty liver disease is an independent risk factor for the development of cardiovascular disease, diabetes, hypertension, and kidney disease, and the clinical importance of non-alcoholic fatty liver disease has recently been increasing. In this study, we aim to extract feature values ​​by applying GLCM, a texture analysis method, to ultrasound images of patients with non-alcoholic fatty liver disease. By applying an artificial neural network model using extracted feature values, we would like to classify the degree of fat deposition in non-alcoholic fatty liver into normal liver, mild fatty liver, moderate fatty liver, and severe fatty liver. As a result of applying the GLCM algorithm, the parameters Autocorrelation, Sum of squares, Sum average, and sum variance showed a tendency for the average value of the feature values ​​to increase as it progressed from mild fatty liver to moderate fatty liver to severe fatty liver. The four parameters of Autocorrelation, Sum of squares, Sum average, and sum variance extracted by applying the GLCM algorithm to ultrasound images of non-alcoholic fatty liver disease were applied as inputs to the artificial neural network model. The classification accuracy was evaluated by applying the GLCM algorithm to the ultrasound images of non-alcoholic fatty liver disease and applying the extracted images to an artificial neural network, showing a high accuracy of 92.5%. Through these results, we would like to present the results of this study as basic data when conducting a texture analysis GLCM study on ultrasound images of patients with non-alcoholic fatty liver disease.

비비만인에서 발견되는 비알콜성 지방간의 대사적 의미

이광은 ( Kwang Eun Lee ),김유미 ( Yoo Mee Kim ),강은석 ( Eun Seok Kang ),김혜진 ( Hae Jin Kim ),정혜원 ( Hae Won Chung ),이시훈 ( Sh Hoon Lee ),김형진 ( Hyeung Jin Kim ),김대중 ( Dae Jung Kim ),김수경 ( Soo Kyung Kim ),안철우 ( Ch 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : It is well known that non-alcoholic fatty liver disease is associated with metabolic syndrome such as obesity, type II diabetes mellitus, dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-obese adults, but the meaning of it is unknown. So we studied the association of non-alcoholic fatty liver disease in non-obese adults and metabolic abnormalities. Methods : We examined 779 Korean adults above 30 years old (274 men, 505 women) participating in medical check-up in Health Promotion Center. Hepatitis B and C serologies were negative, and average weekly alcohol intake was .2 drinks. A standard interview, physical examination and biochemical study was conducted. An experienced operator carried out ultrasound liver studies. Results : 370 subjects had non-alcoholic fatty liver disease (47.3%). The frequency in men was higher than that in women (57.3 vs 42.2%, p<0.05). The frequency in non-obese (BMI<25 kg/m2, n=431) group was lower than that in obese (BMI.25 kg/m2, n=348) group (65.5 vs 32.3%, p<0.05). Compared with obese group, waist circumference, waist hip ratio, body fat, impaired fasting serum glucose, total cholesterol, HDL-cholesterol, total cholesterol to HDL-cholesterol ratio, fasting insulin, proinsulin, HOMA-IR and HOMA-beta were significantly different in non-obese, non-alcoholic fatty liver group. After multiple regression analysis, waist circumference was associated with non-alcoholic fatty liver disease in non-obese individuals. Odd ratios of insulin resistance in non-obese, non-alcoholic fatty liver group were 5.8 (CI: 3.1.10.9). Conclusion : The frequency of non-alcoholic fatty liver disease was very high in non-obese adults and well associated with central obesity and insulin resistance.(Korean J Med 63:488-495, 2002) Key Words : Non - alcoholic fatty liver disease, Body mass index, Metabolic syndrome, Central obesity

Sex Difference in the Association between Serum Homocysteine Level and Non-Alcoholic Fatty Liver Disease

Bo-Youn Won,Kyung-Chae Park,Soo-Hyun Lee,Sung-Hwan Yun,Moon-Jong Kim,Kye-Seon Park,Young-Sang Kim,Ji-Hee Haam,Hyung-Yuk Kim,Hye-Jung Kim,Ki-Hyun Park 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.4

Background: The relationship between serum homocysteine levels and non-alcoholic fatty liver disease is poorly understood. This study aims to investigate the sex-specific relationship between serum homocysteine level and non-alcoholic fatty liver disease in the Korean population. Methods: This cross-sectional study included 150 men and 132 women who participated in medical examination programs in Korea from January 2014 to December 2014. Patients were screened for fatty liver by abdominal ultrasound and patient blood samples were collected to measure homocysteine levels. Patients that consumed more than 20 grams of alcohol per day were excluded from this study. Results: The homocysteine level (11.56 vs. 8.05 nmol/L) and the proportion of non-alcoholic fatty liver disease (60.7% vs. 19.7%) were significantly higher in men than in women. In men, elevated serum homocysteine levels were associated with a greater prevalence of non-alcoholic fatty liver disease (quartile 1, 43.6%; quartile 4, 80.6%; P=0.01); however, in females, there was no significant association between serum homocysteine levels and the prevalence of non-alcoholic fatty liver disease. In the logistic regression model adjusted for age and potential confounding parameters, the odds ratio for men was significantly higher in the uppermost quartile (model 3, quartile 4: odds ratio, 6.78; 95% confidential interval, 1.67 to 27.56); however, serum homocysteine levels in women were not associated with non-alcoholic fatty liver disease in the crude model or in models adjusted for confounders. Conclusion: Serum homocysteine levels were associated with the prevalence of non-alcoholic fatty liver disease in men.

The Impact of Weight Changes on Nonalcoholic Fatty Liver Disease in Adult Men with Normal Weight

Ji-Young Cho,Tae-Heum Chung,Kyoung-Mo Lim,Hee-Jin Park,Jung-Mi Jang 대한가정의학회 2014 Korean Journal of Family Medicine Vol.35 No.5

Background: Although it is known that losing weight has an effect on the treatment of non-alcoholic fatty liver disease, the studies that show how losing weight affects the non-alcoholic fatty liver disease for the normal weight male adults are limited so far. In this study, we set body mass index as criteria and investigated how the weight changes for 4 years makes an impact on the risk of non-alcoholic fatty liver disease for the male adults who have the normal body mass index.Methods: From January to December of 2004, among the normal weight male adults who had general check-up at the Health Promotion Center of Ulsan University Hospital, 180 people (average age, 47.4 ± 4.61 years) who were diagnosed with fatty liver through abdominal ultrasonography were included in this study and were observed according to the variety of data and ultrasonography after 4 years (2008). People who had a history of drinking more than 140 g of alcohol per week or who had a past medical history were excluded from the analysis. The weight change of subjects was calculated using the formula ‘weight change = weight of 2008 (kg) - weight of 2004 (kg)’ and classified into three groups, loss group (≤-3.0 kg), stable group (-2.9 to 2.9 kg), and gain group (≥3.0 kg). The odds for disappearance of non-alcoholic fatty liver disease in those three different groups were compared.Results: Among 180 subjects, compared with stable group (67.2%, 121 subjects), loss group (11.7%, 21 subjects) showed 18.37-fold increase in the odds of disappearance of non-alcoholic fatty liver disease (95% confidence interval [CI], 4.34 to 77.80) and gain group (21.1%, 38 subjects) showed 0.28-fold decrease in the odds of disappearance of non-alcoholic fatty liver disease (95% CI, 0.10 to 0.83).Conclusion: Even for the normal weight people, losing weight has an effect on the improvement of non-alcoholic fatty liver disease.

The Risk of Abdominal Obesity according to the Degree of Non- Alcoholic Fatty Liver Disease in Korean Men

박성근,류재홍,최중명,서민우,박정민 대한의학회 2016 Journal of Korean medical science Vol.31 No.3

Although non-alcoholic fatty liver disease has been reported as a cardiometabolic risk factor, the effect of non-alcoholic fatty liver is yet to be clarified on abdominal obesity. Therefore, this study was conducted to investigate the longitudinal relationship of nonalcoholic fatty liver on the development of abdominal obesity. The study participants were composed of 11,212 Korean men without abdominal obesity. They were followed up from 2005 to 2010 to be monitored for the development of abdominal obesity according to their degree of non-alcoholic fatty liver disease (normal, mild, and moderate to severe). Cox-proportional hazard model was used to calculate the hazard ratios for abdominal obesity according to the degree of non-alcoholic fatty liver disease. While the average incidence was 15.5%, the incidence of abdominal obesity increased according to the degree of non-alcoholic fatty liver (normal: 11.6%, mild: 25.2%, moderate to severe: 41.0%, P < 0.001). Multivariable-adjusted hazard ratios for abdominal obesity independently increased proportionally to the degree of NAFLD (mild [1.07; 0.94-1.23], moderate to severe [1.58; 1.11-2.26], P for trend < 0.001). The risk of abdominal obesity increased proportionally to the degree of non-alcoholic fatty liver disease. This finding guarantees further studies to reveal the incidental relationship of abdominal obesity with non-alcoholic fatty liver disease.

성인 여성에서 비알코올성 지방간의 중증도에 따른 대사증후군 관련성

공은희 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background: The aim of this study was to elucidate the relationship between the grade of non-alcoholic fatty liver diseases diagnosed by ultrasonography and the metabolic syndrome defined by the Third Report of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guideline. Methods: A total of 198 women who visited a health promotion center from January, 2007 to December, 2008 were selected for this study. The ultrasound scan of the liver was performed to determine the presence and the severity of non-alcoholic fatty liver disease. The relationship between non-alcoholic fatty liver and risk categories of metabolic syndrome using NCEP-ATP III guideline were analysed. Results: The prevalence of metabolic syndrome was 19.2% in women with non-alcoholic fatty livers. When odds ratios(95% CI) for metabolic syndrome in groups with moderate and severe non-alcoholic fatty livers were compared to that of group with mild non-alcoholic fatty livers, there was an increased risk of metabolic syndrome with an odds ratio of 2.24(1.31∼4.41). Conclusion: Non-alcoholic fatty liver disease was closely related to the metabolic syndrome in healthy women and the severity classification of non-alcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance and the risk of metabolic syndrome

AHP 기법을 이용한 비알콜성 지방간에 인진호탕(茵蔯蒿湯) 선택과정 분석

김기태 ( Kitae Kim ),고흥 ( Heung Ko ),신선미 ( Seonmi Shin ) 대한한의진단학회 2015 大韓韓醫診斷學會誌 Vol.19 No.3

Abstract Objectives: Lately, non alcoholic fatty liver patients are increasing rapidly and the average age of patients are getting younger. Non alcoholic fatty liver often represents asymptomatic and korean pattern diagnosis is difficult to implement without symptoms. This study aimed to analyze interrelationship between non alcoholic fatty liver disease and Injinho-tang. Methods The AHP is a systematic procedure for analyzing the elements of any problem hierarchically. Based on survey of expertise, as series of pairwise comparison judgements is performed to evaluate the various elements in the hierarchy. We are expected to use the AHP analysis that would apply to oriental doctor`s diagnostic process analysis. Results and conclusion Non-alcoholic fatty liver disease induced complex causes of the metabolic syndrome. Injinho-tang has been widely used disease that causes jaundice and liver biliary disease. According to AHP analysis, LFT is the most important facor in choosing Injinho-tang on non alcoholic fatty liver disease. BMI and body composition by bioelectrical impedance analysis are the next important factors. Personal hot temper also gives a big impact on choicing Injinho-tang on non alcoholic fatty liver disease.

Fibrotic Burden in Non-Alcoholic Fatty Liver Disease Inde-pendently Predicts the Incident Chronic Kidney Disease Development: A Large Prospective Cohort Study

( Young Eun Chon ),( Seong Gyu Hwang ),( Kyu Sung Rim ),( Mi Na Kim ),( Hana Park ),( Yun Bin Lee ),( Joo Ho Lee ),( Yeonjung Ha ),( Mi Jung Lee ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Although non-alcoholic fatty liver disease (NAFLD) is associated with increased risk of incident chronic kidney disease (CKD) development, association between the severity of NAFLD and CKD incidence has not been elucidated. This study investigated the association between the fibrosis in NAFLD and development of incident CKD in a large cohort study. Methods: Among 10,030 subjects in Ansan and Ansung community based cohort in Korea, 6,854 subjects were finally analyzed after excluding patients with excessive alcoholic consumption or CKD at baseline. NAFLD was defined by NAFLD liver fat score, fatty liver index, or hepatic steatosis index. Degree of liver fibrosis was assessed by NAFLD fibrosis score. Incident CKD was defined as eGFR <60 ml/min per 1.73 m² at any time. Results: During 12-years of follow-up period, CKD developed in 1344 subjects (19.6%). NAFLD was a significant predictor for development of incident CKD after adjusting other confounders (using NAFLD liver fat score; odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09- 1.42). In subjects with NAFLD (n=1807, using NAFLD liver fat score), multivariate logistic regression analysis demonstrated an independent association between advanced liver fibrosis assessed by NAFLD fibrosis score and incident CKD development (OR, 1.23; 95% CI, 1.02-1.49). Conclusions: Presence of NAFLD and the amount of fibrosis in NAFLD were independently associated with incident CKD development, and the associations were independent of metabolic syndrome.

Functional Abnormalities of the Liver in Diabetic Patients with and without Viral Hepatitis C in Mongolia

( Altantuya Idkhuu ),( Dashchirev Munkh-orshikh ),( Baasankhuu Enkhtuvshin ),( Uranbaigali Enkhbayar ),( Oidov Baatarkhuu ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: We aimed to compare liver function of diabetes mellitus patients with and without viral hepatitis C using the non-alcoholic fatty liver disease fibrosis score, aspartate transaminase to platelet ratio index, Fibrosis-4 Index, Mac-2-binding protein biomarker and ultrasonic liver stiffness measurements. Introduction: Diabetic patients with viral hepatitis have a high risk of liver cirrhosis. M2BPGi biomarker helps to determine the stage of liver fibrosis in those with fatty liver disease and viral hepatitis in Mongolia. Methods: The study was conducted based on convenience sampling of 123 patients from the General hospital outpatient clinic. Slightly more than half of the study participants were male (53%, n=64). Thirty-three of the diabetics with hepatitis (mean age 52.31±9.8 years) and 90 diabetics without hepatitis (mean age 53.26±8.58) agreed to participate. Anthropometric measurements, non-alcoholic fatty liver disease fibrosis score, aspartate transaminase to platelet ratio index, Fibrosis-4 Index, Mac-2-binding protein biomarker, and ultrasonic transient elastography measurements were compared using independent t-tests for continuous variables and Wilcoxon rank sum tests for ordinal variables. Results: The median values of the Fibrosis-4 Index for those with hepatitis C and without were 1.3 vs 0.9(P<.05), Mac-2-binding proteinbiomarker2.0 vs 1.3 (P<.0001), ultrasonic liver stiffness measurements 10.3 vs 6.9 (P<.0001),aspartate transaminase to platelet ratio 0.6 vs 0.3 (P<.001), and Non-alcoholic fatty liver disease fibrosis scores were -0.2 vs -0.9( P<.004), respectively. Conclusions: Diabetic patients with hepatitis had statistically significantly higher Mac-2-binding protein biomarker, NAFLD Fibrosis Scores than patients without hepatitis. However, other fibrosis test results were similar in diabetic patients with hepatitis and without hepatitis C.

From nonalcoholic fatty liver disease to metabolic-associated fatty liver disease: Big wave or ripple?

( Seong Hee Kang ),( Yuri Cho ),( Soung Won Jeong ),( Seung Up Kim ),( Jin-woo Lee ) 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.2

There is some dissatisfaction with the term “nonalcoholic fatty liver disease (NAFLD),” which overemphasizes alcohol and underemphasizes the importance of metabolic risk factors in this disease. Recently, a consensus recommended “metabolic (dysfunction)-associated fatty liver disease (MAFLD)” as a more appropriate term to describe fatty liver diseases (FLD) associated with metabolic dysfunction. During the definition change from NAFLD to MAFLD, subjects with FLD and metabolic abnormalities, together with other etiologies of liver diseases such as alcohol, virus, or medication who have been excluded from the NAFLD criteria, were added to the MAFLD criteria, while subjects with FLD but without metabolic abnormality, who have been included in the NAFLD criteria, were excluded from the MAFLD criteria. This means that there is an emphasis on the metabolic dysfunction in MAFLD which may underestimate the prognostic value of hepatic steatosis itself, whereas the MAFLD criteria might better identify subjects who are at a higher risk of hepatic or cardiovascular outcomes. However, non-metabolic risk NAFLD subjects who are excluded from the MAFLD criteria are missed from the diagnosis, and their potential risk can be the cause of future diseases. Although huge controversies remain, this review focused on summarizing recent studies that compared the clinical and prognostic characteristics between subjects with NAFLD and MAFLD. (Clin Mol Hepatol 2021;27:257-269)