Page 73 - Read Online

Ballestri et al. Metab Target Organ Damage 2023;3:13 https://dx.doi.org/10.20517/mtod.2023.21 Page 5 of 7

Figure 2. Illustration of US-FLI criteria and metrics: vessels blurring, focal sparing, and visualization of gallbladder wall. Normal
appearance, with optimal visualization, of contours and lumen (highlighted with arrow) of hepatic veins (panel A). This semeiotics
would receive a US-FLI score = 0. Conversely, impaired visualization of contours and lumen of hepatic veins would be assigned a US-FLI
score = 1 (panel B). Panel C shows normal appearance of walls of portal branches (highlighted with an arrow) which would receive a
US-FLI score = 0 and normal visualization of the gallbladder wall (highlighted with a dotted arrow) which is assigned a US-FLI score =
0. Impaired visibility of walls of portal branches (highlighted with an arrow) would receive a US-FLI score = 1 (panel D). An area of focal
sparing (highlighted with an arrow) would be assigned a US-FLI score = 1 (panel E). Impaired visualization of wall of gallbladder
[9]
(highlighted with a dotted arrow) is assigned a US-FLI score = 1 (panel F). Reproduced with permission from Ballestri et al. . US-FLI:
Ultrasonographic fatty liver indicator.
routine liver tests. Moreover, rather than attributing a similar score of 1 to each semeiotics, a more
sophisticated analysis may eventually conduce to give a higher score to certain semeiotics such as vessel
blurring and gallbladder wall visualization. Additionally, US-FLI must be validated among the
cholecystectomized individuals. From a pathogenic perspective, it will be important to understand the
histopathological grounds associating difficult visualization of the gallbladder wall with NASH. We
highlight that NAFLD is associated with extra-hepatic complications, including a high risk of cardiovascular
disease and cancer [15,16,22-24] , although no data on the value of US-FLI in predicting such outcomes are
available. US-FLI may also be combined with the measurement of spleen diameter and volume to detect the
[25]
presence and severity of NAFLD . Finally, it will be important to understand the accuracy of US-FLI
among overweight patients and in the detection of the so-called “at-risk NASH”, i.e., those patients with
NAFLD activity score (NAS) ≥ 4, and fibrosis stage ≥ 2 .
[26]
DECLARATIONS
Authors’ contributions
Conception or design: Lonardo A