Prediction for steatosis in type-2 diabetes: clinico-biological markers versus 1H-MR spectroscopy

Eur Radiol. 2012 Apr;22(4):855-63. doi: 10.1007/s00330-011-2326-9. Epub 2011 Nov 20.


Objectives: The SteatoTest, fatty liver index (FLI) and hepatic steatosis index (HSI) are clinico-biological scores of steatosis validated in general or selected populations. Serum adiponectin (s-adiponectin) and retinol binding protein 4 (s-RBP4) are adipokines that could predict liver steatosis. We investigated whether the Steatotest, FLI, HSI, s-adiponectin and s-RBP4 could be valid predictors of liver steatosis in type-2 diabetic (T2D) patients.

Methods: We enrolled 220 consecutive T2D patients. Reference standard was 3.0 T (1)H-MR spectroscopy (corrected for T1 and T2 decays). Intraclass correlation coefficients (ICCs), Kappa statistic measures of agreement, receiver operating characteristic (ROC) curves were assessed.

Results: Median liver fat content was 91 mg triglyceride/g liver tissue (range: 0-392). ICCs among the Steatotest, FLI, HSI, s-adiponectin, s-RBP4 and spectroscopy were low: 0.384, 0.281, 0.087, -0.297 and 0.048. Agreement between scores and spectroscopy was poor (Kappa range: 0.042-0.281). The areas under the ROC curves were low: 0.674, 0.647, 0.637, 0.616 and 0.540. S-adiponectin and s-RBP4 levels were strongly related to the presence of diabetic nephropathy (P = 0.0037 and P = 0.004; Mann-Whitney).

Conclusion: The SteatoTest, FLI, HSI, s-adiponectin, s-RBP4 are not valid predictors of steatosis in T2D patients. Clino-biological markers cannot replace (1)H-MR spectroscopy for the assessment of liver fat in this population.

Key points: (1) H-MR spectrosopy can reliably estimate the weight fraction of liver steatosis. Type-2 diabetes provides an interesting model for assessing liver steatosis. Clinico-biological markers seem to be invalid predictors for steatosis in type-2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiponectin / blood*
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Fatty Liver / blood
  • Fatty Liver / diagnosis*
  • Fatty Liver / epidemiology
  • Female
  • France / epidemiology
  • Humans
  • Magnetic Resonance Spectroscopy / methods*
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Protons
  • Retinol-Binding Proteins, Plasma / analysis*
  • Risk Assessment
  • Risk Factors
  • Sensitivity and Specificity
  • Triglycerides / analysis*


  • Adiponectin
  • Biomarkers
  • Protons
  • RBP4 protein, human
  • Retinol-Binding Proteins, Plasma
  • Triglycerides