Rogier Julien, Roullet Stéphanie, Cornélis François, Biais Matthieu, Quinart Alice, Revel Philippe, Bioulac-Sage Paulette, Le Bail Brigitte
Emergency Intensive Care Unit, Pellegrin Hospital, University Hospital, Bordeaux, France.
Liver Transpl. 2015 May;21(5):690-5. doi: 10.1002/lt.24105.
Fatty liver disease, including liver steatosis, is a major health problem worldwide. In liver transplantation, macrovesicular steatosis in donor livers is a major cause of graft failure and remains difficult to assess. On one hand, several imaging modalities can be used for the assessment of liver fat, but liver biopsy, which is still considered the gold standard, may be difficult to perform in this context. On the other hand, computed tomography (CT) is commonly used by teams managing cadaveric donors to assess donors and to minimize the risk of complications in recipients. The purpose of our study was to validate the use of CT as a semiquantitative method for assessing macrovesicular steatosis in cadaveric donors with liver biopsy as a reference standard. A total of 109 consecutive cadaveric donors were included between October 2009 and May 2011. Brain death was diagnosed according to French legislation. Liver biopsy and then CT were performed on the same day to determine the degree of macrovesicular steatosis. All liver biopsies and CT scans were analyzed in a double-blinded fashion by a senior pathologist and a senior radiologist, respectively. For CT, we used the liver-to-spleen (L/S) attenuation ratio, which is a validated method for determining 30% or greater steatosis in living liver donors. Fourteen of 109 biopsies exhibited macrovesicular steatosis > 30% upon histologic analysis. A receiver operating characteristic curve was generated for the L/S ratio to identify its ability to predict significant steatosis, which was defined as >30%. A cutoff value of 0.9 for the CT L/S ratio provided a sensitivity of 79% and a specificity of 97% to detect significant steatosis.
脂肪性肝病，包括肝脂肪变性，是全球范围内的一个主要健康问题。在肝移植中，供体肝脏中的大泡性脂肪变性是移植物失败的主要原因，并且仍然难以评估。一方面，几种成像方式可用于评估肝脏脂肪，但肝活检虽仍被视为金标准，在此情况下可能难以实施。另一方面，管理尸体供体的团队通常使用计算机断层扫描（CT）来评估供体，并将受体并发症风险降至最低。我们研究的目的是验证以肝活检作为参考标准，将CT用作评估尸体供体大泡性脂肪变性的半定量方法。2009年10月至2011年5月期间共纳入了109例连续的尸体供体。根据法国法律诊断脑死亡。在同一天进行肝活检，然后进行CT以确定大泡性脂肪变性的程度。所有肝活检和CT扫描分别由一位资深病理学家和一位资深放射科医生以双盲方式进行分析。对于CT，我们使用肝脾（L/S）衰减比，这是一种用于确定活体肝供体中脂肪变性达30%或更高的有效方法。109例活检中有14例在组织学分析中显示大泡性脂肪变性>30%。生成了L/S比的受试者工作特征曲线，以确定其预测显著脂肪变性（定义为>30%）的能力。CT L/S比的截断值为0.9时，检测显著脂肪变性的敏感性为79%，特异性为97%。
