Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Eur Radiol. 2019 Aug;29(8):4427-4435. doi: 10.1007/s00330-018-5905-1. Epub 2018 Dec 19.
To compare the performances of CT indices for diagnosing hepatic steatosis (HS) and to determine and validate the CT index cut-off values.
Three indices were measured on non-enhanced CT images of 4413 living liver donor candidates (2939 men, 1474 women; mean age, 31.4 years): hepatic attenuation (CT), hepatic attenuation minus splenic attenuation (CT), and hepatic attenuation divided by splenic attenuation (CT). The performances of these CT indices in diagnosing HS, relative to pathologic diagnosis, were compared in the development cohort of 3312 subjects by receiver operating characteristic (ROC) analysis. The cut-off values for diagnosing HS > 33% in the development cohort were determined at 95% specificity and 95% sensitivity using bootstrap ROC analysis, and the diagnostic performance of these cut-off values was validated in the test cohort of 1101 subjects.
CT showed the highest performance for diagnosing HS ≥ 5% and HS > 33% (areas under the curve (AUCs) = 0.737 and 0.926, respectively), followed by CT (AUCs = 0.732 and 0.925, respectively) and CT (AUCs = 0.707 and 0.880, respectively). For CT scans using 120 kVp, the CT cut-off values for highly specific (i.e., - 2.1) and highly sensitive (i.e., 7.6) diagnosis of HS > 33% resulted in a specificity of 96.4% with a sensitivity of 64.0% and a sensitivity of 97.3% with a specificity of 54.9%, respectively, in the test cohort.
CT indices using liver and spleen attenuations have higher performance for diagnosing HS than indices using liver attenuation alone. The CT cut-off values in this study may have utility for diagnosing HS in clinical practice and research.
• CT indices based on both liver attenuation and spleen attenuation (CTand CT) have higher diagnostic performance than CTbased on liver attenuation alone in diagnosing HS using various CT techniques. • The CT index cut-off values determined in this study can be utilized for reliable diagnosis or to rule out subjects with moderate to severe HS in clinical practice and research, including the selection of living liver donors and the development of cohorts with HS or healthy controls.
比较 CT 指数在诊断肝脂肪变性（HS）方面的性能，并确定和验证 CT 指数的截断值。
对 4413 名活体肝供体候选者（2939 名男性，1474 名女性；平均年龄 31.4 岁）的非增强 CT 图像测量了三个指数：肝衰减（CT）、肝衰减减去脾衰减（CT）和肝衰减除以脾衰减（CT）。通过接收者操作特征（ROC）分析，在 3312 例研究对象的开发队列中比较了这些 CT 指数在诊断 HS 方面的表现，与病理诊断进行比较。在开发队列中，使用 bootstrap ROC 分析以 95%特异性和 95%敏感性确定诊断 HS>33%的 CT 指数截断值，并在 1101 例研究对象的测试队列中验证这些截断值的诊断性能。
CT 在诊断 HS≥5%和 HS>33%方面表现最佳（曲线下面积（AUCs）分别为 0.737 和 0.926），其次是 CT（AUCs 分别为 0.732 和 0.925）和 CT（AUCs 分别为 0.707 和 0.880）。对于使用 120kVp 的 CT 扫描，用于高度特异性（即-2.1）和高度敏感（即 7.6）诊断 HS>33%的 CT 截断值在测试队列中特异性为 96.4%，敏感性为 64.0%，敏感性为 97.3%，特异性为 54.9%。
使用肝脏和脾脏衰减的 CT 指数在诊断 HS 方面的性能优于仅使用肝脏衰减的指数。本研究中的 CT 截断值可能有助于临床实践和研究中 HS 的诊断。
使用各种 CT 技术时，基于肝衰减和脾衰减的 CT 指数（CTand CT）比基于肝衰减的 CT 指数具有更高的诊断性能，用于诊断 HS。
本研究中确定的 CT 指数截断值可用于临床实践和研究中进行可靠诊断或排除中度至重度 HS 的受试者，包括活体肝供体的选择以及具有 HS 或健康对照的队列的开发。
