Department of Radiology, University of Calgary, Foothills Medical Centre, Calgary, Canada.
Department of Medicine and Gastroenterology, University of Calgary, Calgary, Canada.
Ultrasound Med Biol. 2019 Dec;45(12):3160-3171. doi: 10.1016/j.ultrasmedbio.2019.08.003. Epub 2019 Sep 19.
We investigated whether ultrasound (US) could quantify steatosis and fibrosis in non-alcoholic fatty liver disease (NAFLD). Estimates of fat by gray-scale, hepatorenal index (HRI) and fibrosis by acoustic radiation force impulse (ARFI) were made using the interquartile range (IQR)/median for ARFI quality. Biopsy was the gold standard. US fat assessment correlated with histologic grade and predicted steatosis. HRI predicted steatosis but did not improve accuracy. ARFI of good quality was highly sensitive toward severe fibrosis. The median ARFI value depended linearly on body mass index (BMI). Poor quality ARFI data had higher histologic steatosis, leading to higher mean steatosis grades in rejected data (p = 0.018). The ARFI quality cut with IQR/median >0.15 or >0.3 excluded many more patients with severe steatosis versus normal, influenced by increasing BMI. By combining the baseline US with ARFI, patients can be concurrently diagnosed for steatosis and fibrosis, two of the key pathologies of NAFLD and non-alcoholic steatohepatitis (NASH). However, severe steatosis and high BMI may falsely alter ARFI results.
我们研究了超声（US）是否可以定量非酒精性脂肪性肝病（NAFLD）中的脂肪变性和纤维化。使用四分位距（IQR）/中位数对 ARFI 质量进行灰度、肝肾指数（HRI）和纤维化的估计。肝活检是金标准。US 脂肪评估与组织学分级相关，并预测脂肪变性。HRI 预测脂肪变性，但不能提高准确性。质量好的 ARFI 对严重纤维化高度敏感。ARFI 的中位数值与体重指数（BMI）呈线性关系。质量差的 ARFI 数据有更高的组织学脂肪变性，导致在拒绝的数据中出现更高的平均脂肪变性等级（p=0.018）。用 IQR/中位数>0.15 或>0.3 截断的 ARFI 质量排除了更多的严重脂肪变性患者，这与 BMI 的增加有关。通过将基线 US 与 ARFI 相结合，患者可以同时诊断出脂肪变性和纤维化，这是非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的两个关键病理。然而，严重的脂肪变性和高 BMI 可能会错误地改变 ARFI 的结果。
