Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Radiol. 2020 Apr;21(4):413-421. doi: 10.3348/kjr.2019.0703.
A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD.
This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CTL-S was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort.
The clinical-CT index included CT, body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CTL-S (0.74; < 0.001) and clinical indices (0.73-0.75; < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%.
The clinical-CT index is more accurate than CTL-S and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.
需要一种广泛适用且非侵入性的非酒精性脂肪性肝病（NAFLD）筛查方法。我们旨在开发和验证一种结合 CT 和常规临床数据的指数，以在患有经病理证实的 NAFLD 的大量成年患者中进行 NAFLD 的筛查。
这项回顾性研究纳入了 2218 名接受过肝活检和 CT 检查的活体肝供者，这两项检查在 3 天内完成。供者以 2:1 的比例随机分为开发队列和测试队列。通过从非增强 CT 上的肝衰减值中减去脾脏衰减值来测量 CTL-S。采用多变量逻辑回归分析对开发队列进行分析，以开发预测经病理证实的 NAFLD 的临床 CT 指数。通过分析接收者操作特征曲线下的面积（AUC）来评估诊断性能。在开发队列中确定了用于 90%敏感性和 90%特异性的临床 CT 指数的截断值，并在测试队列中评估了其诊断性能。
临床 CT 指数包括 CT、体重指数、天门冬氨酸转氨酶和甘油三酯浓度。在测试队列中，临床 CT 指数（AUC，0.81）优于 CTL-S（0.74；<0.001）和临床指数（0.73-0.75；<0.001）在诊断 NAFLD 方面。截断值≥46 时的敏感性为 89%，特异性为 41%，而截断值≥56.5 时的敏感性为 57%，特异性为 89%。
与 CTL-S 和单独的临床指数相比，临床 CT 指数更准确地用于诊断 NAFLD，并且可能在 NAFLD 的筛查中具有临床应用价值。
