Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany.
PLoS One. 2020 May 1;15(5):e0231044. doi: 10.1371/journal.pone.0231044. eCollection 2020.
BACKGROUND/AIMS: The aim of our study was to evaluate the diagnostic accuracy of B-Mode ultrasound and Hepatorenal Index (HRI) by high-end devices for the detection and classification of hepatic steatosis in patients with various causes of chronic liver disease (CLD).
We retrospectively enrolled patients with CLD who underwent liver biopsy and baseline ultrasound between March 2016 and May 2019. Sonographic graduation of steatosis (0°-III°) using B-Mode criteria and HRI were correlated with the histological graduation (S0 (<5% fat), S1 (≥5-33%), S2 (>33-66%) and S3 (>66%). Interobserver agreement was calculated.
157 patients were evaluated. B-Mode ultrasound had a sensitivity of 75.6% and a specificity of 76.0% to differentiate between steatosis and no steatosis (AUROC 0.758). Using B-Mode criteria for advanced steatosis (≥II°), specificity for presence of histological steatosis was ≥98.7%. For detection of advanced steatosis (≥S2), sensitivity of B-mode criteria was 90.9%. In a subgroup of patients with advanced liver fibrosis, sensitivity of B-mode criteria was 95.0% for detection of advanced steatosis (S≥2). A HRI cut-off-value of 1.46 differentiates between patients with steatosis and patients without steatosis with a sensitivity of 42.7% and a specificity of 90.7% (AUROC 0.680). Interobserver agreement of both B-Mode and HRI was good to excellent.
B-Mode ultrasound using high-end devices is an excellent method to detect advanced steatosis in patients with various CLD. For diagnosis of mild steatosis, modern ultrasound devices may have higher sensitivity but at the expense of specificity. Stage of fibrosis and etiology of CLD seem not to impact on diagnostic accuracy. The additional calculation of HRI seems to have no additional benefit with regard to detect or grade hepatic steatosis in our study population.
背景/目的：本研究旨在评估高端设备的 B 型超声和肝肾功能指数（HRI）对各种原因慢性肝病（CLD）患者肝脂肪变性的检测和分类的诊断准确性。
我们回顾性纳入了 2016 年 3 月至 2019 年 5 月期间接受肝活检和基线超声检查的 CLD 患者。使用 B 型标准评估脂肪变性的超声分级（0°-III°）和 HRI 与组织学分级（S0（<5%脂肪）、S1（≥5-33%）、S2（>33-66%）和 S3（>66%）相关。计算了观察者间的一致性。
共评估了 157 例患者。B 型超声对区分脂肪变性和非脂肪变性的敏感性为 75.6%，特异性为 76.0%（AUROC 0.758）。使用 B 型标准对高级别脂肪变性（≥II°），存在组织学脂肪变性的特异性≥98.7%。对于检测高级别脂肪变性（≥S2），B 型标准的敏感性为 90.9%。在高级别肝纤维化患者的亚组中，B 型标准检测高级别脂肪变性（S≥2）的敏感性为 95.0%。HRI 截断值为 1.46 时，可区分有或无脂肪变性的患者，其敏感性为 42.7%，特异性为 90.7%（AUROC 0.680）。B 型和 HRI 的观察者间一致性良好至极好。
使用高端设备的 B 型超声是一种极好的方法，可以检测各种 CLD 患者的高级别脂肪变性。对于轻度脂肪变性的诊断，现代超声设备可能具有更高的敏感性，但代价是特异性降低。纤维化阶段和 CLD 的病因似乎对诊断准确性没有影响。在本研究人群中，计算 HRI 似乎对检测或分级肝脂肪变性没有额外的益处。
