Department of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Ultrasonics. 2021 Mar;111:106329. doi: 10.1016/j.ultras.2020.106329. Epub 2020 Dec 6.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. Quantitative ultrasound facilitates clinical grading of hepatic steatosis (the early stage of NAFLD). However, the utility of quantitative ultrasound as a first-line method for community screening of hepatic steatosis remains unclear. Therefore, this study aimed to investigate the utility of quantitative ultrasound to screen for hepatic steatosis and for metabolic evaluation at the community level. In total, 278 participants enrolled from a community satisfied the study criteria. Each subject underwent anthropometric and biochemical examinations, and abdominal ultrasound imaging was performed to measure the controlled attenuation (CAP), integrated backscatter (IB), and information Shannon entropy (ISE). The assessment outcomes were compared with the fatty liver index (FLI), hepatic steatosis index (HSI), metabolic syndrome (MetS), and insulin resistance to evaluate the screening performance through the area under the receiver operating characteristic curve (AUROC) and Delong's test. Ultrasound ISE, CAP, and IB were effective in screening hepatic steatosis, MetS, and insulin resistance. In screening for hepatic steatosis, the AUROCs of ISE, CAP, and IB were 0.85, 0.83, and 0.80 (the cutoff FLI = 60), respectively, and 0.84, 0.75, 0.77 (the cutoff HSI = 36), respectively, and those for the evaluation of MetS and insulin resistance were 0.79, 0.75, 0.79, respectively, and 0.83, 0.76, 0.78, respectively. Delong's test revealed that ISE outperformed CAP and IB for the detection of hepatic steatosis and insulin resistance (P < .05). Based on the present results, ultrasound ISE is a potential imaging biomarker during first-line community screening of hepatic steatosis and insulin resistance.
非酒精性脂肪性肝病（NAFLD）是最常见的慢性肝病。定量超声有助于临床分级肝脂肪变性（NAFLD 的早期阶段）。然而，定量超声作为社区筛查肝脂肪变性的一线方法的效用尚不清楚。因此，本研究旨在探讨定量超声在社区筛查肝脂肪变性和代谢评估中的应用。共有 278 名来自社区的符合研究标准的参与者入组。每位受试者均接受了人体测量和生化检查，并进行了腹部超声成像，以测量受控衰减（CAP）、积分回波（IB）和信息香农熵（ISE）。通过受试者工作特征曲线（AUROC）下面积和 Delong 检验，将评估结果与脂肪肝指数（FLI）、肝脂肪变性指数（HSI）、代谢综合征（MetS）和胰岛素抵抗进行比较，以评估通过筛选性能。超声 ISE、CAP 和 IB 可有效筛查肝脂肪变性、MetS 和胰岛素抵抗。在筛查肝脂肪变性方面，ISE、CAP 和 IB 的 AUROC 分别为 0.85、0.83 和 0.80（截断 FLI=60），0.84、0.75 和 0.77（截断 HSI=36），而评估 MetS 和胰岛素抵抗的 AUROC 分别为 0.79、0.75 和 0.79，0.83、0.76 和 0.78。Delong 检验表明，ISE 在检测肝脂肪变性和胰岛素抵抗方面优于 CAP 和 IB（P<.05）。基于本研究结果，超声 ISE 是社区一线筛查肝脂肪变性和胰岛素抵抗的潜在成像生物标志物。
