9 项定量超声参数在非酒精性脂肪性肝病患者肝脂肪变检测和分级中的诊断性能
Diagnostic Performance of 9 Quantitative Ultrasound Parameters for Detection and Classification of Hepatic Steatosis in Nonalcoholic Fatty Liver Disease.
机构信息
From the Department of Radiology, School of Medicine, Stanford University, California.
Departments of Radiology and Biomedical Engineering, University of Kentucky, Lexington.
出版信息
Invest Radiol. 2022 Jan 1;57(1):23-32. doi: 10.1097/RLI.0000000000000797.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Quantitative ultrasound (QUS) parameters based on radiofrequency raw data show promise in quantifying liver fat.
PURPOSE
The aim of this study was to evaluate the diagnostic performance of 9 QUS parameters compared with magnetic resonance imaging (MRI)-estimated proton density fat fraction (PDFF) in detecting and staging hepatic steatosis in patients with or suspected of NAFLD.
MATERIALS AND METHODS
In this Health Insurance Portability and Accountability Act-compliant institutional review board-approved prospective study, 31 participants with or suspected of NAFLD, without other underlying chronic liver diseases (13 men, 18 women; average age, 52 years [range, 26-90 years]), were examined. The following parameters were obtained: acoustic attenuation coefficient (AC); hepatorenal index (HRI); Nakagami parameter; shear wave elastography measures such as shear wave elasticity, viscosity, and dispersion; and spectroscopy-derived parameters including spectral intercept (SI), spectral slope (SS), and midband fit (MBF). The diagnostic ability (area under the receiver operating characteristic curves and accuracy) of QUS parameters was assessed against different MRI-PDFF cutoffs (the reference standard): 6.4%, 17.4%, and 22.1%. Linearity with MRI-PDFF was evaluated with Spearman correlation coefficients (p).
RESULTS
The AC, SI, Nakagami, SS, HRI, and MBF strongly correlated with MRI-PDFF (P = 0.89, 0.89, 0.88, -0.87, 0.81, and 0.71, respectively [P < 0.01]), with highest area under the receiver operating characteristic curves (ranging from 0.85 to 1) for identifying hepatic steatosis using 6.4%, 17.4%, and 22.1% MRI-PDFF cutoffs. In contrast, shear wave elasticity, shear wave viscosity, and shear wave dispersion did not strongly correlate to MRI-PDFF (P = 0.45, 0.38, and 0.07, respectively) and had poor diagnostic performance.
CONCLUSION
The AC, Nakagami, SI, SS, MBF, and HRI best correlate with MRI-PDFF and show high diagnostic performance for detecting and classifying hepatic steatosis in our study population.
SUMMARY STATEMENT
Quantitative ultrasound is an accurate alternative to MRI-based techniques for evaluating hepatic steatosis in patients with or at risk of NAFLD.
KEY FINDINGS
Our preliminary results show that specific quantitative ultrasound parameters accurately detect different degrees of hepatic steatosis in NAFLD.
背景
非酒精性脂肪性肝病（NAFLD）是全球慢性肝病的主要原因。基于射频原始数据的定量超声（QUS）参数在定量肝脂肪方面显示出很大的前景。
目的
本研究旨在评估 9 个 QUS 参数与磁共振成像（MRI）估计质子密度脂肪分数（PDFF）在检测和分期 NAFLD 患者或疑似 NAFLD 患者肝脂肪变性方面的诊断性能。
材料与方法
本研究符合《健康保险携带和责任法案》（Health Insurance Portability and Accountability Act，HIPAA）规定，经机构审查委员会批准，前瞻性研究纳入 31 例疑似或确诊 NAFLD 患者（13 名男性，18 名女性；平均年龄 52 岁[26-90 岁]）。获得以下参数：声衰减系数（AC）；肝肾指数（HRI）；Nakagami 参数；剪切波弹性测量值，如剪切波弹性、粘度和弥散；以及光谱衍生参数，包括光谱截距（SI）、光谱斜率（SS）和中带拟合（MBF）。使用 MRI-PDFF 不同截断值（参考标准）评估 QUS 参数的诊断能力（受试者工作特征曲线下面积和准确性）：6.4%、17.4%和 22.1%。用 Spearman 相关系数（p）评估与 MRI-PDFF 的线性关系。
结果
AC、SI、Nakagami、SS、HRI 和 MBF 与 MRI-PDFF 具有很强的相关性（P=0.89、0.89、0.88、-0.87、0.81 和 0.71，P＜0.01），用于识别 6.4%、17.4%和 22.1%MRI-PDFF 截断值的肝脂肪变性，受试者工作特征曲线下面积最高（范围 0.85-1）。相比之下，剪切波弹性、剪切波粘度和剪切波弥散与 MRI-PDFF 相关性不强（P=0.45、0.38 和 0.07），诊断性能较差。
结论
AC、Nakagami、SI、SS、MBF 和 HRI 与 MRI-PDFF 相关性最好，在本研究人群中对肝脂肪变性的检测和分级具有较高的诊断性能。
摘要陈述
定量超声是一种评估 NAFLD 患者或有风险患者肝脂肪变性的准确替代 MRI 技术。
关键发现
我们的初步结果表明，特定的定量超声参数可准确检测不同程度的 NAFLD 肝脂肪变性。
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