Hirooka Masashi, Koizumi Yohei, Sunago Kotarou, Nakamura Yoshiko, Hirooka Kana, Watanabe Takao, Yoshida Osamu, Tokumoto Yoshio, Abe Masanori, Hiasa Yoichi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Tōon, Ehime, 791-0295, Japan.
Department of Gastroenterology and Metabology, National Hospital Organization Ehime Medical Center, Tōon, Japan.
J Med Ultrason (2001). 2022 Apr;49(2):199-210. doi: 10.1007/s10396-022-01196-5. Epub 2022 Mar 3.
The accuracy of attenuation coefficients and B-mode ultrasound for distinguishing between S0 (healthy, < 5% fat) and S1-3 (steatosis ≥ 5%) livers compared to a controlled attenuation parameter is unclear. This meta-analysis aimed to comprehensively assess the diagnostic performance of B-mode ultrasound imaging for evaluating steatosis of ≥ 5%. We searched the PubMed, Embase, and Web of Science databases for studies on the accuracy of B-mode ultrasound for differentiating S0 from S1-3 in adults with chronic liver disease. A bivariate random-effects model was performed to estimate the pooled sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and diagnostic odds ratios (DORs). Subgroup analyses by attenuation coefficient, conventional B-mode ultrasound findings, and B-mode ultrasound findings without semi-quantification methods were performed. Liver steatosis was scored as follows: S0, < 5%; S1, 5-33%; S2, 33-66%; and S3, > 66%. Nineteen studies involving 3240 patients were analyzed. The pooled sensitivity and specificity of B-mode ultrasound for detecting S1 were 0.70 (95% confidence interval [CI], 0.63-0.77) and 0.86 (95% CI 0.82-0.89), respectively. The pooled PLR, NLR, and DOR were 4.90 (95% CI 3.69-6.51), 0.35 (95% CI 0.27- 0.44), and 14.1 (95% CI 8.7-23.0), respectively. The diagnostic accuracy was better in patients with attenuation coefficients (area under the curve [AUC], 0.89; sensitivity, 0.75; specificity, 0.86) than in those with conventional B-mode findings (AUC, 0.80; sensitivity, 0.59; specificity, 0.83). In particular, the diagnostic value was better when the attenuation coefficient guided by B-mode ultrasound was utilized. To screen patients with steatosis of ≥ 5%, attenuation coefficient should be used.
与受控衰减参数相比，衰减系数和B型超声在区分S0（健康，脂肪含量<5%）和S1 - 3（脂肪变性≥5%）肝脏方面的准确性尚不清楚。本荟萃分析旨在全面评估B型超声成像对评估≥5%脂肪变性的诊断性能。我们在PubMed、Embase和Web of Science数据库中搜索了关于B型超声在慢性肝病成人中区分S0和S1 - 3准确性的研究。采用双变量随机效应模型来估计合并敏感性、特异性、阳性似然比（PLR）和阴性似然比（NLR）以及诊断比值比（DOR）。按衰减系数、传统B型超声检查结果以及无半定量方法的B型超声检查结果进行亚组分析。肝脏脂肪变性评分如下：S0，<5%；S1，5 - 33%；S2，33 - 66%；S3，>66%。分析了19项涉及3240例患者的研究。B型超声检测S1的合并敏感性和特异性分别为0.70（95%置信区间[CI]，0.63 - 0.77）和0.86（95%CI 0.82 - 0.89）。合并的PLR、NLR和DOR分别为4.90（95%CI 3.69 - 6.51）、0.35（95%CI 0.27 - 0.44）和14.1（95%CI 8.7 - 23.0）。衰减系数患者的诊断准确性（曲线下面积[AUC]，0.89；敏感性，0.75；特异性，0.86）优于传统B型超声检查结果患者（AUC，0.80；敏感性，0.59；特异性，0.83）。特别是，当使用B型超声引导的衰减系数时，诊断价值更好。为筛查脂肪变性≥5%的患者，应使用衰减系数。
