Kim Jeong Woo, Lee Chang Hee, Kim Baek-Hui, Lee Young-Sun, Hwang Soon-Young, Park Bit Na, Park Yang Shin
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Quant Imaging Med Surg. 2022 Mar;12(3):1815-1829. doi: 10.21037/qims-21-895.
Liver biopsy is a gold standard for the diagnosis of non-alcoholic steatohepatitis (NASH), but has several disadvantages including invasiveness, high cost, and sampling error. Ultrasonography (US) is a noninvasive imaging modality widely used in non-alcoholic fatty liver disease (NAFLD) patients. This study aimed: (I) to assess the feasibility of US in the prediction of NASH and (II) to develop various US indices combining US parameters and laboratory data for the detection of NASH in NAFLD patients and to compare the diagnostic performance of them.
Sixty patients who underwent liver biopsy, gray-scale US [hepatorenal index (HRI) and shear-wave elastography (SWE)], and Fibroscan [controlled attenuation parameter (CAP) and transient elastography (TE)] for the evaluation of NASH were included. Patients were classified according to the NAFLD Activity Score (NAS) into the NASH (NAS ≥5) and non-NASH (NAS <5) groups. The diagnostic performance of HRI, CAP, SWE, TE, and laboratory data for grading steatosis, lobular inflammation, ballooning degeneration, and fibrosis was evaluated. After the identification of laboratory data that were independently associated with NASH through univariable and multivariable logistic regression analyses, various US indices were developed by combining US parameters with or without these laboratory data. The diagnostic performance of the US indices was assessed with obtaining area under the curve (AUC) and compared using DeLong test.
Twenty-five NASH and 35 non-NASH patients were included. The mean AUCs for grading steatosis were 0.871 using HRI and 0.583 using CAP. The mean AUCs for grading fibrosis and ballooning degeneration were 0.777 and 0.729 using SWE and 0.830 and 0.708 using TE, respectively. Aspartate aminotransferase (AST) was the only significant laboratory data associated with NASH (OR, 1.019; P=0.032). Using AST, the mean AUCs for grading lobular inflammation and ballooning degeneration were 0.712 and 0.775, respectively. Among various US indices, the index consisting of gray-scale US parameters (SWE and HRI) and AST showed the best diagnostic performance for the detection of NASH in NAFLD patients (AUC =0.806).
The index combining gray-scale US parameters and AST is useful for the detection of NASH and may be used to exclude the need for liver biopsy in NAFLD patients.
肝活检是非酒精性脂肪性肝炎（NASH）诊断的金标准，但存在包括侵入性、高成本和抽样误差等若干缺点。超声检查（US）是一种广泛应用于非酒精性脂肪性肝病（NAFLD）患者的非侵入性成像方式。本研究旨在：（I）评估超声检查在预测NASH方面的可行性；（II）结合超声参数和实验室数据开发各种超声指标，用于检测NAFLD患者的NASH，并比较它们的诊断性能。
纳入60例接受肝活检、灰阶超声检查[肝肾指数（HRI）和剪切波弹性成像（SWE）]以及Fibroscan[受控衰减参数（CAP）和瞬时弹性成像（TE）]以评估NASH的患者。根据非酒精性脂肪性肝病活动评分（NAS）将患者分为NASH组（NAS≥5）和非NASH组（NAS<5）。评估HRI、CAP、SWE、TE和实验室数据对脂肪变性、小叶炎症、气球样变性和纤维化分级的诊断性能。通过单变量和多变量逻辑回归分析确定与NASH独立相关的实验室数据后，通过将超声参数与这些实验室数据结合或不结合来开发各种超声指标。通过获得曲线下面积（AUC）评估超声指标的诊断性能，并使用DeLong检验进行比较。
纳入25例NASH患者和35例非NASH患者。使用HRI对脂肪变性分级的平均AUC为0.871，使用CAP为0.583。使用SWE对纤维化和气球样变性分级的平均AUC分别为0.777和0.729，使用TE分别为0.830和0.708。天冬氨酸转氨酶（AST）是与NASH相关的唯一显著实验室数据（OR，1.019；P=0.032）。使用AST，对小叶炎症和气球样变性分级的平均AUC分别为0.712和0.775。在各种超声指标中，由灰阶超声参数（SWE和HRI）和AST组成的指标在检测NAFLD患者的NASH方面表现出最佳诊断性能（AUC=0.806）。
结合灰阶超声参数和AST的指标可用于检测NASH，可能有助于排除NAFLD患者进行肝活检的必要性。
