From the Departments of Diagnostic and Interventional Radiology (C.C., T.J., S.A., A.B., B.G.), Hepatology A (J.U.B., S.F.), and Hepatology B (P.B.), Saint-Eloi Hospital, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090 Montpellier, France; and Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, Montpellier University, Montpellier, France (C.C., B.G.).
Radiology. 2022 Nov;305(2):353-361. doi: 10.1148/radiol.212846. Epub 2022 Jul 12.
Background US tools to quantify liver fat content have recently been made clinically available by different vendors, but comparative data on their accuracy are lacking. Purpose To compare the diagnostic performances of the attenuation parameters of US machines from three different manufacturers (vendors 1, 2, and 3) in participants who underwent liver fat quantification with the MRI-derived proton density fat fraction (PDFF). Materials and Methods From July 2020 to June 2021, consecutive participants with chronic liver disease were enrolled in this prospective single-center study and underwent MRI PDFF quantification (reference standard) and US on the same day. US was performed with two different machines from among three vendors assessed. Areas under the receiver operating characteristic curve (AUCs) for the staging of liver steatosis (MRI PDFF: ≥5.5% for grade ≥S1 and ≥15.5% for grade ≥S2) were calculated in test and validation samples and then compared between vendors in the study sample. Results A total of 534 participants (mean age, 60 years ± 13 [SD]; 320 men) were evaluated. Failure of measurements occurred in less than 1% of participants for all vendors. Correlation coefficients with the MRI PDFF were 0.71, 0.73, and 0.54 for the attenuation coefficients of vendors 1, 2, and 3, respectively. In the test sample, AUCs for diagnosis of steatosis grade S1 and higher and grade S2 and higher were 0.89 and 0.93 for vendor 1 attenuation, 0.88 and 0.92 for vendor 2 attenuation, and 0.79 and 0.79 for vendor 3 attenuation, respectively. In the validation sample, a threshold value of 0.65 for vendor 1 and 0.66 for vendor 2 yielded sensitivity of 77% and 84% and specificity of 78% and 85%, respectively, for diagnosis of grade S1 and higher. Vendor 2 attenuation had greater AUCs than vendor 3 attenuation ( = .001 and = .003) for diagnosis of grade S1 and higher and grade S2 and higher, respectively, and vender 2 had greater AUCs for attenuation than vendor 1 for diagnosis of grade S2 and higher ( = .04). For all vendors, attenuation was not associated with liver stiffness (correlation coefficients <0.05). Conclusion To stage liver steatosis, attenuation coefficient accuracy varied among US devices across vendors when using MRI proton density fat fraction quantification as the reference standard, with some demonstrating excellent diagnostic performance and similar cutoff values. © RSNA, 2022 See also the editorial by Dubinsky in this issue.
背景 最近，不同供应商已将用于量化肝脏脂肪含量的美国工具在临床上投入使用，但缺乏关于其准确性的比较数据。
目的 在接受肝脏脂肪定量磁共振质子密度脂肪分数（PDFF）检查的参与者中，比较来自 3 家不同制造商（供应商 1、2 和 3）的 US 设备衰减参数的诊断性能。
材料与方法 本前瞻性单中心研究于 2020 年 7 月至 2021 年 6 月连续纳入患有慢性肝病的参与者，并在同一天进行 MRI PDFF 定量（参考标准）和 US 检查。评估了来自 3 家供应商的 3 种不同 US 机器进行的检查。在测试和验证样本中计算了用于分期肝脂肪变性的受试者工作特征曲线（ROC）下面积（AUC）（MRI PDFF：≥S1 级的≥5.5%和≥S2 级的≥15.5%），然后在研究样本中比较了供应商之间的 AUC。
结果 共评估了 534 名参与者（平均年龄，60 岁±13[标准差]；320 名男性）。对于所有供应商，测量失败的参与者比例均低于 1%。供应商 1、2 和 3 的衰减系数与 MRI PDFF 的相关系数分别为 0.71、0.73 和 0.54。在测试样本中，用于诊断 S1 级及以上和 S2 级及以上脂肪变性的 AUC 分别为供应商 1 衰减的 0.89 和 0.93、供应商 2 衰减的 0.88 和 0.92，以及供应商 3 衰减的 0.79 和 0.79。在验证样本中，供应商 1 和供应商 2 的衰减阈值分别为 0.65 和 0.66，其用于诊断 S1 级及以上和 S2 级及以上的敏感性分别为 77%和 84%，特异性分别为 78%和 85%。与供应商 3 衰减相比，供应商 2 衰减在诊断 S1 级及以上和 S2 级及以上时的 AUC 更大（均为 =.001 和 =.003），而供应商 2 衰减在诊断 S2 级及以上脂肪变性时的 AUC 大于供应商 1（=.04）。对于所有供应商，衰减与肝硬度均无相关性（相关系数<.05）。
结论 在使用 MRI PDFF 定量作为参考标准时，不同供应商的 US 设备的衰减系数准确性存在差异，用于分期肝脂肪变性，一些设备的诊断性能和相似的截断值表现出色。
