Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Medicine, Division of Gastroenterology & Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Acad Radiol. 2023 Sep;30(9):1838-1845. doi: 10.1016/j.acra.2022.12.025. Epub 2022 Dec 29.
Non-alcoholic fatty liver disease (NAFLD) is currently diagnosed by liver biopsy or MRI proton density fat fraction (MRI-PDFF) from left hepatic lobe (LTHL) and/or right hepatic lobe (RTHL). The objective of this study was to compare the diagnostic value of ultrasound attenuation coefficients (ACs) from RTHL and LTHL in detecting hepatic steatosis using biopsy or MRI-PDFF as a reference standard.
Sixty-six patients with suspected NAFLD were imaged with an Aplio i800 ultrasound scanner (Canon Medical Systems, Tustin, CA). Five AC measurements from RTHL and LTHL were averaged separately and together to be compared with the reference standard.
Forty-seven patients (71%) were diagnosed with NAFLD. Mean ACs were significantly higher in fatty livers than non-fatty livers (RTHL: 0.73 ± 0.10 vs. 0.63 ± 0.07 dB/cm/MHZ; p < 0.0001, LTHL: 0.78 ± 0.11 vs. 0.63 ± 0.06 dB/cm/MHz; p < 0.0001, RTHL & LTHL: 0.76 ± 0.09 vs. 0.63 ± 0.05 dB/cm/MHz; p < 0.0001). Biopsy steatosis grades (n =31) were better correlated with the mean ACs of RTHL & LTHL (r = 0.72) compared to LTHL (r = 0.67) or RTHL (r = 0.61). Correlation between MRI-PDFF (n = 35) and mean ACs was better for LTHL (r = 0.69) compared to the RTHL & LTHL (r = 0.66) or RTHL (r = 0.45). Higher diagnostic accuracy was shown for the mean ACs of RTHL & LTHL (AUC 0.89, specificity 94%, sensitivity 78%) compared to LTHL (AUC 0.89, specificity 88%, sensitivity 82%) or RTHL (AUC 0.81, specificity 89%, sensitivity 68%).
Ultrasound ACs from RTHL and LTHL showed comparable diagnostic values in detection of hepatic steatosis with the highest diagnostic accuracy when they were averaged together.
目前，非酒精性脂肪性肝病（NAFLD）通过肝活检或左肝叶（LTHL）和/或右肝叶（RTHL）的磁共振质子密度脂肪分数（MRI-PDFF）进行诊断。本研究的目的是比较 RTHL 和 LTHL 的超声衰减系数（AC）在使用肝活检或 MRI-PDFF 作为参考标准检测肝脂肪变性方面的诊断价值。
对 66 例疑似 NAFLD 的患者进行 Aplio i800 超声扫描仪（佳能医疗系统公司，美国加利福尼亚州图森市）成像。分别平均化 RTHL 和 LTHL 的 5 个 AC 测量值，然后与参考标准进行比较。
47 例（71%）患者被诊断为 NAFLD。脂肪肝的平均 AC 值明显高于非脂肪肝（RTHL：0.73±0.10 与 0.63±0.07 dB/cm/MHZ；p<0.0001，LTHL：0.78±0.11 与 0.63±0.06 dB/cm/MHZ；p<0.0001，RTHL 和 LTHL：0.76±0.09 与 0.63±0.05 dB/cm/MHZ；p<0.0001）。肝活检脂肪变性程度（n=31）与 RTHL 和 LTHL 的平均 AC 值相关性更好（r=0.72），而与 LTHL（r=0.67）或 RTHL（r=0.61）的相关性较差。MRI-PDFF（n=35）与 LTHL 的平均 AC 值相关性更好（r=0.69），而与 RTHL 和 LTHL（r=0.66）或 RTHL（r=0.45）的相关性较差。RTHL 和 LTHL 的平均 AC 值显示出较高的诊断准确性（AUC 0.89，特异性 94%，敏感性 78%），优于 LTHL（AUC 0.89，特异性 88%，敏感性 82%）或 RTHL（AUC 0.81，特异性 89%，敏感性 68%）。
RTHL 和 LTHL 的超声 AC 值在检测肝脂肪变性方面具有相当的诊断价值，当它们平均化时，具有最高的诊断准确性。
