Department of Ultrasound, The First Affiliated Hospital of Anhui University of Chinese Medicine, 117 Meishan Road, Shushan District, Hefei, 230031, Anhui, China.
Department of Encephalopathy, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China.
BMC Med Imaging. 2023 Feb 4;23(1):24. doi: 10.1186/s12880-023-00979-7.
To investigate whether the attenuation coefficient (ATT) can be used as a noninvasive index to assess liver involvement in children and adolescents with Wilson's disease (WD).
Children and adolescents diagnosed with WD were retrospectively collected from the First Affiliated Hospital of the Anhui University of Traditional Chinese Medicine between May 2022 and August 2022. The findings on ATT, Shear Wave Measurement (SWM), AST to platelet ratio index (APRI), and fibrosis 4 (FIB-4) score were obtained. The liver involvement of WD was classified into 3 groups based on serum levels of collagen type IV (CIV), hyaluronic acid (HA), laminin (LN) and precollagen type III N-terminal peptide (PIIINP): (1) Group1 (n = 25), no abnormalities in CIV, HA, LN and PIIINP; (2) Group2 (n = 19), elevation of 1 or 2 indexes in CIV, HA, LN, and PIIINP; Group3 (n = 18), elevation of 3 or 4 indicators in CIV, HA, LN, and PIIINP. The levels of ATT, SWM, APRI and FIB-4 were compared between the 3 groups; and correlation of ATT with SWM and triglyceride (TG) was performed using Spearman's correlation analysis. The Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of ATT alone and its combination with SWM, APRI, and FIB-4 in children and adolescents with WD.
A total of 62 children and adolescents with WD were retrospectively retrieved. ATT levels were significantly different in intergroup comparisons (P < 0.001). The ROC curve showed that the area under the curve (AUC) for the diagnosis of hepatic steatosis using ATT was 0.714, 0.712 and 0.867 in Group 1 versus Group 2, Group 2 versus Group 3, and Group 1 versus Group 3, respectively; the sensitivity for the diagnosis of hepatic steatosis in Group 1 versus Group 2 was 89.47% with the cutoff value of ATT of 0.73 dB/cm/MHz. No significant correlation found between ATT and TG (ρ = 0.154, P = 0.231). Compared to ATT alone, the combination of ATT with APRI and FIB-4 or the combination of ATT with SWM, APRI, and FIB-4 showed a better diagnostic efficacy in Group 1 versus Group 2 (both P = 0.038).
ATT could be used as a non-invasive index for the evaluation of liver steatosis in children and adolescents with WD, with a good clinical applicative value. Furthermore, ATT in combination with APRI, FIB-4, and SWM might have better diagnostic efficacy than ATT alone.
探讨衰减系数（ATT）能否作为一种无创指标，用于评估儿童和青少年威尔逊病（WD）的肝脏受累情况。
回顾性收集 2022 年 5 月至 2022 年 8 月期间在安徽中医药大学第一附属医院诊断为 WD 的儿童和青少年病例。获取 ATT、剪切波测量（SWM）、天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化 4（FIB-4）评分的结果。根据胶原类型 IV（CIV）、透明质酸（HA）、层粘连蛋白（LN）和前胶原 III N 端肽（PIIINP）的血清水平，将 WD 的肝脏受累情况分为 3 组：（1）组 1（n=25），CIV、HA、LN 和 PIIINP 无异常；（2）组 2（n=19），CIV、HA、LN 和 PIIINP 中 1 或 2 项升高；组 3（n=18），CIV、HA、LN 和 PIIINP 中 3 或 4 项升高。比较 3 组间的 ATT、SWM、APRI 和 FIB-4 水平；采用 Spearman 相关分析比较 ATT 与 SWM 和甘油三酯（TG）的相关性。采用受试者工作特征（ROC）曲线分析 ATT 单独及与 SWM、APRI 和 FIB-4 联合诊断 WD 儿童和青少年肝脂肪变性的诊断效能。
共回顾性检索到 62 例 WD 儿童和青少年病例。组间比较时 ATT 水平差异有统计学意义（P<0.001）。ROC 曲线显示，在组 1 与组 2、组 2 与组 3、组 1 与组 3 比较中，ATT 诊断肝脂肪变性的曲线下面积（AUC）分别为 0.714、0.712 和 0.867；组 1 与组 2 比较中，ATT 诊断肝脂肪变性的截断值为 0.73 dB/cm/MHz，敏感度为 89.47%。ATT 与 TG 无明显相关性（ρ=0.154，P=0.231）。与 ATT 单独比较，ATT 联合 APRI 和 FIB-4 或 ATT 联合 SWM、APRI 和 FIB-4 在组 1 与组 2 比较中具有更好的诊断效能（均 P=0.038）。
ATT 可作为评估儿童和青少年 WD 患者肝脏脂肪变性的无创指标，具有良好的临床应用价值。此外，ATT 联合 APRI、FIB-4 和 SWM 可能比 ATT 单独应用具有更好的诊断效能。
