Rocky Vista University, Ivins, Utah, USA.
Weill Cornell Medicine, Cornell University, New York, New York, USA.
J Ultrasound Med. 2023 Aug;42(8):1675-1688. doi: 10.1002/jum.16185. Epub 2023 Feb 6.
To assess diagnostic performance of quantitative ultrasound (QUS) biomarkers in assessing hepatic steatosis.
We prospectively recruited 125 participants (mean age 54 years) who underwent liver QUS, magnetic resonance imaging (MRI), and laboratory tests within 30 days in this IRB approved study. Based on MRI-proton density fat fraction (MRI-PDFF) and MRE, we divided 125 participants into normal liver, nonalcoholic fatty liver (NAFL) and liver fibrosis (≥F1) groups. We examined diagnostic performance of ultrasound attenuation coefficient (AC), normalized local variance (NLV), superb microvascular imaging-based vascularity index (SMI-VI), and shear wave velocity (SWV) for determining hepatic steatosis and fibrosis using area under receiver operating characteristic curve (AUC). We also analyzed correlations of QUS biomarkers to MRI using Spearman correlation coefficient.
We observed significant differences in AC, NLV, and SMI-VI among the three groups (22 participants with normal liver, 78 with NAFL, and 25 with liver fibrosis). AUC of AC, NLV, and SMI-VI for determining ≥ mild steatotic livers (MRI-PDFF ≥5%) was 0.95, 0.90, and 0.92, respectively. AUC of SWV for determining ≥ F1 liver fibrosis was 0.93. The correlation of MRI-PDFF was positive to AC (r = 0.91) and negative to NLV (r = -0.74), SMI-VI (r = -0.8) in NAFL group. There was a significant difference in regression slope of AC to MRI-PDFF in livers with and without ≥F1 (0.84 vs 0.91, P = .02).
QUS biomarkers have high sensitivity and specificity to determine and grade hepatic steatosis and detect liver fibrosis. The effect of liver fibrosis on the performance of QUS biomarkers in quantifying liver fat content warrants further investigation.
评估定量超声（QUS）生物标志物在评估肝脂肪变性中的诊断性能。
本研究为前瞻性研究，共纳入 125 例（平均年龄 54 岁）患者，在 30 天内接受了肝脏 QUS、磁共振成像（MRI）和实验室检查。根据 MRI 质子密度脂肪分数（MRI-PDFF）和 MRE，将 125 例患者分为正常肝脏、非酒精性脂肪肝（NAFL）和肝纤维化（≥F1）组。我们使用受试者工作特征曲线下面积（AUC）评估超声衰减系数（AC）、归一化局部方差（NLV）、基于超微血管成像的血管指数（SMI-VI）和剪切波速度（SWV）对确定肝脂肪变性和纤维化的诊断性能。我们还使用 Spearman 相关系数分析了 QUS 生物标志物与 MRI 之间的相关性。
我们观察到三组之间的 AC、NLV 和 SMI-VI 存在显著差异（22 例正常肝脏、78 例 NAFL 和 25 例肝纤维化）。AC、NLV 和 SMI-VI 对确定≥轻度脂肪性肝病（MRI-PDFF≥5%）的 AUC 分别为 0.95、0.90 和 0.92。SWV 对确定≥F1 肝纤维化的 AUC 为 0.93。在 NAFL 组中，MRI-PDFF 与 AC（r=0.91）和 NLV（r=-0.74）、SMI-VI（r=-0.8）呈正相关。在有无≥F1 的肝脏中，AC 对 MRI-PDFF 的回归斜率有显著差异（0.84 与 0.91，P=0.02）。
QUS 生物标志物对确定和分级肝脂肪变性以及检测肝纤维化具有较高的灵敏度和特异性。肝纤维化对 QUS 生物标志物定量肝脂肪含量性能的影响值得进一步研究。
