Garrido Daniel, Noverati Nicholas, Robbins Justin, Dave Jaydev K, Naringrekar Haresh, Mitchell Donald G, Marzio Dina Halegoua-De
Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Clin Transl Hepatol. 2023 Jun 28;11(3):534-539. doi: 10.14218/JCTH.2022.00279. Epub 2023 Jan 10.
Distinguishing alcoholic steatohepatitis (ASH) and nonalcoholic steatohepatitis (NASH) with biopsy alone is often difficult without a reliable clinical context. A novel finding on liver imaging, perivascular branching heterogeneity, has shown promise in distinguishing between these chronic liver diseases. Our study investigated the role of this finding on imaging to differentiate between ASH and NASH. The aim of this study was to determine the utility and reproducibility of this novel radiographic marker to help distinguish ASH from NASH.
This was a retrospective cohort study conducted between 2016 and 2020 in patients with both liver biopsy-confirmed steatohepatitis/chronic hepatitis and abdominal magnetic resonance imaging within 13 months of each other. Two radiologists, blinded to patient clinical history and diagnosis, categorized the appearance of the liver as: 1- homogeneity, 2- mild heterogeneity, 3- moderate heterogeneity, 4- possible perivascular branching, 5- definite perivascular branching.
Of the 90 patients in the study, 60 were identified as NASH and 30 as ASH. The area under the curve (AUC) for both reader 1 and 2 when using the 5-point scale was 0.69 (CI: 0.56-0.82, =0.006) and 0.72 (CI: 0.60-0.85, =0.001), respectively. The positive predictive value (PPV) for identification of ASH when scoring 5 was 64.7% and 66.7% for reader 1 and 2, respectively. Interclass correlation coefficient was 0.74 in patients with ASH, indicating moderate reliability among both readers.
Identification of this perivascular branching pattern on imaging is a promising novel diagnostic marker that can be used with other methods to help distinguish between ASH and NASH.
仅通过活检来区分酒精性脂肪性肝炎（ASH）和非酒精性脂肪性肝炎（NASH）往往很困难，除非有可靠的临床背景。肝脏成像上的一个新发现，即血管周围分支异质性，在区分这些慢性肝病方面显示出前景。我们的研究调查了这一成像发现对区分ASH和NASH的作用。本研究的目的是确定这种新的影像学标志物在帮助区分ASH和NASH方面的实用性和可重复性。
这是一项回顾性队列研究，于2016年至2020年期间对肝活检确诊为脂肪性肝炎/慢性肝炎且在13个月内均进行了腹部磁共振成像的患者进行。两名对患者临床病史和诊断不知情的放射科医生将肝脏外观分类为：1 - 均匀性，2 - 轻度异质性，3 - 中度异质性，4 - 可能的血管周围分支，5 - 明确的血管周围分支。
在该研究的90名患者中，60名被确定为NASH，30名被确定为ASH。使用5分制时，读者1和读者2的曲线下面积（AUC）分别为0.69（CI：0.56 - 0.82，P = 0.006）和0.72（CI：0.60 - 0.85，P = 0.001）。评分为5时识别ASH的阳性预测值（PPV），读者1为64.7%，读者2为66.7%。ASH患者的组内相关系数为0.74，表明两位读者之间的可靠性中等。
在成像上识别这种血管周围分支模式是一种有前景的新型诊断标志物，可与其他方法一起用于帮助区分ASH和NASH。
