超声剪切波衰减成像在志愿者和非酒精性脂肪性肝病患者肝脂肪变分级中的初步研究。

Ultrasound Shear Wave Attenuation Imaging for Grading Liver Steatosis in Volunteers and Patients With Non-alcoholic Fatty Liver Disease: A Pilot Study.

机构信息

Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.

Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.

出版信息

Ultrasound Med Biol. 2023 Oct;49(10):2264-2272. doi: 10.1016/j.ultrasmedbio.2023.06.020. Epub 2023 Jul 21.

DOI:10.1016/j.ultrasmedbio.2023.06.020

PMID:37482477

Abstract

OBJECTIVE

The aims of the work described here were to assess shear wave attenuation (SWA) in volunteers and patients with non-alcoholic fatty liver disease (NAFLD) and compare its diagnostic performance with that of shear wave dispersion (SWD), magnetic resonance imaging (MRI) proton density fat fraction (PDFF) and biopsy.

METHODS

Forty-nine participants (13 volunteers and 36 NAFLD patients) were enrolled. Ultrasound and MRI examinations were performed in all participants. Biopsy was also performed in patients. SWA was used to assess histopathology grades as potential confounders. The areas under curves (AUCs) of SWA, SWD and MRI-PDFF were assessed in different steatosis grades by biopsy. Youden's thresholds of SWA were obtained for steatosis grading while using biopsy or MRI-PDFF as the reference standard.

RESULTS

Spearman's correlations of SWA with histopathology (steatosis, inflammation, ballooning and fibrosis) were 0.89, 0.73, 0.62 and 0.31, respectively. Multiple linear regressions of SWA confirmed the correlation with steatosis grades (adjusted R = 0.77, p < 0.001). The AUCs of MRI-PDFF, SWA and SWD were respectively 0.97, 0.99 and 0.94 for S0 versus ≥S1 (p > 0.05); 0.94, 0.98 and 0.78 for ≤S1 versus ≥S2 (both MRI-PDFF and SWA were higher than SWD, p < 0.05); and 0.90, 0.93 and 0.68 for ≤S2 versus S3 (both SWA and MRI-PDFF were higher than SWD, p < 0.05). SWA's Youden thresholds (Np/m/Hz) (sensitivity, specificity) for S0 versus ≥S1, ≤S1 versus ≥S2 and ≤S2 versus S3 were 1.05 (1.00, 0.92), 1.37 (0.96, 0.96) and 1.51 (0.83, 0.87), respectively. These values were 1.16 (1.00, 0.81), 1.49 (0.91, 0.82) and 1.67 (0.87, 0.92) when considering MRI-PDFF as the reference standard.

CONCLUSION

In this pilot study, SWA increased with increasing steatosis grades, and its diagnostic performance was higher than that of SWD but equivalent to that of MRI-PDFF.

摘要

目的

本研究旨在评估非酒精性脂肪性肝病（NAFLD）患者及志愿者的剪切波衰减（SWA），并比较其与剪切波速度分散度（SWD）、磁共振成像（MRI）质子密度脂肪分数（PDFF）和肝活检的诊断性能。

方法

共纳入 49 名参与者（13 名志愿者和 36 名 NAFLD 患者）。所有参与者均接受了超声和 MRI 检查，部分患者还进行了肝活检。SWA 用于评估组织病理学分级作为潜在混杂因素。通过肝活检评估 SWA、SWD 和 MRI-PDFF 在不同脂肪变性程度下的曲线下面积（AUC）。以肝活检或 MRI-PDFF 为参考标准，获得 SWA 用于脂肪变性分级的 Youden 截断值。

结果

SWA 与组织病理学（脂肪变性、炎症、气球样变和纤维化）的 Spearman 相关系数分别为 0.89、0.73、0.62 和 0.31。SWA 的多元线性回归证实与脂肪变性程度相关（调整 R = 0.77，p < 0.001）。MRI-PDFF、SWA 和 SWD 的 AUC 分别为 S0 与≥S1（p > 0.05）时为 0.97、0.99 和 0.94；S1 与≥S2（MRI-PDFF 和 SWA 均高于 SWD，p < 0.05）时为 0.94、0.98 和 0.78；S2 与 S3（SWA 和 MRI-PDFF 均高于 SWD，p < 0.05）时为 0.90、0.93 和 0.68。SWA 的 Youden 截断值（Np/m/Hz）（灵敏度，特异性）为 S0 与≥S1 时为 1.05（1.00，0.92），S1 与≥S2 时为 1.37（0.96，0.96），S2 与 S3 时为 1.51（0.83，0.87）。当以 MRI-PDFF 为参考标准时，SWA 的这些截断值分别为 1.16（1.00，0.81）、1.49（0.91，0.82）和 1.67（0.87，0.92）。