Gastro Unit, Copenhagen University Hospital, Hvidovre, Denmark.
Department of Radiology, Copenhagen University Hospital, Hvidovre, Denmark.
Hepatol Commun. 2023 Aug 31;7(9). doi: 10.1097/HC9.0000000000000231. eCollection 2023 Sep 1.
Abdominal ultrasound (US) and CT are important tools for the initial evaluation of patients with liver disease. Our study aimed to determine the accuracy of these methods for diagnosing cirrhosis.
In all, 377 participants from 4 prospective cohort studies evaluating patients with various liver diseases were included. All patients were included between 2017 and 2022 and had undergone a liver biopsy as well as US and/or CT. Using the histological assessment as the gold standard, we calculated diagnostic accuracy for US and CT. Liver biopsies were evaluated by expert histopathologists and diagnostic scans by experienced radiologists.
The mean age was 54 ± 14 years and 47% were female. Most patients had NAFLD (58.3%) or alcohol-associated liver disease (25.5%). The liver biopsy showed cirrhosis in 147 patients (39.0%). Eighty-three patients with cirrhosis had Child-Pugh A (56.4% of patients with cirrhosis) and 64 had Child-Pugh B/C (43.6%). Overall, the sensitivity for diagnosing cirrhosis by US was 0.71 (95% CI 0.62-0.79) and for CT 0.74 (95% CI 0.64-0.83). The specificity was high for US (0.94, 95% CI 0.90-0.97) and for CT (0.93, 95% CI 0.83-0.98). When evaluating patients with Child-Pugh A cirrhosis, sensitivity was only 0.62 (95% CI 0.49-0.74) for US and 0.60 (95% CI 0.43-0.75) for CT. For patients with Child-Pugh B/C, sensitivity was 0.83 (95% CI 0.70-0.92) for US and 0.87 (95% CI 0.74-0.95) for CT. When limiting our analysis to NAFLD (20% with cirrhosis), the sensitivity for US was 0.45 (95% CI 0.28-0.64) and specificity was 0.97 (95% CI 0.93-0.99).
US and CT show moderate sensitivity and may potentially overlook compensated cirrhosis underlining the need for additional diagnostic testing.
腹部超声（US）和 CT 是评估肝病患者的重要初始工具。我们的研究旨在确定这些方法诊断肝硬化的准确性。
共有 377 名来自 4 项前瞻性队列研究的患者参与，这些患者均患有各种肝病。所有患者均于 2017 年至 2022 年期间接受了肝活检以及 US 和/或 CT 检查。我们以组织学评估为金标准，计算 US 和 CT 的诊断准确性。肝活检由专家病理学家评估，诊断性扫描由经验丰富的放射科医生进行。
患者的平均年龄为 54 ± 14 岁，47%为女性。大多数患者患有非酒精性脂肪性肝病（58.3%）或酒精相关性肝病（25.5%）。肝活检显示 147 名患者（39.0%）患有肝硬化。83 名患有肝硬化的患者为 Child-Pugh A（56.4%的肝硬化患者），64 名患者为 Child-Pugh B/C（43.6%）。总体而言，US 诊断肝硬化的敏感度为 0.71（95%CI 0.62-0.79），CT 为 0.74（95%CI 0.64-0.83）。US（0.94，95%CI 0.90-0.97）和 CT（0.93，95%CI 0.83-0.98）的特异性均较高。在评估 Child-Pugh A 肝硬化患者时，US 的敏感度仅为 0.62（95%CI 0.49-0.74），CT 为 0.60（95%CI 0.43-0.75）。对于 Child-Pugh B/C 患者，US 的敏感度为 0.83（95%CI 0.70-0.92），CT 为 0.87（95%CI 0.74-0.95）。当将我们的分析限制在非酒精性脂肪性肝病（20%患有肝硬化）时，US 的敏感度为 0.45（95%CI 0.28-0.64），特异性为 0.97（95%CI 0.93-0.99）。
US 和 CT 显示出中等的敏感度，可能会忽略代偿性肝硬化，这突出表明需要进行额外的诊断性检查。
