Dichtel Laura E, Tabari Azadeh, Mercaldo Nathaniel D, Corey Kathleen E, Husseini Jad, Osganian Stephanie A, Chicote Mark L, Rao Elizabeth M, Miller Karen K, Bredella Miriam A
Harvard Medical School, Boston, MA, USA.
Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
J Clin Exp Hepatol. 2023 Sep-Oct;13(5):760-766. doi: 10.1016/j.jceh.2023.04.001. Epub 2023 Apr 13.
Nonalcoholic fatty liver disease (NAFLD) is the most common form of liver disease worldwide. There are limited biomarkers that can detect progression from simple steatosis to nonalcoholic steatohepatitis (NASH). The purpose of our study was to utilize CT texture analysis to distinguish steatosis from NASH.
16 patients with NAFLD (38% male, median (interquartile range): age 57 (48-64) years, BMI 37.5 (35.0-46.8) kg/m) underwent liver biopsy and abdominal non-contrast CT. CT texture analysis was performed to quantify gray-level tissue summaries (e.g., entropy, kurtosis, skewness, and attenuation) using commercially available software (TexRad, Cambridge England). Logistic regression analyses were performed to quantify the association between steatosis/NASH status and CT texture. ROC curve analysis was performed to determine sensitivity, specificity, AUC, 95% CIs, and cutoff values of texture parameters to differentiate steatosis from NASH.
By histology, 6/16 (37%) of patients had simple steatosis and 10/16 (63%) had NASH. Patients with NASH had lower entropy (median, interquartile range (IQR): 4.3 (4.1, 4.8) vs. 5.0 (4.9, 5.2), = 0.013) and lower mean value of positive pixels (MPP) (34.4 (21.8, 52.2) vs. 66.5 (57.0, 70.7), = 0.009) than those with simple steatosis. Entropy values below 4.73 predict NASH with 100% (95%CI: 67-100%) specificity and 80% (50-100%) sensitivity, AUC: 0.88. MPP values below 54.0 predict NASH with 100% (67-100%) specificity and 100% (50-100%) sensitivity, AUC 0.90.
Our study provides preliminary evidence that CT texture analysis may serve as a novel imaging biomarker for disease activity in NAFLD and the discrimination of steatosis and NASH.
非酒精性脂肪性肝病（NAFLD）是全球最常见的肝脏疾病形式。能够检测从单纯性脂肪变性进展为非酒精性脂肪性肝炎（NASH）的生物标志物有限。我们研究的目的是利用CT纹理分析来区分脂肪变性和NASH。
16例NAFLD患者（男性占38%，年龄中位数（四分位间距）：57（48 - 64）岁，BMI 37.5（35.0 - 46.8）kg/m²）接受了肝脏活检和腹部非增强CT检查。使用商用软件（TexRad，英国剑桥）进行CT纹理分析，以量化灰度级组织汇总指标（如熵、峰度、偏度和衰减）。进行逻辑回归分析以量化脂肪变性/NASH状态与CT纹理之间的关联。进行ROC曲线分析以确定纹理参数区分脂肪变性和NASH的敏感性、特异性、AUC、95%置信区间和临界值。
通过组织学检查，6/16（37%）的患者有单纯性脂肪变性，10/16（63%）有NASH。与单纯性脂肪变性患者相比，NASH患者的熵更低（中位数，四分位间距（IQR）：4.3（4.1，4.8）对5.0（4.9，5.2），P = 0.013），阳性像素均值（MPP）更低（34.4（21.8，52.2）对66.5（57.0，70.7），P = 0.009）。熵值低于4.73预测NASH的特异性为100%（95%CI：67 - 100%），敏感性为80%（50 - 100%），AUC：0.88。MPP值低于54.0预测NASH的特异性为100%（67 - 100%），敏感性为100%（50 - 100%），AUC为0.90。
我们的研究提供了初步证据，表明CT纹理分析可能作为一种新的成像生物标志物，用于NAFLD疾病活动以及脂肪变性和NASH的鉴别。
