美国标志物与代谢相关脂肪性肝病中脂肪变性、坏死性炎症、肝纤维化：iLEAD 研究。
US Markers and Necroinflammation, Steatosis, and Fibrosis in Metabolic Dysfunction-associated Steatotic Liver Disease: The iLEAD Study.
机构信息
From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.).
出版信息
Radiology. 2024 Aug;312(2):e233377. doi: 10.1148/radiol.233377.
Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopathologic necroinflammation in patients with MASLD. Materials and Methods This international multicenter prospective study enrolled consecutive patients with biopsy-proven MASLD between June 2019 and March 2023. Before biopsy, all participants underwent multiparametric US, and measurements of DS, AC, and SWS were obtained. Multivariable linear regression analyses were performed to assess the association of clinical variables and imaging markers with pathologic findings. The diagnostic performance of imaging markers for determining inflammation grade, steatosis grade, and fibrosis stage was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 124 participants (mean age, 53 years ± 15 [SD]; 62 males) were evaluated. In multivariable regression, lobular inflammation was associated with DS (regression coefficient, 0.06; = .02), alanine aminotransferase level (regression coefficient, 0.002; = .002), and Hispanic or Latino ethnicity (regression coefficient, -0.68; = .047), while steatosis was associated with AC (regression coefficient, 3.66; < .001) and fibrosis was associated with SWS (regression coefficient, 2.02; < .001) and body mass index (regression coefficient, 0.05; = .02). DS achieved an AUC of 0.72 (95% CI: 0.63, 0.82) for identifying participants with inflammation grade A2 or higher (moderate to severe inflammation). AC showed excellent performance for identifying participants with grade S1 (mild) or higher steatosis (AUC, 0.92 [95% CI: 0.87, 0.97]), while SWS showed excellent performance for identifying participants with fibrosis stage F2 or higher (clinically significant fibrosis) (AUC, 0.91 [95% CI: 0.86, 0.96]). Of the three US markers, SWS showed the highest AUC (0.81 [95% CI: 0.74, 0.89]) for the diagnosis of metabolic dysfunction-associated steatohepatitis. Conclusion Of the three US imaging markers (DS, AC, and SWS), DS was most associated with lobular inflammation grade at histologic examination and demonstrated fair diagnostic performance in distinguishing moderate to severe lobular inflammation. ClinicalTrials.gov Identifier: NCT04012242 Published under a CC BY 4.0 license. See also the editorial by Yin in this issue.
背景 衰减系数 (AC) 和剪切波速度 (SWS) 是评估代谢功能相关脂肪性肝病 (MASLD) 患者的既定超声标志物，而剪切波离散斜率 (DS) 则不是。目的 评估 MASLD 患者多参数超声成像标志物 DS、AC 和 SWS 与肝组织病理坏死性炎症之间的关系。材料与方法 本国际多中心前瞻性研究纳入了 2019 年 6 月至 2023 年 3 月间经活检证实的 MASLD 连续患者。在活检前，所有参与者均接受了多参数超声检查，并获得了 DS、AC 和 SWS 的测量值。采用多元线性回归分析评估临床变量和影像学标志物与病理结果的相关性。使用受试者工作特征曲线下面积 (AUC) 评估影像学标志物对确定炎症等级、脂肪变性等级和纤维化阶段的诊断性能。结果 共评估了 124 名参与者（平均年龄，53 岁±15[标准差]；62 名男性）。在多元回归中，小叶炎症与 DS（回归系数，0.06；P =.02）、丙氨酸氨基转移酶水平（回归系数，0.002；P =.002）和西班牙裔或拉丁裔种族（回归系数，-0.68；P =.047）相关，而脂肪变性与 AC（回归系数，3.66；P<0.001）相关，纤维化与 SWS（回归系数，2.02；P<0.001）和体重指数（回归系数，0.05；P =.02）相关。DS 对识别炎症等级 A2 或更高（中度至重度炎症）患者的 AUC 为 0.72（95%CI：0.63，0.82）。AC 对识别 S1 级（轻度）或更高脂肪变性（AUC，0.92[95%CI：0.87，0.97]）患者具有出色的性能，而 SWS 对识别纤维化 F2 级或更高（临床显著纤维化）（AUC，0.91[95%CI：0.86，0.96]）患者具有出色的性能。在这三个 US 标志物中，SWS 对代谢功能相关脂肪性肝炎的诊断具有最高的 AUC（0.81[95%CI：0.74，0.89]）。结论 在三个 US 成像标志物（DS、AC 和 SWS）中，DS 与组织学检查中小叶炎症程度最相关，在区分中重度小叶炎症方面具有良好的诊断性能。ClinicalTrials.gov 标识符：NCT04012242 在 CC BY 4.0 许可下发布。请参阅本期 Yin 的社论。
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