Kim Hae Young, Jeon Sun Kyung, Ha Tae-Yong, Jung Dong-Hwan, Lee Seungjae, Song In Hye, Chung Sung Won, Kim So Yeon, Lee Seung Soo
Department of Radiology, Asan Medical Center, Seoul, Republic of Korea.
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Liver Transpl. 2025 Mar 1;31(3):333-343. doi: 10.1097/LVT.0000000000000467. Epub 2024 Aug 26.
Hepatic steatosis (HS) criteria for living donor liver transplantation (LDLT) donor eligibility should be based on large droplet fat as per Banff consensus recommendations. We aimed to establish magnetic resonance imaging proton density fat fraction cutoffs for HS assessment in potential LDLT donors. This retrospective study included consecutive potential LDLT donors who underwent MRI and liver biopsy between 2013 and 2023 at 2 tertiary institutions, each as development (n = 3062; 2015 men; median [IQR] age of 32 [25-38] y) and external validation (n = 472; 287 men; 35 [26-44] y) data sets. Proton density fat fraction (PDFF) was measured using dedicated MRI sequences. Histologic HS, defined as a large droplet fat fraction, was used as the reference standard. Dual PDFF cutoffs aimed at 95% sensitivity or 95% specificity, for diagnosing histologic HS of ≥10%, ≥20%, ≥30%, and ≥40%, were determined in the development data set using 10-fold cross-validation. The cutoffs were then validated in the external validation data set. The equation for estimating histologic HS from PDFF was also derived using linear regression. The PDFF cutoffs for histologic HS of ≥10%, ≥20%, ≥30%, and ≥40%, targeting 95% sensitivity, were 3.7%, 5.5%, 8.0%, and 10.0%, respectively. External validation demonstrated high sensitivities ≥97.9% with specificities ranging from 60.9% to 95.1%. The PDFF cutoffs targeting 95% specificity were 6.3%, 8.0%, 9.1%, and 10.1%, respectively. External validation rendered high specificities ranging from 88.5% to 95.3%, with sensitivities ranging from 76.6% to 100%. For diagnosing histologic HS ≥30%, which is the most prevalently used threshold for LDLT donor eligibility assessment, the PDFF cutoffs achieved sensitivities and specificities of over 90%. The equation of (Histologic HS = -2.95 + 1.93 × PDFF) was derived.
根据班夫共识建议，活体肝移植（LDLT）供体资格的肝脂肪变性（HS）标准应以大泡性脂肪为准。我们旨在确定磁共振成像质子密度脂肪分数的临界值，用于评估潜在LDLT供体的HS情况。这项回顾性研究纳入了2013年至2023年期间在2家三级医疗机构连续接受MRI检查和肝活检的潜在LDLT供体，分别作为开发数据集（n = 3062；2015名男性；年龄中位数[四分位间距]为32[25 - 38]岁）和外部验证数据集（n = 472；287名男性；35[26 - 44]岁）。使用专用MRI序列测量质子密度脂肪分数（PDFF）。组织学HS定义为大泡性脂肪分数，用作参考标准。在开发数据集中使用10倍交叉验证确定针对诊断组织学HS≥10%、≥20%、≥30%和≥40%的双PDFF临界值，目标是95%的敏感性或95%的特异性。然后在外部验证数据集中对这些临界值进行验证。还使用线性回归推导了从PDFF估计组织学HS的方程。针对组织学HS≥10%、≥20%、≥30%和≥40%且目标为95%敏感性的PDFF临界值分别为3.7%、5.5%、8.0%和10.0%。外部验证显示敏感性≥97.9%，特异性范围为60.9%至95.1%。针对95%特异性的PDFF临界值分别为6.3%、8.0%、9.1%和10.1%。外部验证的特异性范围为88.5%至95.3%，敏感性范围为76.6%至100%。对于诊断组织学HS≥30%（这是LDLT供体资格评估中最常用的阈值），PDFF临界值的敏感性和特异性均超过90%。推导得出方程（组织学HS = -2.95 + 1.93×PDFF）。
