超声引导下衰减参数和二维剪切波弹性成像在代谢功能障碍相关脂肪性肝病患者中的应用
Performance of ultrasound-guided attenuation parameter and 2D shear wave elastography in patients with metabolic dysfunction-associated steatotic liver disease.
作者信息
Cannella Roberto, Agnello Francesco, Porrello Giorgia, Spinello Alessandro Umberto, Infantino Giuseppe, Pennisi Grazia, Cabibi Daniela, Petta Salvatore, Bartolotta Tommaso Vincenzo
机构信息
Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, Palermo, 90127, Italy.
Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
出版信息
Eur Radiol. 2025 Apr;35(4):2339-2350. doi: 10.1007/s00330-024-11076-w. Epub 2024 Oct 7.
PURPOSE
To assess the performance and the reproducibility of ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS
This study included consecutive adult patients with MASLD who underwent ultrasound with UGAP, 2D-SWE and percutaneous liver biopsy. The median values of 12 consecutive UGAP measurements were acquired by two independent radiologists (R1 and R2). Hepatic steatosis was graded by liver biopsy as: (0) < 5%; (1) 5-33%; (2) > 33-66%; (3) > 66%. Areas under the curve (AUCs) were calculated to determine the diagnostic performance. Inter- and intra-observer reliability was assessed with intraclass correlation coefficient (ICC).
RESULTS
A hundred patients (median age 55.0 years old) with MASLD were prospectively enrolled. At histopathology, 70 and 42 patients had grade ≥ 2 and 3 steatosis, respectively. Median UGAP was 0.78 dB/cm/MHz (IQR/Med: 5.55%). For the diagnosis of grade ≥ 2 steatosis, the AUCs of UGAP were 0.828 (95% CI: 0.739, 0.896) for R1 and 0.779 (95% CI: 0.685, 0.856) for R2. The inter- and intra-operator reliability of UGAP were excellent, with an ICC of 0.92 (95% CI: 0.87-0.95) and 0.95 (95% CI: 0.92-0.96), respectively. The median liver stiffness was 6.76 kPa (IQR/Med: 16.30%). For the diagnosis of advanced fibrosis, 2D-SWE had an AUC of 0.862 (95% CI: 0.757, 0.934), and the optimal cutoff value was > 6.75 kPa with a sensitivity of 80.6% and a specificity of 75.7%.
CONCLUSION
UGAP and 2D-SWE provide a good performance for the staging of steatosis and fibrosis in patients with MASLD with an excellent intra-operator reliability of UGAP.
KEY POINTS
Question How well do ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) perform for quantifying hepatic steatosis and fibrosis? Findings UGAP had a maximum AUC of 0.828 for the diagnosis of grade ≥ 2 steatosis, and 2D-SWE had an AUC of 0.862 for diagnosing advanced fibrosis. Clinical relevance UGAP and 2D-SWE allow rapid, reproducible, and accurate quantification of hepatic steatosis and fibrosis that can be used for the noninvasive assessment of patients with metabolic dysfunction-associated steatotic liver disease.
目的
评估超声引导下衰减参数（UGAP）和二维剪切波弹性成像（2D-SWE）在经活检证实的代谢功能障碍相关脂肪性肝病（MASLD）患者中的性能及可重复性。
方法
本研究纳入连续的成年MASLD患者，这些患者接受了UGAP、2D-SWE超声检查及经皮肝活检。由两名独立的放射科医生（R1和R2）获取连续12次UGAP测量的中位数。肝脂肪变性通过肝活检分级为：（0）<5%；（1）5%-33%；（2）>33%-66%；（3）>66%。计算曲线下面积（AUC）以确定诊断性能。使用组内相关系数（ICC）评估观察者间和观察者内的可靠性。
结果
前瞻性纳入了100例MASLD患者（中位年龄55.0岁）。在组织病理学检查中，分别有70例和42例患者脂肪变性分级≥2级和≥3级。UGAP中位数为0.78 dB/cm/MHz（四分位间距/中位数：5.55%）。对于≥2级脂肪变性的诊断，R1的UGAP的AUC为0.828（95%CI：0.739，0.896），R2的为0.779（95%CI：0.685，0.856）。UGAP的操作者间和操作者内可靠性均极佳，ICC分别为0.92（95%CI：0.87 - 0.95）和0.95（95%CI：0.92 - 0.96）。肝脏硬度中位数为6.76 kPa（四分位间距/中位数：16.30%）。对于晚期纤维化的诊断，2D-SWE的AUC为0.862（95%CI：0.757，0.934），最佳截断值>6.75 kPa，敏感性为80.6%，特异性为75.7%。
结论
UGAP和2D-SWE在MASLD患者脂肪变性和纤维化分期方面表现良好，UGAP的操作者内可靠性极佳。
关键点
问题超声引导下衰减参数（UGAP）和二维剪切波弹性成像（2D-SWE）在量化肝脂肪变性和纤维化方面表现如何？发现UGAP诊断≥2级脂肪变性的最大AUC为0.828，2D-SWE诊断晚期纤维化的AUC为0.862。临床意义UGAP和2D-SWE可实现对肝脂肪变性和纤维化的快速、可重复且准确的量化，可用于代谢功能障碍相关脂肪性肝病患者的无创评估。
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