Chen Zhiyuan, Huang Ye, Zhang Yan, Zhou Dongjing, Yang Yu, Zhang Shuping, Xiao Huanming, Li HaiXia, Liu Yupin
Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
Insights Imaging. 2024 Nov 22;15(1):283. doi: 10.1186/s13244-024-01857-8.
To explore the impact of hepatic steatosis measured by MRI-proton density fat fraction (MRI-PDFF) on liver stiffness measurement (LSM) value and its diagnostic performance for staging liver fibrosis in patients with chronic hepatitis B (CHB).
A total of 914 patients with CHB who underwent liver biopsy and MRI-PDFF were retrospectively reviewed. The influence of MRI-PDFF on LSM value was assessed using univariate and multivariate linear analyses. To assess the influence of liver steatosis on the diagnostic performance of LSM, a series of ROC analyses were performed and compared by stratifying patients into non-steatosis (PDFF < 5%) and steatosis (PDFF ≥ 5%) groups according to MRI-PDFF values. The effects of different LSM cut-off values on the false-positive rate in the steatosis cohort were compared using McNemar's test.
LSM values were significantly affected by MRI-PDFF in the entire cohort (B-coefficient: 0.003, p < 0.001), F1 cohort (B-coefficient: 0.005, p < 0.001), and F2 cohort (B-coefficient: 0.003, p = 0.002). Hepatic steatosis was not observed to have a significant influence on the ROC curve of LSM for staging liver fibrosis. Compared with using the cut-off values for the CHB cohort, using relatively higher cut-off values for hepatic steatosis significantly improved the false-positive rate of LSM in the steatosis cohort.
Steatosis significantly influenced LSM, with a higher value in the early stage of liver fibrosis but did not affect the diagnostic efficiency of LSM for staging liver fibrosis. Moreover, using relatively high cut-off values significantly improved the false-positive rate of LSM in CHB patients with steatosis.
The identified correlation between MRI-PDFF and VCTE-measured LSM is not clinically relevant since the diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis. A higher cut-off should be applied in CHB patients with steatosis to improve the false-positive rate.
Steatosis can affect liver stiff measurement (LSM) values in the early stage of liver fibrosis. The diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis. LSM's cutoffs should be increased in patients with steatosis to improve the false-positive rate.
探讨磁共振成像-质子密度脂肪分数（MRI-PDFF）测量的肝脂肪变性对慢性乙型肝炎（CHB）患者肝脏硬度测量（LSM）值及其肝纤维化分期诊断性能的影响。
回顾性分析914例行肝脏活检及MRI-PDFF检查的CHB患者。采用单因素和多因素线性分析评估MRI-PDFF对LSM值的影响。为评估肝脂肪变性对LSM诊断性能的影响，根据MRI-PDFF值将患者分为非脂肪变性（PDFF＜5%）和脂肪变性（PDFF≥5%）组，进行一系列ROC分析并比较。使用McNemar检验比较不同LSM临界值对脂肪变性队列中假阳性率的影响。
在整个队列（B系数：0.003，p＜0.001）、F1队列（B系数：0.005，p＜0.001）和F2队列（B系数：0.003，p = 0.002）中，LSM值均受MRI-PDFF显著影响。未观察到肝脂肪变性对LSM评估肝纤维化分期的ROC曲线有显著影响。与CHB队列使用的临界值相比，在脂肪变性队列中使用相对较高的临界值可显著提高LSM的假阳性率。
脂肪变性显著影响LSM，在肝纤维化早期LSM值较高，但不影响LSM对肝纤维化分期的诊断效率。此外，使用相对较高的临界值可显著提高CHB脂肪变性患者LSM的假阳性率。
MRI-PDFF与VCTE测量的LSM之间的相关性在临床上不相关，因为LSM对肝纤维化分期的诊断性能不受脂肪变性影响。对于CHB脂肪变性患者应采用较高的临界值以提高假阳性率。
脂肪变性可在肝纤维化早期影响肝脏硬度测量（LSM）值。LSM对肝纤维化分期的诊断性能不受脂肪变性影响。对于脂肪变性患者应提高LSM的临界值以提高假阳性率。
