Park Hee Jun, Kang Hyo Jeong, Kim So Yeon, Yoon Seonghun, Baek Seunghee, Song In Hye, Jang Hyeon Ji, Jang Jong Keon
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ultrasonography. 2025 Jan;44(1):83-91. doi: 10.14366/usg.24138. Epub 2024 Sep 27.
This study assessed the impact of hepatic fibrosis on the diagnostic performance of the controlled attenuation parameter (CAP) in quantifying hepatic steatosis in patients with chronic hepatitis B (CHB).
CHB patients who underwent liver stiffness measurement (LSM) and CAP assessment using transient elastography before liver resection between 2019 and 2022 were retrospectively evaluated. Clinical data included body mass index (BMI) and laboratory parameters. The histologically determined hepatic fat fraction (HFF) and fibrosis stages were reviewed by pathologists blinded to clinical and radiologic data. The Pearson correlation coefficient between CAP and HFF was calculated. The diagnostic performance of CAP for significant hepatic steatosis (HFF ≥10%) was assessed using areas under the receiver operating curve (AUCs), stratified by fibrosis stages (F0-1 vs. F2-4). Factors significantly associated with CAP were determined by univariable and multivariable linear regression analyses.
Among 399 CHB patients (median age 59 years; 306 men), 16.3% showed significant steatosis. HFF ranged from 0% to 60%. Of these patients, 9.8%, 19.8%, 29.3%, and 41.1% had fibrosis stages F0-1, F2, F3, and F4, respectively. CAP positively correlated with HFF (r=0.445, P<0.001). The AUC of CAP for diagnosing significant steatosis was 0.786 (95% confidence interval [CI], 0.726 to 0.845) overall, and significantly lower in F2-4 (0.772; 95% CI, 0.708 to 0.836) than in F0-1 (0.924; 95% CI, 0.835 to 1.000) (P=0.006). Multivariable analysis showed that BMI (P<0.001) and HFF (P<0.001) significantly affected CAP, whereas LSM and fibrosis stages did not.
CAP evaluations of significant hepatic steatosis are less reliable in CHB patients with significant or more advanced (F2-4) than with no or mild (F0-1) fibrosis.
本研究评估了肝纤维化对慢性乙型肝炎（CHB）患者控制衰减参数（CAP）定量肝脂肪变性诊断性能的影响。
回顾性评估2019年至2022年期间在肝切除术前接受肝脏硬度测量（LSM）和使用瞬时弹性成像进行CAP评估的CHB患者。临床数据包括体重指数（BMI）和实验室参数。病理学家在不知道临床和放射学数据的情况下对组织学确定的肝脂肪分数（HFF）和纤维化分期进行回顾。计算CAP与HFF之间的Pearson相关系数。使用受试者工作特征曲线下面积（AUC）评估CAP对显著肝脂肪变性（HFF≥10%）的诊断性能，并按纤维化分期（F0-1与F2-4）分层。通过单变量和多变量线性回归分析确定与CAP显著相关的因素。
在399例CHB患者（中位年龄59岁；306例男性）中，16.3%表现出显著脂肪变性。HFF范围为0%至60%。在这些患者中，分别有9.8%、19.8%、29.3%和41.1%的患者纤维化分期为F0-1、F2、F3和F4。CAP与HFF呈正相关（r = 0.445，P < 0.001）。CAP诊断显著脂肪变性的总体AUC为0.786（95%置信区间[CI]，0.726至0.845），在F2-4期（0.772；95%CI，0.708至0.836）显著低于F0-1期（0.924；95%CI，0.835至1.000）（P = 0.006）。多变量分析显示，BMI（P < 0.001）和HFF（P < 0.001）对CAP有显著影响，而LSM和纤维化分期则无影响。
与无纤维化或轻度纤维化（F0-1）的CHB患者相比，在有显著或更晚期（F2-4）纤维化的CHB患者中，CAP对显著肝脂肪变性的评估可靠性较低。
