Shen Luyao, Patel Richa, Negrete Lindsey, Shon Andy, Lemieux Simon, Liang Tie, Altmayer Stephan, Jha Priyanka, Kamaya Aya
Stanford University, Stanford, USA.
Université Laval, Québec, Canada.
Abdom Radiol (NY). 2025 May 27. doi: 10.1007/s00261-025-05008-5.
To assess the diagnostic performance of standardized qualitative assessment of hepatic steatosis on grayscale ultrasound.
This retrospective, single-center, multi-case, multi-reader study included 200 patients with ultrasound examinations of the liver. Three readers assessed hepatic steatosis based on a standardized system of 3 ultrasound features: presence of increased fine echoes, visualization of right hemidiaphragm, and visualization of portal triads, assigning a four-grade category (normal, mild, moderate, or severe). Magnetic resonance imaging proton density fat fraction (MRI-PDFF) was used as reference standard. Binary discrimination (normal vs. steatosis) was summarized with binary area under the curve (AUC), sensitivity, and specificity. Discrimination across four categories was performed with pairwise comparisons. Reader differences were tested with the Obuchowski-Rockette-Hillis model. Inter-reader agreement was calculated with Gwet's agreement coefficient (AC).
Of the 200 patients, 27% (54/200) had normal liver (MRI-PDFF < 5%), 35% (70/200) had mild steatosis (MRI-PDFF ≥ 5-17.4%), 15% (29/200) had moderate steatosis (MRI-PDFF > 17.4-22.1%), and 24% (47/200) had severe steatosis (MRI-PDFF > 22.1%). Median time interval between ultrasound and MRI exams was 4 days (IQR 1-28). Sensitivity, specific, and binary AUC for readers 1/2/3 were 90%/82%/94%, 65%/82%/54%, and 0.87/0.85/0.88 with no statistically significant difference between readers (p = 0.46). Four-class category analysis showed excellent performance of ultrasound to distinguish extreme categories (AUC > 0.95 for normal vs. severe). Inter-reader agreement was substantial (Gwet's AC 0.63) for steatosis category assignment and moderate to substantial (Gwet's AC 0.55-0.71) for ultrasound features.
Contrary to popular belief, qualitative ultrasound assessment of hepatic steatosis is accurate in detecting and grading steatosis when evaluation criteria are standardized.
评估肝脏脂肪变性的标准化灰阶超声定性评估的诊断性能。
这项回顾性、单中心、多病例、多阅片者研究纳入了200例接受肝脏超声检查的患者。三名阅片者基于3个超声特征的标准化系统评估肝脏脂肪变性：细回声增强、右半膈可视化和门静脉三联征可视化，将其分为四级（正常、轻度、中度或重度）。磁共振成像质子密度脂肪分数（MRI-PDFF）用作参考标准。二元判别（正常与脂肪变性）用二元曲线下面积（AUC）、敏感性和特异性进行总结。通过两两比较进行四类判别。阅片者差异用Obuchowski-Rockette-Hillis模型进行检验。阅片者间一致性用Gwet一致性系数（AC）计算。
200例患者中，27%（54/200）肝脏正常（MRI-PDFF＜5%），35%（70/200）有轻度脂肪变性（MRI-PDFF≥5%-17.4%），15%（29/200）有中度脂肪变性（MRI-PDFF＞17.4%-22.1%），24%（47/200）有重度脂肪变性（MRI-PDFF＞22.1%）。超声检查与MRI检查之间的中位时间间隔为4天（IQR 1-28）。阅片者1/2/3的敏感性、特异性和二元AUC分别为90%/82%/94%、65%/82%/54%和0.87/0.85/0.88，阅片者之间无统计学显著差异（p = 0.46）。四类分析显示超声在区分极端类别方面表现出色（正常与重度的AUC＞0.95）。阅片者间在脂肪变性类别分配方面一致性较高（Gwet's AC 0.63），在超声特征方面一致性为中度到较高（Gwet's AC 0.55-0.71）。
与普遍看法相反，当评估标准标准化时，肝脏脂肪变性的定性超声评估在检测和分级脂肪变性方面是准确的。
