Hamadouche Macil, Vilgrain Valérie, Hobeika Christian, Castera Laurent, Valla Dominique, Rautou Pierre-Emmanuel, Matteini Francesco, Garteiser Philippe, Van Beers Bernard, Correas Jean-Michel, Ronot Maxime, Dioguardi Burgio Marco
Université Paris Cité, INSERM, Centre de recherche sur l'inflammation, Paris, France.
Department of Radiology, Hôpital Beaujon, AP-HP Nord, Clichy, France.
Eur Radiol. 2025 Jun 25. doi: 10.1007/s00330-025-11774-z.
To evaluate the performance of the ultrasound hepatorenal index (US-HRI) for the diagnosis of hepatic steatosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (MRI-PDFF) as reference.
This two-center prospective study included 129 and 263 patients in the training and validation cohorts, respectively, between 2019 and 2022. Hepatic steatosis was classified according to MRI-PDFF as S0 (≤ 6.5%), S1 (6.5-16.5%), S2 (16.5-22%), and S3 (> 22%). Obuchowski measurement (OB) was performed to assess the diagnostic performance of US-HRI in the whole cohort. Optimal cut-offs of US-HRI for diagnosing ≥ S1 and ≥ S2 were identified in the training cohort by maximizing the Youden index and were applied in the validation cohort.
Overall, 392 patients were included (mean age, 59 years ± 9.5; 235 men). The OB (four class problem S0 to S3) was 0.79 ± 0.01. Pairwise accuracy was good for S0 vs S1, S2 or S3 (0.78 to 0.89) but decreased for distinguishing among higher grades (0.54 to 0.62). Optimal US-HRI threshold for diagnosing ≥ S1 was 1.16, with a sensitivity of 82.7% (95% CI: 77.4-87.3), specificity of 80.0% (95% CI: 56.3-94.3), and AUC of 0.81 (95% CI: 0.76-0.86). The threshold for diagnosing ≥ S2 was 1.47, with a sensitivity of 49.0% (95% CI: 39.1-59.0), specificity of 73.0% (95% CI: 65.3-79.7), and AUC of 0.61 (95% CI: 0.55-0.67).
US-HRI was a reliable tool for diagnosing steatosis in type 2 diabetic patients with MASLD. However, its performance in assessing more severe grades of steatosis was inadequate.
Question Ultrasound hepatorenal index (US-HRI) performance for the diagnosis of steatosis in type 2 diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not well defined. Findings US-HRI demonstrated good diagnostic performance for steatosis (S0 vs S1-S3), but this decreased for diagnosing S2-S3. Clinical relevance US-HRI provides a quantitative approach for detecting hepatic steatosis in patients with MASLD and type 2 diabetes, but has shown limited effectiveness in grading higher grades.
以磁共振成像质子密度脂肪分数（MRI-PDFF）为参照，评估超声肝肾指数（US-HRI）在2型糖尿病患者及代谢功能障碍相关脂肪性肝病（MASLD）患者中诊断肝脂肪变的性能。
这项双中心前瞻性研究在2019年至2022年期间分别纳入了129例和263例患者，分别作为训练队列和验证队列。根据MRI-PDFF将肝脂肪变分为S0（≤6.5%）、S1（6.5-16.5%）、S2（16.5-22%）和S3（>22%）。采用奥布霍夫斯基测量法（OB）评估US-HRI在整个队列中的诊断性能。通过最大化约登指数在训练队列中确定诊断≥S1和≥S2的US-HRI最佳截断值，并应用于验证队列。
总共纳入了392例患者（平均年龄59岁±9.5；男性235例）。OB（S0至S3四级问题）为0.79±0.01。S0与S1、S2或S3之间的两两准确性良好（0.78至0.89），但在区分更高等级时准确性下降（0.54至0.62）。诊断≥S1的最佳US-HRI阈值为1.16，灵敏度为82.7%（95%CI：77.4-87.3），特异度为80.0%（95%CI：56.3-94.3），曲线下面积（AUC）为0.81（95%CI：0.76-0.86）。诊断≥S2的阈值为1.47，灵敏度为49.0%（95%CI：39.1-59.0），特异度为73.0%（95%CI：65.3-79.7），AUC为0.61（95%CI：0.55-0.67）。
US-HRI是诊断2型糖尿病合并MASLD患者脂肪变的可靠工具。然而，其在评估更严重等级脂肪变方面的性能不足。
问题 超声肝肾指数（US-HRI）在诊断2型糖尿病合并代谢功能障碍相关脂肪性肝病（MASLD）患者脂肪变方面的性能尚未明确界定。发现 US-HRI在诊断脂肪变（S0与S1-S3）方面表现出良好的诊断性能，但在诊断S2-S3时性能下降。临床意义 US-HRI为检测MASLD和2型糖尿病患者的肝脂肪变提供了一种定量方法，但在对更高等级进行分级方面效果有限。
