Huang Tong-Yi, Li Zhi-Yan, Tian Jie, Xie Xiao-Juan, Lee Jeong Min, Ren Xin-Ping, Xie Xiao-Yan
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, People's Republic of China.
Ultrasonography Division, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, People's Republic of China.
Radiology. 2025 Jul;316(1):e242564. doi: 10.1148/radiol.242564.
Background Quantitative US is promising in assessing metabolic dysfunction-associated steatotic liver disease (MASLD), but prospective multicenter studies are lacking. Purpose To evaluate the diagnostic performance of quantitative US in assessing MASLD and metabolic dysfunction-associated steatohepatitis (MASH). Materials and Methods This prospective study included participants with MASLD from tertiary hospitals in China and Korea, undergoing multiparametric US from August 2021 to December 2023. Diagnostic performance of tissue attenuation imaging (TAI), tissue scatter-distribution imaging (TSI), and two-dimensional shear-wave elastography (SWE) parameters for assessment of MASLD and MASH was evaluated using area under the receiver operating characteristic curve (AUC) analysis, with histopathologic analysis as a reference. Univariable and multivariable analyses identified clinical factors associated with each US parameter. Results A total of 114 participants (median age, 40 years; IQR, 31-50 years; 67 female participants) were evaluated, 76 participants (67%) with MASH and 39 participants (34%) with high-risk MASH (fibrosis score ≥F2). Multivariable analysis indicated TAI and TSI were independently associated with steatosis and SWE was independently associated with fibrosis (all < .001). TAI and TSI showed excellent performance for assessing steatosis grades S1 or higher, S2 or higher, and S3 (AUCs for TAI: 0.90, 0.93, and 0.78, respectively; AUCs for TSI, 0.94, 0.89, and 0.80, respectively), with TSI demonstrating good performance for inflammation grade I1 or more (AUC, 0.84; 95% CI: 0.75, 0.92; sensitivity, 79%; specificity, 79%). SWE exhibited excellent performance for staging fibrosis scores of F1 or higher, F2 or higher, F3 or higher, and F4 (AUCs: 0.81, 0.96, 0.89, and 0.97, respectively; sensitivities: 75%, 90%, 87%, and 100%, respectively; specificities: 80%, 93%, 83%, and 96%, respectively). The combined TSI and SWE model showed diagnostic advantages for MASH (AUC, 0.92; 95% CI: 0.85, 0.98) and high-risk MASH (AUC, 0.82; 95% CI: 0.74, 0.90) compared with TSI ( = .72 for MASH; = .002 for high-risk MASH) and SWE ( < .001 for MASH; = .31 for high-risk MASH). Conclusion TAI, TSI, and SWE helped provide accurate assessment of MASLD, and combining TSI and SWE showed good discrimination for predicting MASH and high-risk MASH. ClinicalTrials.gov Identifier: NCT04985188 © RSNA, 2025 See also the editorial by Dighe and Dhyani in this issue.
定量超声在评估代谢功能障碍相关脂肪性肝病（MASLD）方面具有前景，但缺乏前瞻性多中心研究。目的：评估定量超声在评估MASLD和代谢功能障碍相关脂肪性肝炎（MASH）中的诊断性能。材料与方法：这项前瞻性研究纳入了来自中国和韩国三级医院的MASLD患者，于2021年8月至2023年12月接受多参数超声检查。以组织病理学分析为参考，采用受试者操作特征曲线下面积（AUC）分析评估组织衰减成像（TAI）、组织散射分布成像（TSI）和二维剪切波弹性成像（SWE）参数对MASLD和MASH的诊断性能。单变量和多变量分析确定与每个超声参数相关的临床因素。结果：共评估了114名参与者（中位年龄40岁；四分位间距，31 - 50岁；67名女性参与者），76名参与者（67%）患有MASH，39名参与者（34%）患有高危MASH（纤维化评分≥F2）。多变量分析表明TAI和TSI与脂肪变性独立相关，SWE与纤维化独立相关（均P <.001）。TAI和TSI在评估脂肪变性分级S1及以上、S2及以上和S3时表现出色（TAI的AUC分别为0.90、0.93和0.78；TSI的AUC分别为0.94、0.89和0.80），TSI在评估炎症分级I1及以上时表现良好（AUC，0.84；95%CI：0.75, 0.92；敏感性，79%；特异性，79%）。SWE在分期纤维化评分F1及以上、F2及以上、F3及以上和F4时表现出色（AUC分别为0.81、0.96、0.89和0.97；敏感性分别为75%、90%、87%和100%；特异性分别为80%、93%、83%和96%）。与TSI（MASH时P =.72；高危MASH时P =.002）和SWE（MASH时P <.001；高危MASH时P =.31）相比，联合TSI和SWE模型在MASH（AUC，0.92；95%CI：0.85, 0.98）和高危MASH（AUC，当0.8；95%CI：0.74, 0.90）中显示出诊断优势。结论：TAI、TSI和SWE有助于对MASLD进行准确评估，联合TSI和SWE对预测MASH和高危MASH具有良好的鉴别能力。临床试验注册号：NCT04985188 © RSNA，2025 另见本期Dighe和Dhyani的社论。
