使用深部腹部探头（DAX）评估脂肪性肝病中的肝脂肪变性和纤维化：超声衍生脂肪分数（UDFF）和自动剪切波弹性成像（pSWE）与肝活检的相关性
Evaluation of Hepatic Steatosis and Fibrosis in Steatotic Liver Disease Ultrasound-Derived Fat Fraction (UDFF) and Auto pSWE by Using Deep Abdominal Transducer (DAX) and Liver Biopsy Correlation.
作者信息
Kale Ahmet Burak, Faraşat Mustafa, Pekindil Gökhan, Ayhan Semin, Tarhan Serdar, Buran Tahir
机构信息
Department of Radiology, University of Manisa Celal Bayar of Medicine, Manisa, Turkey.
Department of Pathology, University of Manisa Celal Bayar of Medicine, Manisa, Turkey.
出版信息
J Ultrasound Med. 2025 Jul 23. doi: 10.1002/jum.70005.
OBJECTIVES
To evaluate the diagnostic performance of ultrasound-derived fat fraction (UDFF) in detecting and grading hepatosteatosis using liver histology as the reference, and to assess the effectiveness of point shear wave elastography (pSWE), UDFF, and auto-pSWE in diagnosing steatohepatitis and detecting fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS
In this prospective study, patients underwent liver biopsy following UDFF and pSWE measurements using deep abdominal transducer (DAX) and conventional abdominal probes by 2 operators. Imaging findings were compared with histopathology to assess diagnostic performance. Associations between nonalcoholic fatty liver disease activity score (NAS), fibrosis stage, and imaging parameters were also evaluated.
RESULTS
A total of 121 patients were included. The median age was 50 years, and 57 (41%) were male. Histology confirmed steatotic liver disease in 43 cases. Excellent interobserver agreement was observed for UDFF (ICC = 0.974), pSWE (ICC = 0.958), and auto-pSWE (ICC = 0.960). UDFF showed a stepwise increase with steatosis grade and was moderately correlated with histological fat content (r = 0.676 for Sonographer 1, r = 0.638 for Sonographer 2; P < .001). For detecting S ≥ 1 steatosis, the optimal UDFF thresholds were ≥8.4% (Area Under the Curve (AUC) = 0.968; Se = 92.5%, Sp = 93.2%) for Sonographer 1 and ≥8.6% (AUC = 0.951; Se = 90.0%, Sp = 86.3%) for Sonographer 2. For moderate steatosis (S ≥ 2), the cutoffs were ≥10.4% (AUC = 0.932; Se = 100%, Sp = 79.6%) and ≥10.6% (AUC = 0.925; Se = 100%, Sp = 76.5%), and for severe steatosis (S = 3), ≥18.3% (AUC = 0.961; Se = 100%, Sp = 77.4%) and ≥18.7% (AUC = 0.949; Se = 100%, Sp = 77.4%) for Sonographer 1 and 2, respectively. UDFF positively correlated with body mass index and subcutaneous fat thickness, and negatively with both pSWE and auto-pSWE. A strong correlation was observed between pSWE and auto-pSWE for both observers. A weak positive correlation was found between NAS and auto-pSWE in MASLD cases. The optimal thresholds to detect fibrosis (≥F1) were 5.05 and 4.95 kPa for Sonographer 1, and 5.05 and 4.85 kPa for Sonographer 2, for pSWE and auto-pSWE measurements, respectively.
CONCLUSION
DAX-derived UDFF and auto-pSWE are reproducible, noninvasive biomarkers with strong diagnostic value in assessing steatosis and fibrosis in MASLD.
目的
以肝脏组织学为参照，评估超声衍生脂肪分数（UDFF）在检测肝脂肪变性及分级中的诊断性能，并评估点剪切波弹性成像（pSWE）、UDFF和自动pSWE在诊断脂肪性肝炎及检测代谢功能障碍相关脂肪性肝病（MASLD）纤维化中的有效性。
方法
在这项前瞻性研究中，患者在使用深部腹部探头（DAX）和传统腹部探头由两名操作人员进行UDFF和pSWE测量后接受肝脏活检。将影像学检查结果与组织病理学结果进行比较，以评估诊断性能。还评估了非酒精性脂肪性肝病活动评分（NAS）、纤维化分期与影像学参数之间的相关性。
结果
共纳入121例患者。中位年龄为50岁，男性57例（41%）。组织学证实43例患者患有脂肪性肝病。UDFF（组内相关系数[ICC]=0.974）、pSWE（ICC=0.958）和自动pSWE（ICC=0.960）的观察者间一致性良好。UDFF随脂肪变性分级呈逐步升高，与组织学脂肪含量中度相关（超声检查者1的r=0.676，超声检查者2的r=0.638；P<0.001）。对于检测S≥1级脂肪变性，超声检查者1的最佳UDFF阈值为≥8.4%（曲线下面积[AUC]=0.968；灵敏度[Se]=92.5%，特异度[Sp]=93.2%），超声检查者2的最佳UDFF阈值为≥8.6%（AUC=0.951；Se=90.0%，Sp=86.3%）。对于中度脂肪变性（S≥2），截断值分别为≥10.4%（AUC=0.932；Se=100%，Sp=79.6%）和≥10.6%（AUC=0.925；Se=100%，Sp=76.5%），对于重度脂肪变性（S=3），超声检查者1和2的截断值分别为≥18.3%（AUC=0.961；Se=100%，Sp=77.4%）和≥18.7%（AUC=0.949；Se=100%，Sp=77.4%）。UDFF与体重指数和皮下脂肪厚度呈正相关，与pSWE和自动pSWE均呈负相关。两名观察者的pSWE与自动pSWE之间均观察到强相关性。在MASLD病例中，NAS与自动pSWE之间发现弱正相关。对于pSWE和自动pSWE测量，检测纤维化（≥F1）的最佳阈值，超声检查者1分别为5.05和4.95kPa，超声检查者2分别为5.05和4.85kPa。
结论
DAX衍生的UDFF和自动pSWE是可重复的、无创的生物标志物，在评估MASLD的脂肪变性和纤维化方面具有很强的诊断价值。
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