超声声衰减成像评估肝脂肪变性严重程度的病理学对照研究

A pathological control study of ultrasound attenuation imaging in assessing the degree of hepatic steatosis

目的:以病理组织学检查为金标准,探讨超声声衰减成像(attenuation imaging,ATI)技术无创评估肝脂肪变性严重程度的诊断效能。方法:收集2020年9月—2022年6月于复旦大学附属中山医院就诊并进行肝脏活组织病理学检查或者肝脏良性肿瘤手术的肝脂肪变性患者97例,其中男性56例,女性41例。分析脂肪变性不同病理学等级患者ATI测值的稳定性及差异。采用多元线性回归分析ATI测值的影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估ATI对肝脂肪变性的诊断效能。结果:分析发现脂肪变性不同病理学等级患者ATI测值组内相关系数(intra-class correlation coefficient,ICC)均大于0.90。不同组间ATI测值差异有统计学意义(P<0.05),但S2组与S3组ATI测值差异无统计学意义(P>0.05)。Pearson相关分析显示ATI测值和病理肝脂肪变性程度呈显著正相关(r=0.75,P<0.01),多元回归分析发现肝脂肪变性病理学程度是ATI测值的独立影响因素(b=0.13,t=9.12,P<0.001)。以病理组织学检查结果为金标准,ATI测值诊断肝脂肪变性程度≥S1、≥S2和≥S3的曲线下面积(area under curve,AUC)分别为0.966(95%CI 0.895~0.987)、0.931(95%CI 0.876~0.978)和0.708(95%CI 0.655~0.818)。结论:肝脂肪变性程度是ATI测值的独立影响因素。ATI技术在不同程度的肝脂肪变性的评估中均表现出良好的诊断效能,特别是对较低水平的肝脂肪变性。

Objective:To explore the diagnostic performance of ultrasound attenuation imaging(ATI)in assessing the severity of hepatic steatosis using pathohistology as the gold standard.Methods:Ninety-seven patients with hepatic steatosis were prospectively collected from September 2020 to June 2022,including 56 male and 41 female patients.The stability and differences of ATI measurements in patients with different steatosis grades were analyzed.Multiple linear regression was used to analyze the factors affecting the ATI measurements.The receiver operating characteristic(ROC)curves were used to assess the diagnostic performance of ATI measurements in diagnosis of hepatic steatosis.Results:The analysis found that the intra-class correlation coefficient(ICC)of patients with different pathological grades of hepatic steatosis exceeded 0.90.Significant differences were found in ATI measurement between different groups(P<0.05),but there was no significant difference between S2 and S3 in ATI measurements(P>0.05).Pearson correlation analysis showed a significant positive correlation between ATI measurement and pathological steatosis(r=0.75,P<0.01),and multiple regression analysis found that the degree of liver steatosis was an independent influencing factor of ATI measurement(b=0.13,t=9.12,P<0.001).Taking pathological results as the gold standard,the area under the ROC curve(AUC)of ATI assessing the degree of hepatic steatosis of more than S1,S2 and S3 was 0.966(95%CI 0.895-0.987),0.931(95%CI 0.876-0.978),0.708(95%CI 0.655-0.818),respectively.Conclusion:The degree of hepatic steatosis was an independent factor influencing the ATI measurement.The ATI technique showed good diagnostic performance in the evaluation of hepatic steatosis,especially for lower levels of hepatic steatosis.