多模态超声评估代谢相关脂肪性肝病脂肪变性的研究

Application of multimodal ultrasound for assessing steatosis in simple metabolism-related fatty liver disease

目的探讨多模态超声检查在早期评估单纯性代谢相关脂肪性肝病(MAFLD)脂肪变性的应用价值。方法回顾性分析2021年10月~2022年11月于华北理工大学附属医院就诊的单纯性MAFLD患者(MAFLD组)161例及健康体检者(对照组)54例。所有研究对象均行核磁共振(MRI)、肝脏质子密度脂肪分数(PDFF)成像及超声衰减系数成像(ATI)、剪切波弹性成像(SWE)、剪切波频散成像(SWD)检查。以MRI-PDFF诊断结果确定研究对象是否有肝脏脂肪变性。应用受试者工作特征(ROC)曲线评价ATI参数、SWE参数、SWD参数及其联合诊断肝脏脂肪变性的诊断效能。结果MAFLD组ATI、SWE、SWD参数均高于对照组,超声定量指标诊断MAFLD脂肪变性的最佳截断值:ATI为0.635dB/(cm·MHz),SWE为6.15kPa,SWD为12.91(m/s)/kHz;ATI+SWD联合诊断模型的最佳截断值为0.673。对应的ROC曲线下面积(AUC)分别为0.950、0.644、0.631、0.950(P<0.05)。结论多模态超声检查技术可用于早期诊断单纯性MAFLD脂肪变性;ATI检查是较为准确、简单、便捷的检查方法,其单独诊断效能与ATI+SWD的联合诊断效能相当。

Objective To investigate the application value of multimodal ultrasonography in the early assessment of steatosis in simple metabolism-related fatty liver disease(MAFLD).Methods A retrospective analysis was performed on 161 patients with simple MAFLD(MAFLD group)and 54 healthy subjects(control group)who were treated in the Affiliated Hospital of North China University of Science and Technology from October 2021 to November 2022.All subjects underwent magnetic resonance imaging(MRI),liver proton density fat fraction(PDFF)imaging and ultrasonic attenuation coefficient imaging(ATI),shear wave elastic imaging(SWE),shear wave dispersion imaging(SWD)inspection.The diagnosis results of MRI-PDFF were used to determine whether the subjects had hepatic steatosis.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of ATI parameters,SWE parameters,SWD parameters and combined diagnosis of hepatic steatosis.Results The ATI,SWE and SWD parameters in the MAFLD group were higher than those in the control group.The optimal cut-off values for the diagnosis of steatosis in MAFLD group were as follows:ATI was 0.635dB/(cm·MHz),SWE was 6.15kPa and SWD was 12.91(m/s)/kHz.The optimal truncation value of ATI+SWD combined diagnosis model is 0.673.The corresponding area under ROC curve(AUC)were 0.950,0.644,0.631 and 0.950,respectively(P<0.05).Conclusion Multimodal ultrasound examination can be used for the early diagnosis of simple MAFLD steatosis;ATI examination is a relatively accurate,simple,and convenient method,and its individual diagnostic performance is comparable to that of the combined diagnostic performance of ATI+SWD.