Non-invasive assessment of hepatic steatosis in patients with NAFLD using controlled attenuation parameter and 1H-MR spectroscopy.
Non-invasive assessment of hepatic steatosis in patients with NAFLD using controlled attenuation parameter and 1H-MR spectroscopy.
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DOI：
10.1371/journal.pone.0091987
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Wiegand J
中科院分区：
文献类型：
--
作者：
Karlas T;Petroff D;Garnov N;Böhm S;Tenckhoff H;Wittekind C;Wiese M;Schiefke I;Linder N;Schaudinn A;Busse H;Kahn T;Mössner J;Berg T;Tröltzsch M;Keim V;Wiegand J
脂肪变性和纤维化的非侵入性评估在非酒精性脂肪性肝病（NAFLD）中的相关性越来越大。1H-磁共振波谱（1H-MRS）和基于超声的受控衰减参数（CAP）与活检证实的脂肪变性相关，但迄今为止尚未相互关联。因此，我们对两种方法进行了头对头比较。对50例经活检证实的NAFLD患者和15例健康志愿者进行了1H-MRS和包括CAP在内的瞬态弹性成像（TE）评价。脂肪变性根据受影响肝细胞的百分比定义：S1 5- 33%，S2 34- 66%，S3 ≥ 67%。NAFLD患者的脂肪变性分级为S1 36%，S2 40%和S3 24%。CAP和1H-MRS与组织病理学显著相关，并显示出检测肝脏脂肪变性的相似准确性：脂肪变性≥S1的受试者工作特征曲线下面积分别为0.93 vs. 0.88，≥S2的受试者工作特征曲线下面积分别为0.94 vs. 0.88。Boot-strapping分析显示，检测S2-3脂肪变性的CAP截止值为300 dB/m，而健康个体的定义则保留较低的截止值215 dB/m。CAP和1H-MRS之间的直接比较仅显示出适度的相关性（总队列：r = 0.63 [0.44，0.76]; NAFLD病例：r = 0.56 [0.32，0.74]）。 对于检测F2-4纤维化，TE在8.85 kPa的临界值下的灵敏度和特异性分别为100%和98.1%。我们的数据表明CAP和1H-MRS对肝脏脂肪变性定量的诊断价值相当。与同时进行的TE纤维化评估相结合，CAP代表了NAFLD非侵入性表征的有效方法。CAP和1H-MRS之间的有限相关性可以通过不同的技术方面、人体测量学和晚期肝纤维化的存在来解释。
Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). 1H-Magnetic resonance spectroscopy (1H-MRS) and the ultrasound-based controlled attenuation parameter (CAP) correlate with biopsy proven steatosis, but have not been correlated with each other so far. We therefore performed a head-to-head comparison between both methods. Fifty patients with biopsy-proven NAFLD and 15 healthy volunteers were evaluated with 1H-MRS and transient elastography (TE) including CAP. Steatosis was defined according to the percentage of affected hepatocytes: S1 5-33%, S2 34–66%, S3 ≥67%. Steatosis grade in patients with NAFLD was S1 36%, S2 40% and S3 24%. CAP and 1H-MRS significantly correlated with histopathology and showed comparable accuracy for the detection of hepatic steatosis: areas under the receiver-operating characteristics curves were 0.93 vs. 0.88 for steatosis ≥S1 and 0.94 vs. 0.88 for ≥S2, respectively. Boot-strapping analysis revealed a CAP cut-off of 300 dB/m for detection of S2-3 steatosis, while retaining the lower cut-off of 215 dB/m for the definition of healthy individuals. Direct comparison between CAP and 1H-MRS revealed only modest correlation (total cohort: r = 0.63 [0.44, 0.76]; NAFLD cases: r = 0.56 [0.32, 0.74]). For detection of F2–4 fibrosis TE had sensitivity and specificity of 100% and 98.1% at a cut-off value of 8.85 kPa. Our data suggest a comparable diagnostic value of CAP and 1H-MRS for hepatic steatosis quantification. Combined with the simultaneous TE fibrosis assessment, CAP represents an efficient method for non-invasive characterization of NAFLD. Limited correlation between CAP and 1H-MRS may be explained by different technical aspects, anthropometry, and presence of advanced liver fibrosis.
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