Hepatorenal Index as an Accurate, Simple, and Effective Tool in Screening for Steatosis
Hepatorenal Index as an Accurate, Simple, and Effective Tool in Screening for Steatosis
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DOI：
10.2214/ajr.11.6677
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发表时间：
2012-11-01
影响因子：
5
通讯作者：
Davis, Nancy K.
中科院分区：
文献类型：
--
作者：
Marshall, Richard H.;Eissa, Marna;Davis, Nancy K.
OBJECTIVE.据报道，肝肾指数是量化脂肪变性的敏感和非侵入性测试，但它繁琐耗时，需要专门的软件。本研究的目的是改善和简化肝肾指数的计算，并确定它是否是一个有效的工具，区分脂肪变性患者与非脂肪变性，从而消除了大量患者活检的需要。从患者数据库中选择了101例在我们机构接受超声引导下经皮肝活检的患者。排除肾脏疾病患者、肝脏肿块患者以及肝脏和右肾未包含在同一图像中的患者。采用高分辨率超声采集图像，并根据肝脏和肾脏亮度的比较，使用免费软件计算肝肾指数。在101例患者中，63例脂肪变性≤ 5%，38例脂肪变性> 5%。使用美国国立卫生研究院在线提供的免费软件，我们计算了所有患者的肝肾指数值。我们的数据显示肝肾指数和脂肪百分比之间有很强的相关性（r = 0.71，p < 0.0001）。肝肾指数1.28或更高时，识别5%以上脂肪的灵敏度为100%，特异性为54%，阳性预测值为0.57，阴性预测值为1.0。如果在我们的样本中前瞻性地使用这种方法来选择活检患者，则可以避免34%的活检。肝肾指数是一种简单、可靠、经济有效的筛查工具，可用于识别不应接受肝活检评估脂肪变性的患者。
OBJECTIVE. The hepatorenal index has been reported to be a sensitive and noninvasive test to quantify steatosis, but it is cumbersome and time-consuming and requires specialized software. The aim of this study was to improve and simplify the hepatorenal index calculation and determine whether it is an effective tool for differentiating patients with steatosis from those without steatosis, thereby eliminating the need for biopsy in a large number of patients.MATERIALS AND METHODS. One hundred one patients who had undergone ultrasound-guided percutaneous liver biopsy at our institution were selected from a patient database. Patients with renal disease, patients with liver masses, and patients whose liver and right kidney were not included on the same image were excluded. Images were acquired with high-resolution ultrasound, and the hepatorenal index was calculated using freeware based on comparison of hepatic and renal brightness.RESULTS. Of the 101 patients, 63 had 5% or less steatosis and 38 had more than 5% steatosis. Using freeware available online from the National Institutes of Health, we calculated hepatorenal index values for all patients. Our data showed a strong correlation between the hepatorenal index and percentage of fat (r = 0.71, p < 0.0001). A hepatorenal index of 1.28 or greater had a 100% sensitivity for identifying more than 5% fat, 54% specificity, 0.57 positive predictive value, and 1.0 negative predictive value. If this method had been used prospectively to select patients for biopsy in our sample, 34% of biopsies could have been avoided.CONCLUSION. The hepatorenal index is a simple, reliable, and cost-effective screening tool for identifying patients who should not undergo liver biopsy for evaluation of steatosis.