声衰减成像对肥胖儿童非酒精性脂肪性肝病的诊断价值研究  

Value of ultrasound attenuation imaging in the diagnosis of non-alcoholic fatty liver disease in obese children

作　　者：赵静 沈志云[1] 王慧[1] 李金凝 朱云开[1] 陈亚青[1] ZHAO Jing;SHEN Zhiyun;WANG Hui;LI Jinning;ZHU Yunkai;CHEN Yaqing(Department of Ultrasound in Medicine,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Radiology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院超声科,上海200092 [2]上海交通大学医学院附属新华医院放射科,上海200092

出　　处：《肿瘤影像学》2024年第2期163-169,共7页Oncoradiology

摘　　要：目的:探索声衰减成像(attenuation imaging,ATI)技术在肥胖儿童非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)肝脂肪变性及其分级中的诊断价值。方法:纳入2022年9月—2023年11月在上海交通大学医学院附属新华医院就诊的肥胖儿童70例,2名观察者采用ATI技术分别测定肥胖儿童肝脏声衰减系数(attenuation coefficient,AC),以磁共振质子密度脂肪分数(magnetic resonance imaging-proton density fat fraction,MRI-PDFF)为参考标准,并依据肝右叶MRI-PDFF将受试者分为正常肝脏(S0)、轻度肝脂肪变性(S1)、中度肝脂肪变性(S2)及重度肝脂肪变性(S3)。采用Spearman相关性分析检验AC与MRI-PDFF的相关性;应用方差分析比较S0、S1、S2及S3的AC;应用受试者工作特征(receiver operating characteristic,ROC)曲线分析AC对NAFLD肝脂肪变性及其分级中的诊断效能;应用双向混合效应模型组内相关系数(intraclass correlation coefficient,ICC)获取观察者之间的一致性。结果:观察者1及观察者2的AC与MRI-PDFF相关系数分别为0.822、0.809;观察者1的S0、S1、S2及S3级的AC分别为(0.59±0.05)、(0.73±0.11)、(0.82±0.09)及(0.89±0.08)dB·cm^(-1)·MHz^(-1),观察者2的S0、S1、S2及S3级的AC分别为(0.61±0.07)、(0.74±0.10)、(0.82±0.10)及(0.89±0.07)dB·cm^(-1)·MHz^(-1),各级别之间的AC差异均有统计学意义(P<0.05);ROC曲线分析显示观察者1 AC诊断≥S1、≥S2、≥S3的AUC分别为0.954、0.887、0.877,观察者2 AC诊断≥S1、≥S2、≥S3的AUC分别为0.938、0.880、0.882;双向混合效应模型ICC分析显示AC在观察者之间的ICC为0.897(95%CI 0.939~0.934)。结论:ATI技术获得的AC对肥胖儿童NAFLD有较高的诊断价值,在肥胖儿童NAFLD诊断和肝脂肪变性分级方面具有较好的应用前景。Objective:To explore the value of acoustic attenuation imaging(ATI)technology in the detection and grading of non-alcoholic fatty liver disease(NAFLD)in obese children.Methods:A total of 70 obese children were consecutively recruited at Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to November 2023.ATI was performed by two independent operators to calculate attenuation coefficient(AC)of the liver.Using magnetic resonance imaging proton density fat fraction(MRI-PDFF)as the reference standard,patients were divided into four groups(S0,S1,S2,S3)according to the mean MRI-PDFF of right lobe of liver.Spearman correlation analysis was employed to study the correlation between AC values and MRI-PDFF.ANOVA analysis was used to compare AC values in S0,S1,S2,and S3.Diagnostic performance was assessed using the area under the receiver operating characteristic curve(AUC)for the categories of steatosis.Two-way mixed-model intraclass correlation coefficients(ICC)were used to assess interrater reliability between operators.Results:The Spearman correlation coefficients between AC and MRI-PDFF were 0.822 and 0.809 for operator 1 and operator 2,respectively.The AC values of S0,S1,S2,and S3 were(0.59±0.05),(0.73±0.11),(0.82±0.09)and(0.89±0.08)dB·cm^(-1)·MHz^(-1)respectively for operator 1(P<0.05),and(0.61±0.07),(0.74±0.10),(0.82±0.10)and(0.89±0.07)dB·cm^(-1)·MHz^(-1)respectively for operator 2(P<0.05).The AUC for the detection of S≥1,S≥2 and S3 steatosis were 0.954,0.887 and 0.877 respectively by operator 1,and 0.938,0.880 and 0.882 respectively by operator 2.The ICC between operators was 0.897(95%CI 0.939-0.934).Conclusion:The AC measured by ATI could accurately detected and quantified NAFLD in obese children,and showed potential application in the diagnosis,grading and clinical management of pediatric NAFLD.

关 键 词：儿童肥胖 非酒精性脂肪性肝病 声衰减成像 磁共振质子密度脂肪分数 

分 类 号：R575.5[医药卫生—消化系统] R445.1[医药卫生—内科学]