超声衍生脂肪分数、受控衰减参数及肝肾回声比值对代谢相关脂肪性肝病肝脂肪变性分级的诊断价值比较OA北大核心

Objective To investigate the diagnostic accuracy and grading capability of ultrasound-derived fat fraction(UDFF),controlled attenuation parameter(CAP),and hepatic/renal ratio(HRR)in assessing hepatic steatosis in metabolic associated fatty liver disease(MAFLD)with magnetic resonance imaging-proton density fat fraction(MRI-PDFF)as the gold standard.Methods A total of 150 patients with MAFLD who attended The First Hospital of Hebei Medical University from January 2023 to December 2024 were enrolled,and 148 healthy volunteers were recruited.All subjects underwent MRI-PDFF,UDFF,CAP,and HRR examinations.Hepatic steatosis was graded based on MRI-PDFF(S0:148 cases;S1:92 cases;S2:21 cases;S3:37 cases),and the MAFLD patients with different grades of hepatic steatosis were compared in terms of UDFF,CAP,HRR,and clinical features.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups and the Tukey HSD test was used for further comparision between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Mann-Whitney U test was used for further comparison between two groups;the chi-square test was used for comparison of categorical data between groups.The Spearman correlation analysis was used to investigate the correlation between UDFF,CAP,HRR,and MRI-PDFF in different grades of MAFLD;the receiver operating characteristic(ROC)curve was used to investigate the efficacy of UDFF,CAP,and HRR in the diagnosis of different degrees of hepatic steatosis in MAFLD;the Bland-Altman difference plot was used to analyze the consistency between UDFF and MRI-PDFF in different degrees of hepatic steatosis in MAFLD.Results UDFF measurement gradually increased with the increase in the grade of fatty liver(H=201.52,P<0.001).The Spearman correlation analysis showed that there was a strong correlation between any two indicators of UDFF,CAP,HRR,and MRI-PDFF in S1,S2,and S3 MAFLD(all P<0.001),with the strongest correlation between UDFF and MRI-PDFF(rs1=0.884,rs2=0.962,rs3=0.929,all P<0.001).The ROC curve analysis showed that UDFF had a larger area under the ROC curve(AUC)than CAP and HRR in the graded diagnosis of S1 and S3(all P<0.05),while in the diagnosis of S2 MAFLD,UDFF had a significantly larger AUC than HRR(P<0.05)and a similar AUC to CAP(P>0.05).The Bland-Altman difference plot showed good consistency between UDFF and MRI-PDFF in different degrees of hepatic steatosis in MAFLD.Conclusion Compared with CAP and HRR,UDFF can accurately measure liver fat content and has good efficacy in identifying varying degrees of hepatic steatosis in MAFLD.