目的 探讨双层探测器光谱CT(DLCT)衍生的肝细胞外体积分数(fECV)与定量CT(QCT)测量的肝脂肪含量(Fat%)的相关性,验证fECV评估非酒精性脂肪肝(NAFLD)分期的可行性。方法 纳入2022-01至2024-12于解放军总医院海南医院就诊的NAFLD患者165例(男87例,女78例),根据QCT测得的Fat%分为轻度组(<14%,115 ROI)、中度组(14%～28%,528 ROI)及重度组(≥28%,347 ROI)。采用DLCT获取fECV,通过单因素方差分析、Pearson相关及ROC曲线评估其诊断效能。结果 各组fECV与Fat%呈负相关,轻度组Fat%(0.10±0.04),fECV(0.29±0.04);中度组Fat%(0.21±0.08),fECV(0.24±0.05);重度组Fat%(0.37±0.06),fECV(0.14±0.06),差异有统计学意义。线性回归方程为Fat%=0.36-0.58×fECV(R2=0.668),提示fECV每降低0.1,Fat%增加5.8%。ROC分析显示,fECV诊断中度及以上(AUC=0.873)和重度脂肪变性(AUC=0.918)效能优异,敏感度＞78%,特异度＞81%。结论 DLCT衍生的fECV可作为NAFLD无创分期的可靠定量指标,为临床精准管理提供影像学新策略。
Abstract
Objective To investigate the correlation between hepatic extracellular volume fraction (fECV) derived from dual-layer detector spectral CT (DLCT) and the liver fat content (Fat%) measured by quantitative CT (QCT), and to verify the feasibility of using fECV to assess the stages of non-alcoholic fatty liver disease (NAFLD). Methods A total of 165 NAFLD patients (87 males and 78 females) in Hainan Hospital of PLA General Hospital from January 2022 to December 2024 were included and categorized into mild (<14% Fat%, 115 ROIs), moderate (14%-28% Fat%, 528 ROIs), and severe (≥28% Fat%, 347 ROIs) groups based on QCT measurement. fECV was obtained using DLCT (Philips IQon Spectral CT), and its diagnostic efficacy was evaluated via one-way ANOVA, Pearson correlation, and ROC curve. Results Significant negative correlations were observed between fECV and Fat% across all groups, with Fat% (0.10±0.04) and fECV(0.29±0.04) in the mild group, Fat%(0.21±0.08) and fECV(0.24±0.05) in the moderate group, Fat%(0.37±0.06) and fECV(0.14±0.06) in the severe group. The differences were statistically significant. Linear regression equation was Fat%=0.36-0.58×fECV (R2=0.668), indicating that for every 0.1 decrease in fECV, Fat% increased by 5.8%. ROC analysis showed that fECV had excellent diagnostic efficacy for moderate and above (AUC=0.873) and severe fatty liver (AUC=0.918), with a sensitivity>78% and specificity>81%. Conclusions The fECV derived from DLCT can be used as a reliable quantitative indicator for noninvasive staging of NAFLD, providing a new imaging strategy for clinical precision management.
关键词
光谱CT /
定量CT /
双层探测器光谱CT /
细胞外体积分数 /
脂肪肝
Key words
spectral CT /
quantitative CT /
dual-layer detector spectral CT /
extracellular volume fraction /
fatty liver
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Cataldo I,Sarcognato S,Sacchi D,et al.Pathology of non-alcoholic fatty liver disease [J]. Pathologica,2021,113(3):194-202.
[2] O’Reilly E M,Yu K H,Lamarre N,et al.Real-world overall survival of patients diagnosed with recurrent versus de novo metastatic pancreatic ductal adenocarcinoma (PDAC) [J].J Clin Oncol,2021,39(15 suppl):e16250.
[3] Leitão H S,Paulino C,Rodrigues D,et al.MR fat fraction mapping: a simple biomarker for liver steatosis quantification in nonalcoholic fatty liver disease patients[J].Acad Radiol,2013,20(8):957-961.
[4] Shi Y W,Fan J G.Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis[J].Clin Mol Hepatol,2023,29(Suppl):S228-S243.
[5] Chalasani N,Younossi Z,Lavine J E,et al.The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases [J].Hepatology,2018,67(1):328-357.
[6] Ooi G J,Clouston A,Johari Y,et al.Evaluation of the histological variability of core and wedge biopsies in nonalcoholic fatty liver disease in bariatric surgical patients[J].Surg Endosc,2021,35(3):1210-1218.
[7] 陈白如,郭鸣周,屈 敏,等.应用定量CT测量肝脏脂肪含量的可重复性分析[J].中华健康管理学杂志,2020,14(4):318-321.
[8] 徐 黎,端木羊羊,张 勇,等.定量CT测量动物肝脏脂肪含量的实验研究[J].放射学实践,2017,18(5):466-470.
[9] 陈 刚,索方方,陈少武,等.QCT和MR在非酒精性脂肪肝诊断中的应用价值[J].中国CT和MRI杂志,2018,16(8):93-95,103.
[10] Goertz R S,Zopf Y,Jugl V,et al.Measurement of liver elasticity with acoustic radiation force impulse (ARFI) technology: an alternative noninvasive method for staging liver fibrosis in viral hepatitis[J].Ultraschall Med,2010,31(2):151-155.
[11] Cosgrove D,Piscaglia F,Bamber J, et al.EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography.Part 2: clinical applications[J].Ultraschall Med,2013,34(3):238-253.
[12] Popescu A,Bota S,Sporea I,et al.The influence of food intake on liver stiffness values assessed by acoustic radiation force impulse elastography-preliminary results[J].Ultrasound Med Biol,2013,39(4):579-584.
[13] Bandula S,Punwani S,Rosenberg W M,et al.Equilibrium contrast-enhanced CT imaging to evaluate hepatic fibrosis: initial validation by comparison with histopathologic sampling[J].Radiology,2015,275(1):136-143.
[14] Guzmán-Aroca F,Frutos-Bernal M D,Bas A,et al.Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging[J].Eur Radiol,2012,22(11):2525-2532.
[15] 徐馨炀,王可欣,李 忠.基于影像学的细胞外体积分数的研究进展[J].中国现代医生,2024,33(10):135-138,146.
[16] Abdelmalek M F.Nonalcoholic fatty liver disease: another leap forward[J].Nat Rev Gastroenterol Hepatol,2021,18(2):85-86.
[17] Guo Z,Blake G M,Li K,et al.Liver fat content measurement with quantitative CT validated against MRI proton density fat fraction: a prospective study of 400 healthy volunteers[J].Radiology,2020,294(1):89-97.
[18] Swets J A.Measuring the accuracy of diagnostic systems[J].Science,1988,240(4857):1285-1293.
[19] Bohte A E,van Werven J R,Bipat S,et al.The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: a meta-analysis[J].Eur Radiol,2011,21(1):87-97.
[20] Cheng X,Blake G M, Brown J K,et al.The measurement of liver fat from single-energy quantitative computed tomography scans[J].Quant Imaging Med Surg,2017,7(3):281-291.
[21] Xu L,Duanmu Y, Blake G M,et al.Validation of goose liver fat measurement by QCT and CSE-MRI with biochemical extraction and pathology as reference[J].Eur Radiol,2018,28(5):2003-2012.
[22] Varenika V,Fu Y,Maher J J, et al.Hepatic fibrosis: evaluation with semiquantitative contrast-enhanced CT[J].Radiology,2013,266(1):151-158.
[23] Zissen M H,Wang Z J,Yee J,et al.Contrast-enhanced CT quantification of the hepatic fractional extracellular space: correlation with diffuse liver disease severity[J].AJR Am J Roentgenol,2013,201(6):1204-1210.
[24] 苏李娜,郭顺林,王莉莉,等.肝细胞外基质体积分数定量评价肝纤维化的诊断价值[J].临床放射学杂志,2016(8):1195-1198.
[25] Shi W,Liang X,Wu N,et al.Assessment of split renal function using a combination of contrast-enhanced CT and serum creatinine values for glomerular filtration rate estimation[J].AJR Am J Roentgenol,2020,215(1):142-147.
[26] Bak S,Kim J E,Bae K,et al.Quantification of liver extracellular volume using dual-energy CT: utility for prediction of liver-related events in cirrhosis[J].Eur Radiol,2020,30(10):5317-5326.
[27] Tamaki N,Ajmera V,Loomba R.Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD[J].Nat Rev Endocrinol,2022,18(1):55-66.
[28] Chen H,Tan H,Wan J,et al.PPAR-γ signaling in nonalcoholic fatty liver disease: pathogenesis and therapeutic targets[J].Pharmacol Ther,2023,245:108391.
PDF(1416 KB)
