肝/脾CT值、受控衰减参数（CAP）和磁共振质子密度脂肪分数（MRI-PDFF）在慢性乙型肝炎脂肪变性患者中的应用价值

鲁景楠; 李岩松; 温雅; 王雄慧; 屈兆宇; 李建龙; 张炜

doi:10.12449/JCH240109

肝/脾CT值、受控衰减参数（CAP）和磁共振质子密度脂肪分数（MRI-PDFF）在慢性乙型肝炎脂肪变性患者中的应用价值

DOI: 10.12449/JCH240109

1.
延安大学附属医院影像科，陕西延安 716000
2.
西安国际医学中心医院核医学科，西安 710100

基金项目:

延安市科学技术研究发展计划项目 (2018KS-11)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：鲁景楠、张炜对研究的思路或设计有关键贡献；李岩松、温雅、王雄慧、屈兆宇参与了研究数据的获取分析解释过程；鲁景楠、张炜、李建龙参与起草及修改文章关键内容。

详细信息

通信作者:
张炜， 304180598@qq.com （ORCID： 0009-0009-2951-1115）

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出版历程
- 收稿日期: 2023-04-20
- 录用日期: 2023-05-06
- 出版日期: 2024-01-23

Application value of liver/spleen CT value， controlled attenuation parameter， and magnetic resonance imaging-proton density fat fraction in chronic hepatitis B patients with hepatic steatosis

1.
Department of Medical Imaging，Affiliated Hospital of Yan’an University，Yan’an，Shaanxi 716000，China
2.
Department of Nuclear Medicine，Xi’an International Medical Center Hospital，Xi’an 710100，China

Research funding:

Science and Technology Research and Development Project of Yan’an (2018KS-11)

More Information

Corresponding author: ZHANG Wei， 304180598@qq.com （ORCID： 0009-0009-2951-1115）

摘要

摘要: 目的探讨肝/脾CT值（CT_L/S）、受控衰减参数（CAP）和磁共振质子密度脂肪分数（MRI-PDFF）在慢性乙型肝炎（CHB）肝脂肪变性患者中的应用价值。方法回顾性收集2018年10月—2022年12月在延安大学附属医院行肝脏CT、CAP和MRI-PDFF检查的213例CHB患者的临床资料。根据MRI-PDFF结果，将213例患者分为单纯CHB组（MRI-PDFF<5%，n=111）和CHB合并脂肪变性组（MRI-PDFF≥5%，n=102）；其中轻度脂肪变性69例，中度至重度脂肪变性33例。符合正态分布的计量资料组间比较采用成组t检验；不符合正态分布的计量资料组间比较采用Mann-Whitney U检验。绘制Bland-Altman图，评价两位医师测量MRI-PDFF的一致性。采用Spearman相关系数分析CT_L/S和MRI-PDFF、CAP和MRI-PDFF的相关性。通过分析受试者工作特征曲线（ROC曲线），计算曲线下面积（AUC），评估CT_L/S和CAP对不同程度脂肪变性的诊断价值，并使用DeLong检验比较两种影像诊断方法的AUC。结果 MRI-PDFF在CHB患者中具有较高的可重复性及稳定性，CT_L/S和MRI-PDFF之间呈显著负相关（r=-0.800，P<0.001），CAP与MRI-PDFF之间呈显著正相关（r=0.692，P<0.001）。CT_L/S和CAP诊断CHB肝脂肪变性均有较高的准确度（AUC分别为0.951、0.902），且CT_L/S优于CAP（P<0.05）。在检测轻度和中重度脂肪变性时，CT_L/S的AUC分别为0.921和0.895，CAP的AUC分别为0.859和0.825。结论 MRI-PDFF技术在CHB患者中具有较高的可重复性及稳定性，CT_L/S和CAP对不同程度的CHB肝脂肪变性均具有较高的诊断价值。
- 乙型肝炎，慢性 /
- 脂肪肝 /
- 诊断
Abstract: Objective To investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. Methods A retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. Results MRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. Conclusion MRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.
- Hepatitis B， Chronic /
- Fatty Liver /
- Diagnosis

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图 1 CT_L/S测量示例图

注： a，47岁男性，CHB合并轻度脂肪变性，CT_L/S为0.85；b，44岁男性，CHB合并重度脂肪变性，CT_L/S为0.43。

Figure 1. Sample figure of CT_L/S measurements

下载: 全尺寸图片幻灯片

图 2 MRI-PDFF测量示例图

注： a，57岁女性，CHB合并轻度脂肪变性，MRI-PDFF为6.82%；b，46岁男性，CHB合并重度脂肪变性，MRI-PDFF为17.04%。

Figure 2. Sample figure of MRI-PDFF measurements

下载: 全尺寸图片幻灯片

图 3 测量者间的一致性分析（Bland-Altman图）

Figure 3. Interobserver agreement analysis （Bland-Altman plot）

下载: 全尺寸图片幻灯片

图 4 MRI-PDFF与CT_L/S、CAP的相关性分析

Figure 4. Correlation analysis of MRI-PDFF with CT_L/S and CAP

下载: 全尺寸图片幻灯片

图 5 CT_L/S和CAP检测不同程度脂肪变性的ROC曲线

注： a，有无脂肪变性；b，轻度脂肪变性；c，中重度脂肪变性。

Figure 5. ROC curves of CT_L/S and CAP to detect different degrees of steatosis

下载: 全尺寸图片幻灯片

表 1 单纯CHB组和CHB合并脂肪变性组的临床特征、影像学特征比较

Table 1. Comparison of clinical and imaging features between simple CHB group and CHB with steatosis group

项目	单纯CHB组（n=111）	CHB合并脂肪变性组（n=102）	统计值	P值
性别［例（%）］			χ²=6.191	0.013
男	66（59）	77（75）
女	45（41）	25（25）
年龄（岁）	50.00±11.17	47.00±9.79	t=0.146	0.084
BMI（kg/m²）	23.67（21.86～25.26）	26.38（23.88～28.40）	Z=-5.887	P<0.001
CAP（dB/m）	216.00±42.21	291.50±42.91	t=-14.236	P<0.001
CT_L/S	1.27（1.20～1.34）	0.97（0.83～1.04）	Z=-11.368	P<0.001
MRI-PDFF	2.45%（2.19%～2.80%）	7.55%（6.12%～11.85%）	Z=-12.598	P<0.001

下载: 导出CSV

表 2 CT_L/S和CAP对慢性乙型肝炎不同程度脂肪变性的诊断效能

Table 2. Diagnostic efficacy of CT_L/S and CAP for different degrees of steatosis in chronic hepatitis B

项目	无脂肪变性 vs 脂肪变性	无脂肪变性 vs 轻度脂肪变性	轻度脂肪变性 vs 中重度脂肪变性
CT_L/S
最佳截断值	1.09	1.17	0.97
AUC	0.951	0.921	0.895
灵敏度（%）	86.3	91.2	93.9
特异度（%）	93.7	83.9	71.0
阳性预测值（%）	92.6	77.5	60.8
阴性预测值（%）	88.1	94.0	96.1
CAP
最佳截断值	251.5	251.5	285.5
AUC	0.902^1）	0.859	0.825
灵敏度（%）	89.2	83.8	90.9
特异度（%）	77.5	76.8	63.8
阳性预测值（%）	78.4	68.7	54.5
阴性预测值（%）	88.7	88.7	93.6
注：与CT_L/S比较，1）P<0.05。

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