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Eur Radiol:小儿肝脂肪变性诊断知多少?

2021-03-14 shaosai MedSci原创

非酒精性脂肪性肝病(NAFLD)是全世界范围内最常见的小儿肝病,它是一系列疾病的总称,包括肝脂肪变性、脂肪性肝炎、肝纤维化和肝硬化。

    非酒精性脂肪性肝病(NAFLD)是全世界范围内最常见的小儿肝病,它是一系列疾病的总称,包括肝脂肪变性、脂肪性肝炎、肝纤维化和肝硬化。NAFLD在一般儿童人群中的患病率约在3 - 10%之间,尤其在肥胖儿童中十分常见。因此,临床实践指南建议对肥胖儿童进行常规NAFLD筛查

    一项研究报告称,11%的肥胖儿童最终会发展成晚期肝纤维化,因此早期发现肝脏脂肪变性对儿童和青少年肥胖患者至关重要。B型超声成像是最常用的无创评估小儿肝脏脂肪变性的方式,其在检测中度至重度儿童肝脂肪变性上准确性极高。然而,使用超声扫描可以明显识别的脂肪变性的最低数量约为20% ,同时诊断也取决于医生的经验。因此,对于轻度脂肪变性的检测诊断准确性较低。

由于缺乏可靠的超声筛查方法,目前还没有用于肝脂肪变性的高精度筛查工具,这限制了对儿童脂肪变性进展的准确评估。因此,对入射超声与肝脏微结构(即散射体)相互作用形成的原始背散射信号进行分析,也许是一种客观、准确评价儿童肝脏脂肪变性的方法。超声背散射信号本质上是随机的,因此可以使用数学统计分布或分析技术来描述相应的统计特性。相比之下,回声振幅分布的一般近似模型Nakagami统计分布因其计算能力强、复杂度较低而被广泛用于描述肝脏背散射统计。最近,Nakagami统计分析方法已经被集成到美国食品和药物管理局(FDA)批准的医疗软件(AmCAD-US)中,该软件能够利用原始背散射数据对Nakagami参数进行估计和成像,以用于组织特征的显示。


    近日,发表在European Radiology杂志的一项研究评价了使用超声Nakagami成像产生的参数图像来分析回波幅度分布以达到评价小儿肝脂肪变性的可行性,为临床提供了一种客观且准确评价儿童肝脏脂肪变性的影像学方法。

    本研究共纳入68例儿童受试者,并将其分为健康对照组(n = 26)和研究组(n = 42)。使用AmCAD-US软件对每位受试者进行超声成像的原始数据采集,AmCAD-US是美国食品和药物管理局批准的用于超声Nakagami成像的软件。采用相关分析、单因素方差分析(ANOVA)和受试者工作特征(ROC)曲线对Nakagami参数、肝脏脂肪变性指数(HSI)和脂肪变性分级(G0: HSI < 30;G1: 30≤HSI < 36;G2: 36≤HSI < 41.6;G3: 41.6≤HSI < 43;G4: HSI≥43)进行分析。

    随着肝脂肪变性等级从G0增加到G4,Nakagami参数从0.53±0.13增加到0.82±0.05,并且不同等级的肝脂肪变性之间存在显著对统计学差异(p <.05)。在诊断肝脂肪变性≥G1、≥G2、≥G3和≥G4时的ROC曲线下面积分别为0.96、0.92、0.85和0.82。

图 (a) HSI, (b)年龄,(c)组,(d)脂肪变性分级的Nakagami参数比较。Nakagami参数与HSI值具有很强的相关性,对年龄的依赖性较小,且各组间和肝脂肪变性的级别有显著差异。

表 采用单因素方差分析对各级别肝脂肪变性的数据进行比较。

    Nakagami参数值量化了由脂肪浸润引起的超声背向散射信号回波幅度分布的变化,为临床早期检测儿童肝脏脂肪变性提供了一种新颖、无创、有效的数据分析技术。


原始出处:

Yao-Hung Chuang,Chiao-Shan Hsieh,Ming-Wei Lai,et al. Detection of pediatric hepatic steatosis through ultrasound backscattering analysis.DOI:10.1007/s00330-020-07391-7

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    2021-03-16 huangdf
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    2021-03-14 王静6093

    学习了!

    0

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    2021-03-14 wxl882001

    了解

    0

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    2021-03-14 ms2000001241007484

    好文章

    0

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    2021-03-14 carrotlyl

    好文章

    0

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