CT鉴定高风险的非酒精性脂肪肝病(NAFLD)的患者
![A and B, True-positive assessments in 58-year-old woman (A) and 52-year-old man (B) with high-risk NAFLD and associated NASH. CT images show hepatic enlargement, heterogeneously low-attenuation hepatic parenchyma, and surrounding ascites. Readers correctly identified NASH according to these imaging features. Readers also correctly identified fibrosis stage F3.C and D, False-positive assessments in 73-year-old woman (C) and 61-year-old woman (D) with high-risk NAFLD but without pathologic evidence of NASH. CT images show findings similar to A and B. Readers incorrectly identified NASH because of these imaging findings but correctly identified fibrosis stages F3 (C) and F4 (D).E, False-negative assessment in 56-year-old woman. CT image shows liver is not enlarged, heterogeneous, or low in attenuation, and ascites is not present. Both readers interpreted image as not showing findings indicative of NASH. However, NASH was diagnosed from surgical pathology. Credit: American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR) CT鉴定高风险的非酒精性脂肪肝病(NAFLD)的患者](https://scx1.b-cdn.net/csz/news/800a/2021/ctidentifies.jpg)
根据加勒比海盗的美国人杂志杂志(AJR),纤维化-4(FIB-4)和多重CT结果可以鉴定高风险的非酒精性脂肪肝病(NAFLD)的纤维化或肝硬化的患者,这是 - 尽管存在非酒精性脱脂性炎(NASH)仍然难以实现在CT上
“通过训练读者对多种形态学和单独定量参数的主观评估,以及组合两个CT特征,肝脏表面结节(LSN)和肝节段制比(LSVR)的简单定量三参数模型,以及临床评分(FIB-4)“威斯康星大学医学院和公共卫生学院放射科的第一作者Meghan G. Lubner写道,与先进纤维化的存在良好。
根据在檀香山2019年ARRS年会上的一份报告,活检证实的NAFLD患者在活检后1年内接受了CT检查。一位有经验的胃肠病理学家进行组织病理学检查,以确定脂肪变性、炎症和纤维化。出现任何小叶炎症和肝细胞气球化的患者被归类为非酒精性脂肪性肝炎(NASH),而伴有NAFLD和晚期纤维化(F3期或以上)的患者被归类为高危NAFLD。两名读者主观评估了NASH和纤维化的存在。
最终队列包括186名患者(平均年龄49岁;112名女性和74名男性),其中87人(47%)患有NASH, 112人(60%)患有中重度脂肪变性。F0期51例,F1期42例,F2期23例,F3期37例,F4期33例。70例(38%)有晚期纤维化(F3或F4期),被认为有高危NAFLD。FIB-4评分与纤维化相关,单项CT指标以LSVR和脾体积表现最佳。同时,主观阅读者评价在所有参数中表现最好。FIB-4与主观得分相辅相成,在NASH评估中,FIB-4表现最好。
注意到CT在识别肝脏脂肪变性方面的良好应用,这篇AJR文章的作者总结说,CT也可以是“一种评估NAFLD患者和识别高危NAFLD的高度可及、常用的方法”纤维化他们可能是最需要干预的人群。”
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