Ultrasound-based steatosis grading system using 2D-attenuation imaging: An individual patient data meta-analysis with external validation

作者：Christian Hobeika, Maxime Ronot, Boris Guiu, Giovanna Ferraioli, Hiroko Iijima, Toshifumi Tada, Dong Ho Lee, Hidekatsu Kuroda, Young Hwan Lee, Jeong Min Lee, So Yeon Kim, Christophe Cassinotto, Laura Maiocchi, Ambra Raimondi, Takashi Nishimura, Takashi Kumada, Eun Young Kwon, Jong Keon Jang, Jean-Michel Corréas, Dominique Valla, Valérie Vilgrain, Marco Dioguardi Burgio · 发表于：Hepatology · 年份：2024 · DOI：10.1097/hep.0000000000000895 · 被引用次数：25 · 研究领域：Liver Disease Diagnosis and Treatment、Cardiovascular Function and Risk Factors、Liver Disease and Transplantation

BACKGROUND AND AIMS: Noninvasive tools assessing steatosis, such as ultrasonography-based 2D-attenuation imaging (ATI), are needed to tackle the worldwide burden of steatotic liver disease. This one-stage individual patient data (IPD) meta-analysis aimed to create an ATI-based steatosis grading system. APPROACH AND RESULTS: A systematic review (EMBASE + MEDLINE, 2018-2022) identified studies, including patients with histologically or magnetic resonance imaging proton-density fat fraction (MRI-PDFF)-verified ATI for grading steatosis (S0 to S3). One-stage IPD meta-analyses were conducted using generalized mixed models with a random study-specific intercept. Created ATI-based steatosis grading system (aS0 to aS3) was externally validated on a prospective cohort of patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (n=174, histologically and MRI-PDFF-verified steatosis). Eleven enrolled studies included 1374 patients, classified into S0, S1, S2, and S3 in 45.4%, 35.0%, 9.3%, and 10.3% of the cases. ATI was correlated with histological steatosis ( r = 0.60; 95% CI: 0.52, 0.67; p < 0.001) and MRI-PDFF ( r = 0.70; 95% CI: 0.66, 0.73; p < 0.001) but not with liver stiffness ( r = 0.03; 95% CI: -0.04, 0.11, p = 0.343). Steatosis grade was an independent factor associated with ATI (coefficient: 0.24; 95% CI: [0.22, 0.26]; p < 0.001). ATI marginal means within S0, S1, S2, and S3 subpopulations were 0.59 (95% CI: [0.58, 0.61]), 0.69 (95% CI [0.67,...