控制衰减参数（CAP）和磁共振成像衍生质子密度脂肪分数（MRI-PDFF）对成人慢性肠衰竭患者肠衰竭相关性肝脂肪变性的诊断价值

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-08-14 DOI:10.1016/j.clnesp.2025.08.016

Angelique Huijbers , Julia W. Korzilius , Veerle E.L.M. Gillis , Marinette van der Graaf , Geert J.A. Wanten

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引用次数: 0

摘要

背景与目的：慢性肠衰竭（CIF）可导致肠衰竭相关性肝病（IFALD），肝脂肪变性是成人CIF患者的主要特征。无症状脂肪变性可发展为脂肪性肝炎及其下游并发症。虽然质子磁共振波谱（1H-MRS）被认为是量化肝脏脂肪变性最准确的非侵入性技术之一，但其高昂的成本和有限的可用性阻碍了临床的广泛应用。因此，在日常实践中，需要更容易获得和可靠的替代方法来对CIF患者的肝脏脂肪进行常规临床评估。控制衰减参数（CAP）是一种非侵入性的、基于超声的方法，通过瞬态弹性成像获得，用于量化肝脂肪变性。本研究旨在评价控制衰减参数（CAP）和磁共振成像衍生质子密度脂肪分数（MRI-PDFF）对CIF患者肝脏脂肪变性的诊断准确性，以1H-MRS为参考标准。方法：纳入60例成人CIF患者，接受至少3个月的家庭肠外营养或静脉输液。采用1H-MRS法测定肝脏脂肪含量（LFC）。通过受试者工作特征（ROC）曲线分析，评价CAP和MRI-PDFF对肝脏脂肪变性（定义为LFC > 5.5%）的诊断价值，并确定最佳临界值。Spearman’s rho相关用于评估1H-MRS测量的LFC与两种非侵入性模式之间的关联。结果：60例1H-MRS患者，53例MRI-PDFF患者和34例CAP患者获得了有效的肝脏脂肪测量。根据1H-MRS， 17%的患者存在肝脏脂肪变性。1H-MRS与CAP、1H-MRS与MRI-PDFF的Spearman相关系数分别为0.70、0.82。CAP和MRI-PDFF检测脂肪变性（LFC > 5.5%）的曲线下面积分别为0.95 （p < 0.001, CI 0.88-1.00）和1.00 （p < 0.0005, CI 1.00-1.00）。结论：MRI-PDFF和CAP对成人CIF患者肝脂肪变性（LFC > 5.5%）的诊断准确率较高。此外，CAP表现出很强的相关性，而MRI-PDFF与1h - mrs衍生的LFC的严重程度表现出极好的相关性。这两种非侵入性技术可能在该人群中脂肪变性和脂肪变性严重程度的常规评估中发挥有价值的作用，有可能改善早期诊断、监测和了解IFALD发病机制，最终改善患者预后。

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The diagnostic value of controlled attenuation parameter (CAP) and magnetic resonance imaging derived proton density fat fraction (MRI-PDFF) for the evaluation of intestinal failure-associated liver steatosis among adult chronic intestinal failure patients

Background & aims

Chronic intestinal failure (CIF) can cause intestinal failure-associated liver disease (IFALD), with hepatic steatosis being a predominant feature in adult CIF patients. Asymptomatic steatosis may progress to steatohepatitis and its downstream complications. While proton magnetic resonance spectroscopy (1H-MRS) is considered one of the most accurate non-invasive techniques for quantifying liver steatosis, its high cost and limited availability hinder widespread clinical use. Therefore, more accessible and reliable alternatives are needed for routine clinical assessment of liver fat in CIF patients in daily practice. Controlled Attenuation Parameter (CAP) is a non-invasive, ultrasound-based method, obtained via transient elastography, to quantify hepatic steatosis. This study aims to evaluate the diagnostic accuracy of controlled attenuation parameter (CAP) and magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) for assessing liver steatosis in CIF patients, using 1H-MRS as the reference standard.

Methods

Sixty adult CIF patients, receiving home parenteral nutrition or intravenous fluids for at least three months, were enrolled. Liver fat content (LFC) was measured using 1H-MRS. The diagnostic performance of CAP and MRI-PDFF in detecting liver steatosis (defined as LFC >5.5 %) was evaluated through receiver operating characteristic (ROC) curve analysis, and optimal cut-off values were determined. Spearman's rho correlation was used to assess associations between LFC as measured by 1H-MRS and the two non-invasive modalities.

Results

Valid liver fat measurements were obtained in 60 patients with 1H-MRS, 53 with MRI-PDFF and 34 with CAP. According to 1H-MRS, liver steatosis was present in 17 % of patients.

The Spearman correlation coefficients between 1H-MRS and CAP and between 1H-MRS and MRI-PDFF were 0.70 and 0.82 respectively. The area under the curve for CAP and MRI-PDFF in detecting steatosis (LFC >5.5 %) were 0.95 (p < 0.001, CI 0.88–1.00) and 1.00 (p < 0.0005, CI 1.00–1.00) respectively.

Conclusion

Both MRI-PDFF and CAP demonstrate high diagnostic accuracy in detecting liver steatosis (LFC >5.5 %) in adult CIF patients. Additionally, CAP shows a strong correlation, while MRI-PDFF exhibits an excellent correlation with severity of 1H-MRS-derived LFC. Both non-invasive techniques, may serve a valuable role in routine assessment of steatosis and steatosis severity in this population, potentially improving early diagnosis, monitoring and understanding of IFALD pathogenesis, ultimately improving patient outcomes.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.