Initial Study On Noninvasive Quantification Evaluating Nonalcoholic Fatty Liver Disease By Acoustic Radiation Force Impulse

Objective: To evaluate the clinical application value of noninvasive assessment of the degree of steatosis in patients with nonalcoholic fatty liver disease(NAFLD)by acoustic radiation force pulse imaging(ARFI).Methods: The patients of all cases were in Hospital from September 2016 to December 2016,whom has been examined by the abdominal ultrasonography,computer tomography(CT)and lab examination.According to the results of 2D-ultrasonography and CT,the target population was divided into four groups: control group,mild fatty liver group,moderate fatty liver group and severe fatty liver group.Among them,the healthy control group is 65 cases and there were 155 patients with NAFLD,including mild fatty liver group(n=71),moderate fatty liver group(n=48),and severe fatty liver group(n=36).4 groups' comparison of measurement data will adopt variance analysis in general population characteristics,blood biochemical index,liver,spleen elastic ultrasound index and 2 groups will use LSD method.Chi square test will be used to count the data.Correlation analysis use Spearman rank correlation and consistency analysis use kappa analysis.Truncated value analysis will use The ROC curve and the bilateral P<0.05 is statistically significant when sensitivity and specificity are added to the maximum.Results: Kappa=0.7721,P=0.007.single factor Spearman related analysis showed that liver VTQ,liver/spleen VTQ and APRI were correlated with the degree of fatty liver,the correlation coefficients were 0.61,0.47,0.37(P<0.001).There were no statistics meaning between the normal group and the mild fatty liver group in VTQ,liver/spleen VTQ,APRI,ALT and AST.The VTQ,liver/spleen VTQ,APRI,ALT and AST in the severe fatty liver group were higher than those in the normal and mild Fatty liver group.TG,GT,APO B and HDL were higher than the normal group;Cys C was higher than mild fatty liver group.The moderate level of VTQ,liver/spleen VTQ,APRI,HDL,ALT and AST in fatty liver group was higher than those in normal and mild fatty liver group.TG,GT and APO B were higher than those in normal group.NAFLD patients with mild or moderate fatty liver: liver VTQ,liver/spleen VTQ and APRI average values were 1.16±0.28m/s,0.46±0.14,0.39±0.22,moderate fatty liver: liver VTQ,liver/spleen VTQ and APRI,the average values were 1.45 ± 0.41m/s,0.59±0.16,0.52±0.23 respectively.The mean values of Severe fatty liver: liver VTQ,liver/spleen VTQ and APRI were 1.62±0.34m/s,0.65±0.04,0.57±0.22.Two kinds of technology and three test values were related to the condition of fatty liver,the correlation coefficients were liver VTQ 0.61(P<0.001),liver/spleen VTQ 0.47(P <0.001),APRI index 0.37(P<0.001).The hepatic VTQ cutoff values of the patients with mild to moderate severe fatty liver with ARFI diagnosis of nonalcoholic fatty liver disease were 1.00m/s,1.22m/s,1.42m/s,AUC under cure was 0.57,0.86,0.97,the sensitivity was: 76%,94%,94%,specificity were: 60%,71%,92%.The liver/spleen VTQ cut off values of the patients with mild to moderate severe fatty liver with ARFI diagnosis of nonalcoholic fatty liver disease were 0.51,0.51,0.56 and AUC under cure were 0.51,0.74 and 0.84 respectively.The sensitivities were 94%,88%,94%,specificities were 20%,0.68%,80%.The mild moderate severe fatty liver cutoff values of the patients with ARFI diagnosis of nonalcoholic fatty liver disease were: 0.33×10~9,0.43×10~9,0.50×10~9,AUC under cure was 0.55,0.71,0.81,the sensitivities were 57%,58%,70%,specificities were 60%,75%,83%.Conclusion: the liver VTQ,Liver/spleen VTQ and APRI index are significant for the quantitative evaluation of mild fatty liver,moderate fatty liver and severe fatty liver.Compared with the APRI index,ARFI technology,as a real-time ultrasonic elastosonography,can give more accurate non-invasive and quantitative evaluation of the severity of NAFLD,compared with the liver/spleen VTQ value,liver VTQ value measured by the ARFI technique can have more accurate and comprehensive quantitative assessment of the severity of NAFLD.Kappa=0.7721,P=0.007,indicates that the two methods of liver VTQ and CT examination in the ARFI technique are in good agreement with the quantitative assessment of nonalcoholic fatty liver disease.