Abstract：
OBJECTIVE: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity.
METHODS: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC).
RESULTS: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s.
CONCLUSIONS: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.
METHODS: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC).
RESULTS: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s.
CONCLUSIONS: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.
摘要：
目的：确定显著纤维化对于评估非酒精性脂肪性肝病（NAFLD）患者的预后和治疗干预至关重要。我们评估了声辐射力脉冲(ARFI)弹性成像的性能，APRI,FIB-4Forns,NFS和BARD评分在确定重度肥胖患者肝纤维化中的作用.
方法：一项前瞻性研究纳入了108例接受减肥手术的患者。术中获取肝活检标本，并根据NAFLD活动评分进行分类。使用血清学标记物评估患者，术前使用SiemensS2000超声系统测量肝脏的剪切波速度。使用接收器工作特征曲线下面积（AUROC）确定最佳临界值。
结果：在整个队列中，NAFLD的患病率为80.6%，脂肪性肝炎25.9%和显著纤维化19.4%。预测显着纤维化的最佳测试是FIB-4和Forns评分（AUROC0.78），其次是APRI（AUROC0.74），NFS（AUROC0.68），BARD（AUROC0.64）和ARFI（AUROC0.62）。ARFI弹性成像在73％的患者中成功。较高的体重指数（BMI）与无效的ARFI测量相关。在BMI<42kg/m2的患者中，ARFI对存在明显纤维化的患者显示出92.3％的敏感性和82.6％的特异性，AUROC0.86和截止值1.32m/s。
结论：FIB-4和Forns评分对于预测肥胖患者的显著纤维化是最准确的。ARFI在重度肥胖患者中的适用性和准确性有限。在BMI<42kg/m2的患者中，ARFI弹性成像能够以相关的准确性预测显着纤维化。
方法：一项前瞻性研究纳入了108例接受减肥手术的患者。术中获取肝活检标本，并根据NAFLD活动评分进行分类。使用血清学标记物评估患者，术前使用SiemensS2000超声系统测量肝脏的剪切波速度。使用接收器工作特征曲线下面积（AUROC）确定最佳临界值。
结果：在整个队列中，NAFLD的患病率为80.6%，脂肪性肝炎25.9%和显著纤维化19.4%。预测显着纤维化的最佳测试是FIB-4和Forns评分（AUROC0.78），其次是APRI（AUROC0.74），NFS（AUROC0.68），BARD（AUROC0.64）和ARFI（AUROC0.62）。ARFI弹性成像在73％的患者中成功。较高的体重指数（BMI）与无效的ARFI测量相关。在BMI<42kg/m2的患者中，ARFI对存在明显纤维化的患者显示出92.3％的敏感性和82.6％的特异性，AUROC0.86和截止值1.32m/s。
结论：FIB-4和Forns评分对于预测肥胖患者的显著纤维化是最准确的。ARFI在重度肥胖患者中的适用性和准确性有限。在BMI<42kg/m2的患者中，ARFI弹性成像能够以相关的准确性预测显着纤维化。
