Abstract：
BACKGROUND: A liver biopsy is the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Here, we combine preoperative transient elastography (TE) and intraoperative standardized visual liver score (VLS) which is compared with intraoperative liver biopsy for prediction of NAFLD and NASH in patients undergoing bariatric surgery.
OBJECTIVE: Evaluate the combined diagnostic accuracy of TE and VLS in assessing NAFLD or NASH and compare it with liver biopsy in patients undergoing bariatric surgery.
METHODS: In a prospective cohort of 70 morbidly obese undergoing bariatric surgery, preoperative TE and intraoperative VLS were calculated. Findings of TE and VLS were compared with histology from intraoperative liver biopsy.
RESULTS: Histologically, 44 (62.85%) had NAFLD (≥ S1). Significant steatosis was seen in 20 (28.57%) while significant fibrosis was visible in 18 (25.71%). Area Under the Receiver Operating Characteristics (AUROC) TE for diagnosis of NAFLD was excellent (0.844, p = 0.001). At the optimal cutoff of 8.1, the positive predictive value (PPV) was 92.9%, and diagnostic accuracy was 90.6%. VLS had a sensitivity of 90.9% for NAFLD. The combined sensitivity of TE + VLS was 95.5% for ruling out NAFLD. Fourteen (20%) had NASH. VLS had a diagnostic accuracy of 97% in identifying NASH in comparison to TE. AUROC-VLS was 0.987, p ≤ 0.001, and a sensitivity of 100%. The overall sensitivity of combined TE and VLS was 100% with a negative predictive value (NPV) of 100%.
CONCLUSIONS: TE when combined with intraoperative VLS is comparable to liver biopsy and can be used for the diagnosis of NAFLD and NASH in patients undergoing bariatric surgery.
OBJECTIVE: Evaluate the combined diagnostic accuracy of TE and VLS in assessing NAFLD or NASH and compare it with liver biopsy in patients undergoing bariatric surgery.
METHODS: In a prospective cohort of 70 morbidly obese undergoing bariatric surgery, preoperative TE and intraoperative VLS were calculated. Findings of TE and VLS were compared with histology from intraoperative liver biopsy.
RESULTS: Histologically, 44 (62.85%) had NAFLD (≥ S1). Significant steatosis was seen in 20 (28.57%) while significant fibrosis was visible in 18 (25.71%). Area Under the Receiver Operating Characteristics (AUROC) TE for diagnosis of NAFLD was excellent (0.844, p = 0.001). At the optimal cutoff of 8.1, the positive predictive value (PPV) was 92.9%, and diagnostic accuracy was 90.6%. VLS had a sensitivity of 90.9% for NAFLD. The combined sensitivity of TE + VLS was 95.5% for ruling out NAFLD. Fourteen (20%) had NASH. VLS had a diagnostic accuracy of 97% in identifying NASH in comparison to TE. AUROC-VLS was 0.987, p ≤ 0.001, and a sensitivity of 100%. The overall sensitivity of combined TE and VLS was 100% with a negative predictive value (NPV) of 100%.
CONCLUSIONS: TE when combined with intraoperative VLS is comparable to liver biopsy and can be used for the diagnosis of NAFLD and NASH in patients undergoing bariatric surgery.
摘要：
背景：肝活检是非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）诊断的金标准。这里,我们将术前瞬时弹性成像(TE)和术中标准化视觉肝脏评分(VLS)与术中肝脏活检相比较,以预测接受减肥手术的患者的NAFLD和NASH.
目的：评估TE和VLS在评估NAFLD或NASH中的联合诊断准确性，并将其与接受减肥手术的患者的肝活检进行比较。
方法：在接受减肥手术的70例病态肥胖的前瞻性队列中，术前计算TE和术中VLS。将TE和VLS的发现与术中肝活检的组织学进行比较。
结果：组织学，44例（62.85%）患有NAFLD（≥S1）。显著的脂肪变性见于20例(28.57%),而显著的纤维化见于18例(25.71%)。用于诊断NAFLD的接收器工作特性下面积（AUROC）TE非常出色（0.844，p=0.001）。在最佳临界值8.1时，阳性预测值（PPV）为92.9％，诊断准确率为90.6%。VLS对NAFLD的敏感性为90.9%。TE+VLS排除NAFLD的联合敏感性为95.5%。14人（20%）患有NASH。与TE相比，VLS在识别NASH方面的诊断准确性为97％。AUROC-VLS为0.987，p≤0.001，灵敏度为100%。联合TE和VLS的总体敏感性为100％，阴性预测值（NPV）为100％。
结论：TE结合术中VLS与肝活检相当，可用于减肥手术患者NAFLD和NASH的诊断。
目的：评估TE和VLS在评估NAFLD或NASH中的联合诊断准确性，并将其与接受减肥手术的患者的肝活检进行比较。
方法：在接受减肥手术的70例病态肥胖的前瞻性队列中，术前计算TE和术中VLS。将TE和VLS的发现与术中肝活检的组织学进行比较。
结果：组织学，44例（62.85%）患有NAFLD（≥S1）。显著的脂肪变性见于20例(28.57%),而显著的纤维化见于18例(25.71%)。用于诊断NAFLD的接收器工作特性下面积（AUROC）TE非常出色（0.844，p=0.001）。在最佳临界值8.1时，阳性预测值（PPV）为92.9％，诊断准确率为90.6%。VLS对NAFLD的敏感性为90.9%。TE+VLS排除NAFLD的联合敏感性为95.5%。14人（20%）患有NASH。与TE相比，VLS在识别NASH方面的诊断准确性为97％。AUROC-VLS为0.987，p≤0.001，灵敏度为100%。联合TE和VLS的总体敏感性为100％，阴性预测值（NPV）为100％。
结论：TE结合术中VLS与肝活检相当，可用于减肥手术患者NAFLD和NASH的诊断。
