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

This one-stage individual patient data (IPD) meta-analysisaimed to create an ATI-based steatosis grading system.

这项单阶段个体患者数据(IPD)荟萃分析旨在创建一个基于ATI的脂肪肝分级系统。

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).

一项系统综述（EMBASE + MEDLINE, 2018-2022）识别了包括组织学或磁共振成像质子密度脂肪分数（MRI-PDFF）验证的ATI患者在内的研究，用于分级脂肪变性（S0至S3）。

One-stage IPD meta-analyses were conducted using generalized mixed models with a random study-specific intercept.

使用具有随机研究特定截距的广义混合模型进行了一阶段IPD荟萃分析。

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).

基于ATI的脂肪变性分级系统（aS0至aS3）在一组前瞻性队列中得到外部验证，该队列包括174名2型糖尿病和代谢功能障碍相关脂肪肝病患者，脂肪变性通过组织学和MRI-PDFF验证。

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.

纳入的11项研究共有1374名患者，根据脂肪变性程度被分类为S0、S1、S2和S3，分别占45.4%、35.0%、9.3%和10.3%。

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).

ATI与组织学脂肪变性(r = 0.60; 95% 置信区间: 0.52, 0.67; p < 0.001)和MRI-PDFF(r = 0.70; 95% 置信区间: 0.66, 0.73; p < 0.001)呈相关性，但与肝脏硬度(r = 0.03; 95% 置信区间: -0.04, 0.11, p = 0.343)无相关性。

Steatosis grade was an independent factor associated with ATI (coefficient: 0.24; 95% CI: [0.22, 0.26]; p < 0.001).

脂肪变性等级是与ATI独立相关的因素(系数: 0.24; 95% 置信区间: [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, 0.71]), 0.78 (95% CI: [0.76, 0.81]), and 0.85 (95% CI: [0.83, 0.88]) dB/cm/MHz; all contrasts between grades were significant ( p < 0.0001).

ATI在S0、S1、S2和S3亚群中的边际均值分别为0.59（95%置信区间：[0.58, 0.61]）、0.69（95%置信区间[0.67, 0.71]）、0.78（95%置信区间：[0.76, 0.81]）和0.85（95%置信区间：[0.83, 0.88]）dB/cm/MHz；所有等级之间的对比均有显著性（p < 0.0001）。

Three ATI thresholds were calibrated to create a new ATI-based steatosis grading system (aS0 to aS3, cutoffs: 0.66, 0.73, and 0.81 dB/cm/MHz).

通过校准三个ATI阈值，创建了一个新的基于ATI的脂肪变性分级系统（aS0至aS3，截断值：0.66、0.73和0.81 dB/cm/MHz）。

Its external validation showed Obuchowski measures of 0.84 ± 0.02 and 0.82 ± 0.02 with histologically based and MRI-PDFF-based references.

其外部验证显示，基于组织学和基于MRI-PDFF的参考标准，Obuchowski测量值分别为0.84 ± 0.02和0.82 ± 0.02。

Conclusions

ATI is a reliable, noninvasive marker of steatosis.

ATI是脂肪变性的可靠、非侵入性标志物。

This validated ATI-based steatosis grading system could be valuable in assessing patients with metabolic dysfunction-associated steatotic liver disease.

这项经过验证的基于ATI的脂肪变性分级系统在评估代谢功能障碍相关脂肪性肝病患者方面可能具有重要价值。