Korean J Radiol.  2020 Apr;21(4):413-421. 10.3348/kjr.2019.0703.

Development and Validation of a Simple Index Based on Non-Enhanced CT and Clinical Factors for Prediction of Non-Alcoholic Fatty Liver Disease

Affiliations
  • 1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. seungsoolee@amc.seoul.kr
  • 2Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD.
MATERIALS AND METHODS
This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CT(L-S) was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort.
RESULTS
The clinical-CT index included CT(L-S), body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CT(L-S) (0.74; p < 0.001) and clinical indices (0.73-0.75; p < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%.
CONCLUSION
The clinical-CT index is more accurate than CT(L-S) and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.

Keyword

Non-alcoholic fatty liver disease; Computed tomography; Diagnostic index

MeSH Terms

Adult
Aspartate Aminotransferases
Biopsy
Body Mass Index
Cohort Studies
Diagnosis
Humans
Liver
Logistic Models
Mass Screening
Methods
Non-alcoholic Fatty Liver Disease*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Tissue Donors
Triglycerides
Aspartate Aminotransferases
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