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Objectives <p>To evaluate the performance of the ultrasound hepatorenal index (US-HRI) for the diagnosis of hepatic steatosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (MRI-PDFF) as reference.</p> Materials and methods <p>This two-center prospective study included 129 and 263 patients in the training and validation cohorts, respectively, between 2019 and 2022. Hepatic steatosis was classified according to MRI-PDFF as S0 (≤ 6.5%), S1 (6.5–16.5%), S2 (16.5–22%), and S3 (&gt; 22%). Obuchowski measurement (OB) was performed to assess the diagnostic performance of US-HRI in the whole cohort. Optimal cut-offs of US-HRI for diagnosing ≥ S1 and ≥ S2 were identified in the training cohort by maximizing the Youden index and were applied in the validation cohort.</p> Results <p>Overall, 392 patients were included (mean age, 59 years ± 9.5; 235 men). The OB (four class problem S0 to S3) was 0.79 ± 0.01. Pairwise accuracy was good for S0 vs S1, S2 or S3 (0.78 to 0.89) but decreased for distinguishing among higher grades (0.54 to 0.62). Optimal US-HRI threshold for diagnosing ≥ S1 was 1.16, with a sensitivity of 82.7% (95% CI: 77.4–87.3), specificity of 80.0% (95% CI: 56.3–94.3), and AUC of 0.81 (95% CI: 0.76–0.86). The threshold for diagnosing ≥ S2 was 1.47, with a sensitivity of 49.0% (95% CI: 39.1–59.0), specificity of 73.0% (95% CI: 65.3–79.7), and AUC of 0.61 (95% CI: 0.55–0.67).</p> Conclusion <p>US-HRI was a reliable tool for diagnosing steatosis in type 2 diabetic patients with MASLD. However, its performance in assessing more severe grades of steatosis was inadequate.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Ultrasound hepatorenal index (US-HRI) performance for the diagnosis of steatosis in type 2 diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not well defined</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>US-HRI demonstrated good diagnostic performance for steatosis (S0 vs S1-S3), but this decreased for diagnosing S2-S3</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>US-HRI provides a quantitative approach for detecting hepatic steatosis in patients with MASLD and type 2 diabetes, but has shown limited effectiveness in grading higher grades</i>.</p> Graphical Abstract <p></p>

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Ultrasound hepatorenal index for the diagnosis of steatosis in patients with type 2 diabetes: a prospective validation study

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • Macil Hamadouche,
  • Valérie Vilgrain,
  • Christian Hobeika,
  • Laurent Castera,
  • Dominique Valla,
  • Pierre-Emmanuel Rautou,
  • Francesco Matteini,
  • Philippe Garteiser,
  • Bernard Van Beers,
  • Jean-Michel Correas,
  • Maxime Ronot,
  • Marco Dioguardi Burgio

摘要

Objectives

To evaluate the performance of the ultrasound hepatorenal index (US-HRI) for the diagnosis of hepatic steatosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD), using MRI proton density fat fraction (MRI-PDFF) as reference.

Materials and methods

This two-center prospective study included 129 and 263 patients in the training and validation cohorts, respectively, between 2019 and 2022. Hepatic steatosis was classified according to MRI-PDFF as S0 (≤ 6.5%), S1 (6.5–16.5%), S2 (16.5–22%), and S3 (> 22%). Obuchowski measurement (OB) was performed to assess the diagnostic performance of US-HRI in the whole cohort. Optimal cut-offs of US-HRI for diagnosing ≥ S1 and ≥ S2 were identified in the training cohort by maximizing the Youden index and were applied in the validation cohort.

Results

Overall, 392 patients were included (mean age, 59 years ± 9.5; 235 men). The OB (four class problem S0 to S3) was 0.79 ± 0.01. Pairwise accuracy was good for S0 vs S1, S2 or S3 (0.78 to 0.89) but decreased for distinguishing among higher grades (0.54 to 0.62). Optimal US-HRI threshold for diagnosing ≥ S1 was 1.16, with a sensitivity of 82.7% (95% CI: 77.4–87.3), specificity of 80.0% (95% CI: 56.3–94.3), and AUC of 0.81 (95% CI: 0.76–0.86). The threshold for diagnosing ≥ S2 was 1.47, with a sensitivity of 49.0% (95% CI: 39.1–59.0), specificity of 73.0% (95% CI: 65.3–79.7), and AUC of 0.61 (95% CI: 0.55–0.67).

Conclusion

US-HRI was a reliable tool for diagnosing steatosis in type 2 diabetic patients with MASLD. However, its performance in assessing more severe grades of steatosis was inadequate.

Key Points

Question Ultrasound hepatorenal index (US-HRI) performance for the diagnosis of steatosis in type 2 diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not well defined.

Findings US-HRI demonstrated good diagnostic performance for steatosis (S0 vs S1-S3), but this decreased for diagnosing S2-S3.

Clinical relevance US-HRI provides a quantitative approach for detecting hepatic steatosis in patients with MASLD and type 2 diabetes, but has shown limited effectiveness in grading higher grades.

Graphical Abstract