Application Of Transient Elastography In The Evaluation Of Hepatic Steatosis In Liver Transplantation

Objective: Using liver biopsy as the gold standard,transient elastography(TE),ultrasound and CT were used to evaluate the steatosis of donor liver,and the accuracy and advantages of TE in the evaluation of donor liver quality were discussed.The relationship between the degree of hepatic steatosis detected by TE and the value of controlled attenuation parameter(CAP)was studied to explore the accuracy of CAP in the diagnosis of fatty liver.Methods: A retrospective study was conducted,From June 2021 to December 2022,75 organ donors who completed ultrasound,CT,TE and liver biopsy related liver examinations in Beijing Tsinghua Changgung Hospital were selected as the research objects.The pathological tissue results were used as the gold standard and the donors were grouped according to the degree of steatosis.The CT,ultrasound and CAP values of all cases were counted,and SPSS 26.0 statistical software was used for analysis to explore the evaluation value of TE in liver transplantation donor steatosis.Results: 40 cases(53.30%)were negative(S0 stage)and 35 cases(46.70%)were positive,including 29 cases(38.67%)of mild(S1 stage)and 6 cases(8.03%)of moderate(S2 stage).TE negative(S0 stage)40cases(53.30%),positive 35 cases(46.70%),including mild(S1 stage)25cases(33.34%),moderate(S2 stage)10 cases(13.36%);ultrasound was negative in 47 cases(62.67%)(S0 stage)and positive in 28 cases(37.33%),including 21 cases(28.00%)of mild(S1 stage)and 7 cases(9.33%)of moderate(S2 stage).CT negative(S0 stage)60 cases(80.00%),positive 15cases(20.00 %),including mild(S1 stage)10 cases(13.33%),moderate(S2 stage)5 cases(6.67 %.Sensitivity and specificity: CT was 93.3% and65.0%,ultrasound was 78.6% and 72.3%;TE was 85.7% and 87.5%.The consistency between ultrasound and liver biopsy was good(Kappa coefficient=0.485,P<0.001),the consistency between CT and liver biopsy was low(Kappa coefficient=0.389,P<0.001),and the consistency between TE and liver biopsy was strong(Kappa coefficient=0.732,P<0.001).The area under the ROC curve of ultrasound,CT and TE was 0.739,0.688 and0.866,respectively.The controlled attenuation parameters(CAP)corresponding to different degrees of steatosis in the donor liver were: S0(199.30±41.17)d B/m,S1(243.72±27.95)d B/m and S2(283.17±7.06)d B/m,respectively.The difference between the groups was statistically significant(P<0.001).The degree of hepatic steatosis was positively correlated with CAP(r=0.634,P<0.001).The ROC of CAP in the diagnosis of S1 steatosis of donor liver was 0.833,the optimal threshold was 240.5 d B/m,the sensitivity was 82.8%,and the specificity was 78.3%.The ROC of S2 was0.973,the optimal threshold was 270.0 d B/m,the sensitivity was 100%,and the specificity was 94.2%.Conclusion : Compared with CT and ultrasound,the accuracy of liver transient elastography in the diagnosis of donor fatty liver is closer to that of liver biopsy.It is an advantageous imaging method for clinical diagnosis of donor fatty liver.CAP value is positively correlated with the degree of steatosis,and CAP value measured by TE can diagnose fatty liver.