CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement
Background Hepatic steatosis (HS) can be comprehensively assessed by visually comparing the hepatic and vessel attenuation on unenhanced computed tomography (CT). We aimed to evaluate the reliability and reproducibility of a CT-based visual grading system (VGS) for comprehensive assessment of HS. Me...
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| Veröffentlicht in: | Hepatology international 2022-10, Vol.16 (5), p.1075-1084 |
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| creator | Park, Hyo Jung Kim, Kyoung Won Kwon, Heon-Ju Lee, Sunyoung Kim, Dong Wook Moon, Hye Hyeon Song, Gi-Won Lee, Sung-Gyu |
| description | Background
Hepatic steatosis (HS) can be comprehensively assessed by visually comparing the hepatic and vessel attenuation on unenhanced computed tomography (CT). We aimed to evaluate the reliability and reproducibility of a CT-based visual grading system (VGS) for comprehensive assessment of HS.
Methods
In this retrospective study, a four-point VGS based on the visual comparison of liver and hepatic vessels was validated by six reviewers with diverse clinical experience using the unenhanced CT images of 717 potential liver donors. The diagnostic performance of VGS and quantitative indices (difference and ratio of the hepatic and splenic attenuation) to diagnose HS were evaluated using multi-reader multi-case receiver operating characteristics (ROC) analysis (reference: pathology). The interobserver agreement was assessed using Fleiss κ statistics.
Results
Using the VGS, all six reviewers showed areas under the ROC curves (AUROCs) higher than 0.9 for diagnosing total steatosis (TS) ≥ 30%, macrovesicular steatosis (MaS) ≥ 30%, and MaS ≥ 10%. No difference was noted between the AUROCs of the VGS and quantitative indices (
p
≥ 0.1). The reviewers showed substantial agreement (Fleiss
κ
, 0.61). Most discrepancies occurred between the two lowest grades of VGS (81.5%; 233/283), in which most subjects (97.0%; 226/233) had a MaS |
| doi_str_mv | 10.1007/s12072-022-10373-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2685030545</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2685030545</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-5dca858577eaca6cdc90e92c237e4beb31ff4c8f0b632475bd53f06be7cbd3443</originalsourceid><addsrcrecordid>eNp9kU1LAzEQhhdRsFb_gKeAFy-r-dhsWm9S_IKCl3oO2ezsmtJN1sxuof_e1IqCB08zzDzvyzBvll0yesMoVbfIOFU8p5znjAolcnqUTdhclDmVBTv-6YU4zc4Q15RKWbJykm0Xq7wyCDXZOhzNhrTR1M63BHc4QEeaEIlBBMQO_EBCQ96hN4OzJK3NENDhHamdaX3A_bSHmCSd8RaI8TVxfoAYKoS4heTURoC90Xl20pgNwsV3nWZvjw-rxXO-fH16WdwvcyskH3JZWzOTM6kUGGtKW9s5hTm3XCgoKqgEa5rCzhpalYIXSla1FA0tK1C2qkVRiGl2ffDtY_gYAQfdObSw2RgPYUTNy5mkIv1IJvTqD7oOY_TpOs0VmyvBpWKJ4gfKxoAYodF9dJ2JO82o3kehD1HoFIX-ikLTJBIHESbYtxB_rf9RfQI0xI6O</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2719732571</pqid></control><display><type>article</type><title>CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement</title><source>SpringerLink Journals - AutoHoldings</source><creator>Park, Hyo Jung ; Kim, Kyoung Won ; Kwon, Heon-Ju ; Lee, Sunyoung ; Kim, Dong Wook ; Moon, Hye Hyeon ; Song, Gi-Won ; Lee, Sung-Gyu</creator><creatorcontrib>Park, Hyo Jung ; Kim, Kyoung Won ; Kwon, Heon-Ju ; Lee, Sunyoung ; Kim, Dong Wook ; Moon, Hye Hyeon ; Song, Gi-Won ; Lee, Sung-Gyu</creatorcontrib><description>Background
Hepatic steatosis (HS) can be comprehensively assessed by visually comparing the hepatic and vessel attenuation on unenhanced computed tomography (CT). We aimed to evaluate the reliability and reproducibility of a CT-based visual grading system (VGS) for comprehensive assessment of HS.
Methods
In this retrospective study, a four-point VGS based on the visual comparison of liver and hepatic vessels was validated by six reviewers with diverse clinical experience using the unenhanced CT images of 717 potential liver donors. The diagnostic performance of VGS and quantitative indices (difference and ratio of the hepatic and splenic attenuation) to diagnose HS were evaluated using multi-reader multi-case receiver operating characteristics (ROC) analysis (reference: pathology). The interobserver agreement was assessed using Fleiss κ statistics.
Results
Using the VGS, all six reviewers showed areas under the ROC curves (AUROCs) higher than 0.9 for diagnosing total steatosis (TS) ≥ 30%, macrovesicular steatosis (MaS) ≥ 30%, and MaS ≥ 10%. No difference was noted between the AUROCs of the VGS and quantitative indices (
p
≥ 0.1). The reviewers showed substantial agreement (Fleiss
κ
, 0.61). Most discrepancies occurred between the two lowest grades of VGS (81.5%; 233/283), in which most subjects (97.0%; 226/233) had a MaS < 10%. The average-reader sensitivity and specificity of the VGS were 0.80 and 0.94 to detect TS ≥ 30% and 0.93 and 0.81 to detect MaS ≥ 10%.
Conclusion
VGS was reliable and reproducible in assessing HS. It may be useful as a non-invasive and simple tool for comprehensive HS assessment.
Graphical abstract</description><identifier>ISSN: 1936-0533</identifier><identifier>EISSN: 1936-0541</identifier><identifier>DOI: 10.1007/s12072-022-10373-0</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Attenuation ; Colorectal Surgery ; Computed tomography ; Fatty liver ; Hepatology ; Liver ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Organ donors ; Original Article ; Reliability analysis ; Reproducibility ; Statistical analysis ; Steatosis ; Surgery ; Vessels</subject><ispartof>Hepatology international, 2022-10, Vol.16 (5), p.1075-1084</ispartof><rights>Asian Pacific Association for the Study of the Liver 2022</rights><rights>Asian Pacific Association for the Study of the Liver 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-5dca858577eaca6cdc90e92c237e4beb31ff4c8f0b632475bd53f06be7cbd3443</citedby><cites>FETCH-LOGICAL-c352t-5dca858577eaca6cdc90e92c237e4beb31ff4c8f0b632475bd53f06be7cbd3443</cites><orcidid>0000-0001-6471-6727</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12072-022-10373-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12072-022-10373-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Park, Hyo Jung</creatorcontrib><creatorcontrib>Kim, Kyoung Won</creatorcontrib><creatorcontrib>Kwon, Heon-Ju</creatorcontrib><creatorcontrib>Lee, Sunyoung</creatorcontrib><creatorcontrib>Kim, Dong Wook</creatorcontrib><creatorcontrib>Moon, Hye Hyeon</creatorcontrib><creatorcontrib>Song, Gi-Won</creatorcontrib><creatorcontrib>Lee, Sung-Gyu</creatorcontrib><title>CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement</title><title>Hepatology international</title><addtitle>Hepatol Int</addtitle><description>Background
Hepatic steatosis (HS) can be comprehensively assessed by visually comparing the hepatic and vessel attenuation on unenhanced computed tomography (CT). We aimed to evaluate the reliability and reproducibility of a CT-based visual grading system (VGS) for comprehensive assessment of HS.
Methods
In this retrospective study, a four-point VGS based on the visual comparison of liver and hepatic vessels was validated by six reviewers with diverse clinical experience using the unenhanced CT images of 717 potential liver donors. The diagnostic performance of VGS and quantitative indices (difference and ratio of the hepatic and splenic attenuation) to diagnose HS were evaluated using multi-reader multi-case receiver operating characteristics (ROC) analysis (reference: pathology). The interobserver agreement was assessed using Fleiss κ statistics.
Results
Using the VGS, all six reviewers showed areas under the ROC curves (AUROCs) higher than 0.9 for diagnosing total steatosis (TS) ≥ 30%, macrovesicular steatosis (MaS) ≥ 30%, and MaS ≥ 10%. No difference was noted between the AUROCs of the VGS and quantitative indices (
p
≥ 0.1). The reviewers showed substantial agreement (Fleiss
κ
, 0.61). Most discrepancies occurred between the two lowest grades of VGS (81.5%; 233/283), in which most subjects (97.0%; 226/233) had a MaS < 10%. The average-reader sensitivity and specificity of the VGS were 0.80 and 0.94 to detect TS ≥ 30% and 0.93 and 0.81 to detect MaS ≥ 10%.
Conclusion
VGS was reliable and reproducible in assessing HS. It may be useful as a non-invasive and simple tool for comprehensive HS assessment.
Graphical abstract</description><subject>Attenuation</subject><subject>Colorectal Surgery</subject><subject>Computed tomography</subject><subject>Fatty liver</subject><subject>Hepatology</subject><subject>Liver</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Organ donors</subject><subject>Original Article</subject><subject>Reliability analysis</subject><subject>Reproducibility</subject><subject>Statistical analysis</subject><subject>Steatosis</subject><subject>Surgery</subject><subject>Vessels</subject><issn>1936-0533</issn><issn>1936-0541</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kU1LAzEQhhdRsFb_gKeAFy-r-dhsWm9S_IKCl3oO2ezsmtJN1sxuof_e1IqCB08zzDzvyzBvll0yesMoVbfIOFU8p5znjAolcnqUTdhclDmVBTv-6YU4zc4Q15RKWbJykm0Xq7wyCDXZOhzNhrTR1M63BHc4QEeaEIlBBMQO_EBCQ96hN4OzJK3NENDhHamdaX3A_bSHmCSd8RaI8TVxfoAYKoS4heTURoC90Xl20pgNwsV3nWZvjw-rxXO-fH16WdwvcyskH3JZWzOTM6kUGGtKW9s5hTm3XCgoKqgEa5rCzhpalYIXSla1FA0tK1C2qkVRiGl2ffDtY_gYAQfdObSw2RgPYUTNy5mkIv1IJvTqD7oOY_TpOs0VmyvBpWKJ4gfKxoAYodF9dJ2JO82o3kehD1HoFIX-ikLTJBIHESbYtxB_rf9RfQI0xI6O</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Park, Hyo Jung</creator><creator>Kim, Kyoung Won</creator><creator>Kwon, Heon-Ju</creator><creator>Lee, Sunyoung</creator><creator>Kim, Dong Wook</creator><creator>Moon, Hye Hyeon</creator><creator>Song, Gi-Won</creator><creator>Lee, Sung-Gyu</creator><general>Springer India</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6471-6727</orcidid></search><sort><creationdate>20221001</creationdate><title>CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement</title><author>Park, Hyo Jung ; Kim, Kyoung Won ; Kwon, Heon-Ju ; Lee, Sunyoung ; Kim, Dong Wook ; Moon, Hye Hyeon ; Song, Gi-Won ; Lee, Sung-Gyu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-5dca858577eaca6cdc90e92c237e4beb31ff4c8f0b632475bd53f06be7cbd3443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Attenuation</topic><topic>Colorectal Surgery</topic><topic>Computed tomography</topic><topic>Fatty liver</topic><topic>Hepatology</topic><topic>Liver</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Organ donors</topic><topic>Original Article</topic><topic>Reliability analysis</topic><topic>Reproducibility</topic><topic>Statistical analysis</topic><topic>Steatosis</topic><topic>Surgery</topic><topic>Vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Hyo Jung</creatorcontrib><creatorcontrib>Kim, Kyoung Won</creatorcontrib><creatorcontrib>Kwon, Heon-Ju</creatorcontrib><creatorcontrib>Lee, Sunyoung</creatorcontrib><creatorcontrib>Kim, Dong Wook</creatorcontrib><creatorcontrib>Moon, Hye Hyeon</creatorcontrib><creatorcontrib>Song, Gi-Won</creatorcontrib><creatorcontrib>Lee, Sung-Gyu</creatorcontrib><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Hyo Jung</au><au>Kim, Kyoung Won</au><au>Kwon, Heon-Ju</au><au>Lee, Sunyoung</au><au>Kim, Dong Wook</au><au>Moon, Hye Hyeon</au><au>Song, Gi-Won</au><au>Lee, Sung-Gyu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement</atitle><jtitle>Hepatology international</jtitle><stitle>Hepatol Int</stitle><date>2022-10-01</date><risdate>2022</risdate><volume>16</volume><issue>5</issue><spage>1075</spage><epage>1084</epage><pages>1075-1084</pages><issn>1936-0533</issn><eissn>1936-0541</eissn><abstract>Background
Hepatic steatosis (HS) can be comprehensively assessed by visually comparing the hepatic and vessel attenuation on unenhanced computed tomography (CT). We aimed to evaluate the reliability and reproducibility of a CT-based visual grading system (VGS) for comprehensive assessment of HS.
Methods
In this retrospective study, a four-point VGS based on the visual comparison of liver and hepatic vessels was validated by six reviewers with diverse clinical experience using the unenhanced CT images of 717 potential liver donors. The diagnostic performance of VGS and quantitative indices (difference and ratio of the hepatic and splenic attenuation) to diagnose HS were evaluated using multi-reader multi-case receiver operating characteristics (ROC) analysis (reference: pathology). The interobserver agreement was assessed using Fleiss κ statistics.
Results
Using the VGS, all six reviewers showed areas under the ROC curves (AUROCs) higher than 0.9 for diagnosing total steatosis (TS) ≥ 30%, macrovesicular steatosis (MaS) ≥ 30%, and MaS ≥ 10%. No difference was noted between the AUROCs of the VGS and quantitative indices (
p
≥ 0.1). The reviewers showed substantial agreement (Fleiss
κ
, 0.61). Most discrepancies occurred between the two lowest grades of VGS (81.5%; 233/283), in which most subjects (97.0%; 226/233) had a MaS < 10%. The average-reader sensitivity and specificity of the VGS were 0.80 and 0.94 to detect TS ≥ 30% and 0.93 and 0.81 to detect MaS ≥ 10%.
Conclusion
VGS was reliable and reproducible in assessing HS. It may be useful as a non-invasive and simple tool for comprehensive HS assessment.
Graphical abstract</abstract><cop>New Delhi</cop><pub>Springer India</pub><doi>10.1007/s12072-022-10373-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6471-6727</orcidid></addata></record> |
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| subjects | Attenuation Colorectal Surgery Computed tomography Fatty liver Hepatology Liver Medical diagnosis Medicine Medicine & Public Health Organ donors Original Article Reliability analysis Reproducibility Statistical analysis Steatosis Surgery Vessels |
| title | CT-based visual grading system for assessment of hepatic steatosis: diagnostic performance and interobserver agreement |
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