Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2025; 17(5): 104272
Published online May 28, 2025. doi: 10.4329/wjr.v17.i5.104272
Diagnostic accuracy of noninvasive steatosis biomarkers with magnetic resonance imaging proton density fat fraction as gold standard
Jia-Liang Chen, Shao-Jie Duan, Sheng Xie, Shu-Kun Yao
Jia-Liang Chen, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Shao-Jie Duan, Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China
Sheng Xie, Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
Shu-Kun Yao, Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Chen JL and Yao SK designed and performed the research study; Chen JL, Duan SJ and Xie S collected and analyzed the data; Chen JL wrote the manuscript; Yao SK supervised the report; all authors reviewed and approved the final manuscript.
Supported by the Leap-forward Development Program for Beijing Biopharmaceutical Industry (G20), No. Z171100001717008; and the Fundamental Research Funds for the Central Universities and Research projects on biomedical transformation of China-Japan Friendship Hospital, No. PYBZ1815.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of China-Japan Friendship Hospital (No. 2018-110-K79-1).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Kun Yao, MD, Chief Physician, Professor, Department of Gastroenterology, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing 100029, China. yao_sk@126.com
Received: December 16, 2024
Revised: March 16, 2025
Accepted: April 11, 2025
Published online: May 28, 2025
Processing time: 161 Days and 13.4 Hours
Abstract
BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The accuracy of noninvasive biomarkers for detecting hepatic steatosis is still limited.

AIM

To assess the diagnostic performance of noninvasive steatosis biomarkers in diagnosing NAFLD using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the gold standard.

METHODS

A total of 131 suspected NAFLD patients (60% male, median age 36 years) undergoing MRI-PDFF were consecutively recruited from a tertiary hospital. Steatosis grades determined by MRI-PDFF were classified as none (< 5%), mild (5%-11%), moderate (11%-17%), and severe (≥ 17%). Six steatosis biomarkers were calculated according to clinical parameters and laboratory tests, including fatty liver index, hepatic steatosis index, ZJU index, Framingham steatosis index, triglycerides and glucose index, and visceral adiposity index. The accuracy of these biomarkers in detecting hepatic steatosis was evaluated using the area under the receiver operating characteristic curves (AUCs). The Youden index was used to determine the optimal cut-off for each biomarker. The linear trend analysis of each biomarker across the steatosis grades was conducted by Mantel-Haenszel χ2 test. Spearman's rank correlation assessed the relationship between steatosis biomarkers and MRI-PDFF.

RESULTS

Steatosis grades based on MRI-PDFF prevalence were: None 27%, mild 40%, moderate 15% and severe 18%. Six steatosis biomarkers showed a linear trend across the steatosis grades and a significant positive correlation with MRI-PDFF. The six steatosis biomarkers demonstrated AUCs near 0.90 (range: 0.857-0.912, all P < 0.001) for diagnosing NAFLD by MRI-PDFF ≥ 5%. The optimal cut-offs showed sensitivity between 84.4%-91.7% and specificity between 71.4%-85.7%. The diagnostic performance of these biomarkers in detecting moderate-to-severe and severe steatosis was relatively weaker.

CONCLUSION

These noninvasive steatosis biomarkers accurately diagnosed NAFLD and correlated well with MRI-PDFF for detecting NAFLD, but they did not effectively detect moderate or severe steatosis.

Keywords: Nonalcoholic fatty liver disease; Diagnosis; Noninvasive biomarker; Magnetic resonance imaging proton density fat fraction; Chinese population

Core Tip: This is the first study to investigate the accuracy of noninvasive biomarkers for detecting nonalcoholic fatty liver disease (NAFLD) based on magnetic resonance imaging proton density fat fraction (MRI-PDFF) in the Chinese population, which is currently considered the gold standard in diagnosing hepatic steatosis. Two types of cut-offs (single optimal cut-off and dual cut-off) of six steatosis biomarkers were analyzed. These noninvasive steatosis biomarkers demonstrated great accuracy in diagnosing NAFLD (MRI-PDFF ≥ 5%) and exhibited a strong correlation with MRI-PDFF. However, they may be ineffective in detecting moderate or severe steatosis.