Preoperative noninvasive assessment for predicting steatosis grade in hepatocellular Carcinoma Patients with chronic hepatitis B : comparison of Attenuation Imaging with controlled attenuation parameter

Objectives The purpose of this study was to assess the diagnostic performance of Attenuation Imaging (ATI) in predicting steatosis grade in hepatocellular carcinoma (HCC) patients with chronic hepatitis B adapted to hepatectomy comparing to controlled attenuation parameter (CAP) Methods HCC patients with chronic hepatitis B who were scheduled to undergo hepatectomy were prospectively enrolled in this study. All patients underwent ATI and CAP examinations. The histologic hepatic steatosis was grade. Steatosis was graded as follows: S0 (< 5%); S1 (5–32%); S2 (33–66%) to S3 (> 66%). Receiver operating characteristic (ROC) analyses was used to assess the diagnostic performance of ATI and CAP. Multivariable linear regression analysis was used to find the determinant factors for AC value and CAP. Results A total of 164 participants were included. ATI had a higher success rate than CAP (98.0% vs 81.6%). There was a good positive correlation between AC and CAP values ( r  = 0.714, p  = 0.000). Both AC and CAP values were correlated with steatosis grade( r  = 0.725, 0.678, p  = 0.001, respectively), and both were significantly different among patients with different steatosis grade. The area under the receiver operating characteristic curve (AUROC) of ATI were 0.926, 0.914 for predicting ≥ S1, ≥S2, respectively. The optimal cutoff AC values were 0.69, 0.76 dB/cm/MHz for ≥ S1, ≥S2, respectively. The AUROCs of CAP were 0.895, 0.904 for predicting ≥ S1, ≥S2, respectively. The optimal cutoff CAP were 224, 240 dB/m for ≥ S1, ≥S2, respectively. There was no significant difference in diagnostic performance between the two methods (Z = 1.057, 0.220, p  = 0.29, 0.83). Steatosis grade and TG for AC value were significant determinant factors. Steatosis grade was the only significant determinant factor for CAP. Conclusions ATI is a efficient, noninvasive and reliable tool for predicting liver steatosis grade in HCC patients with CHB, shows a high correlation with CAP, and has a higher success rate than CAP.