Development and validation of a simple index based on non-enhanced CT and clinical factors for prediction of non-alcoholic fatty liver disease

Yura Ahn, Sung Cheol Yun, Seung Soo Lee, Jung Hee Son, Sora Jo, Jieun Byun, Yu Sub Sung, Ho Sung Kim, Eun Sil Yu

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD. Materials and Methods: This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CTL-S was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort. Results: The clinical-CT index included CTL-S, body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CTL-S (0.74; p < 0.001) and clinical indices (0.73–0.75; p < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%. Conclusion: The clinical-CT index is more accurate than CTL-S and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.

Original languageEnglish
Pages (from-to)413-421
Number of pages9
JournalKorean Journal of Radiology
Issue number4
StatePublished - Apr 2020

Bibliographical note

Funding Information:
Received September 22, 2019; accepted after revision November 27, 2019. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, Information and Communications Technology (ICT) and Future Planning (NRF-2017R1A2B4003114), and the Bio and Medical Technology Development Program of the NRF funded by the Ministry of Science and ICT (NRF-2016M3A9A7918706). *These authors contributed equally to this work. †Current affiliation: Department of Radiology, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea. Corresponding author: Seung Soo Lee, MD, PhD, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. • Tel: (822) 3010-5765 • Fax: (822) 2045-4127 • E-mail: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Publisher Copyright:
© 2020 The Korean Society of Radiology.


  • Computed tomography
  • Diagnostic index
  • Non-alcoholic fatty liver disease


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