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

Publisher Copyright:
© 2020 The Korean Society of Radiology.


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


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