Nonalcoholic fatty liver disease (NAFLD) is a common digestive system disease, which is often diagnosed by imaging methods in clinical work. At present, there is a lack of research on the effectiveness evaluation of imaging diagnostic methods with histology as the gold standard.

To study the consistency of imaging and histological diagnosis of NAFLD, and to analyze the influencing factors of gallstone disease (GD) complicated with NAFLD.

From January 2021 to July 2022, 53 patients with GD who underwent simple cholecystectomy and liver biopsy were selected from the Department of Hepatobiliary surgery, Nanjing Hospital affiliated to Nanjing University of traditional Chinese Medicine. The demographic characteristics, BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the subjects were collected, and the laboratory indexes, imaging and histological results were collected. The consistency of imaging and histological diagnosis of NAFLD was evaluated by Kappa consistency test. According to the histological diagnostic criteria, the subjects were divided into NAFLD group (n=15) and non-NAFLD group (n=38). Multivariate Logistic regression analysis was used to explore the influencing factors of NAFLD in patients with GD.

The imaging detection rate of NAFLD in GD patients was 20.7% (11/53), which was lower than that of histology (28.3%) (15/53) (Kappa=0.404, P=0.001). The sensitivity of imaging diagnosis was 60.0% (9/15), the specificity was 94.7% (36/38), and the rate of missed diagnosis was 40.0% (6/15). There were 8 cases of nonalcoholic fatty liver (NAFL), 7 cases of nonalcoholic steatohepatitis (NASH) and no NASH associated cirrhosis in 15 patients with histological manifestation of NAFLD. The proportion of fibrosis in the NASH group was higher than that in the NAFL group. There were significant differences in the levels of BMI, SBP, fasting blood glucose (FPG) and aspartate aminotransferase (AST) between NAFLD group and non-NAFLD group (P<0.05). Multivariate Logistic regression analysis showed that BMI (OR=1.500, 95%CI=1.084-2.075, P=0.014) and FPG (OR=2.163, 95%CI=1.246-3.756, P=0.006) were the influencing factors of GD patients with NAFLD.

Compared with histological diagnosis, the missed diagnosis rate of imaging diagnosis of NAFLD is higher, and the incidence of NAFLD may be underestimated by imaging diagnosis as a means of epidemiological investigation. High BMI and high FPG are the main risk factors of GD complicated with NAFLD.

非酒精性脂肪性肝病（NAFLD）是常见的消化系统疾病，临床工作中常用影像学检查方法对其诊断，目前尚缺乏以组织学为"金标准"评估影像学诊断方法效能的研究。

研究影像学和组织学诊断NAFLD的一致性，并分析胆石症（GD）患者合并NAFLD的影响因素。

选取2021年1月—2022年7月南京中医药大学附属南京医院（南京市第二医院）肝胆外科收治的行单纯胆囊切除术且进行术中肝组织活检的53例GD患者为研究对象。收集研究对象的人口学特征、BMI、收缩压（SBP）和舒张压（DBP）、实验室指标、影像学及组织学结果，采用Kappa一致性检验评价影像学和组织学诊断NAFLD的一致性，依据组织学诊断标准将研究对象分为NAFLD组（n=15）和非NAFLD组（n=38），采用多因素Logistic回归分析探讨GD患者合并NAFLD的影响因素。

GD患者中NAFLD影像学检出率20.7%（11/53），低于组织学检出率28.3%（15/53）（Kappa=0.404，P=0.001），影像学检查诊断NAFLD的灵敏度为60.0%（9/15），特异度为94.7%（36/38），漏诊率为40.0%（6/15）。15例组织学表现NAFLD的患者中非酒精性脂肪肝（NAFL）8例、非酒精性脂肪性肝炎（NASH）7例，无NASH相关肝硬化患者，NASH亚组纤维化比例（5/7）高于NAFL亚组（1/8）（P=0.041）。NAFLD组和非NAFLD组的BMI、SBP、空腹血糖（FPG）、天冬氨酸氨基转移酶（AST）水平比较，差异有统计学意义（P<0.05）；多因素Logistic回归分析结果显示，BMI（OR=1.500，95%CI=1.084~2.075，P=0.014）和FPG（OR=2.163，95%CI=1.246~3.756，P=0.006）是GD患者合并NAFLD的影响因素。

与组织学诊断比较，影像学诊断NAFLD漏诊率较高，以影像学诊断为流行病学调查手段可能低估NAFLD的发病率；高BMI和高FPG是GD合并NAFLD的主要危险因素。