Nishiura T, Watanabe H, Ito M, Matsuoka Y, Yano K, Daikoku M, Yatsuhashi H, Dohmen K, Ishibashi H
Clinical Laboratory, NHO National Nagasaki Medical Centre, Omura, Nagasaki, 856-8562 Japan.
Br J Radiol. 2005 Mar;78(927):189-97. doi: 10.1259/bjr/75208448.
A liver biopsy is currently considered the definitive diagnostic modality for establishing the severity of hepatic fibrosis. We analysed the diagnostic sensitivity and accuracy of ultrasound (US) using both low frequency and high frequency probes as a repeatable, inexpensive, and reliable method to determine the fibrosis stage in chronic liver disease and then compared our results with the histological findings. A total of 103 patients with chronic liver disease (60 males and 43 females, average age 51 years old) who had undergone both a liver biopsy and US with 2-5 MHz frequency and 5-12 MHz frequency probes were prospectively evaluated in this study. An US scoring system using both the low frequency and high frequency probes was performed by evaluating the edge, surface and parenchymal texture of the liver. Each score was obtained by evaluating three parameters; the bluntness of the liver edge, the irregularity of the surface and the coarseness of the parenchymal texture were evaluated and then compared with the histological findings. The US scores of the liver edge (rs: 0.6668), liver surface (rs: 0.9007) and liver parenchymal texture (rs: 0.8853) correlated significantly with the fibrosis stage obtained based on the biopsy findings. The accumulated US scores of these three parameters, however, was found to be the most reliable indicator (rs: 0.9524). Patients with an accumulated score of 6.5 or more were all found to have fibrosis stage 4 in which the accuracy of our scoring system for correctly predicting cirrhosis was found to be 100% sensitive. When an accumulated US score of 3 was interpreted to indicate mild fibrosis (a fibrosis score of 0 or 1), all 42 patients with stage 0 or 1 fibrosis were found to have an accumulated US score of 3 or less (a probability of 100%) and 42 of 53 patients with a score of 3 or less were found to have stage 0 or 1 fibrosis (specificity of 79.2%). An ultrasound evaluation of the liver fibrosis stage based on the scoring system using both low and high frequency probes was found to be a reliable and effective alternative to the histological staging in chronic liver diseases.
目前，肝活检被认为是确定肝纤维化严重程度的金标准诊断方法。我们分析了使用低频和高频探头的超声（US）作为一种可重复、廉价且可靠的方法来确定慢性肝病纤维化阶段的诊断敏感性和准确性，然后将我们的结果与组织学结果进行比较。本研究前瞻性评估了103例慢性肝病患者（60例男性和43例女性，平均年龄51岁），这些患者均接受了肝活检以及使用2 - 5MHz频率和5 - 12MHz频率探头的超声检查。通过评估肝脏的边缘、表面和实质纹理，使用低频和高频探头进行超声评分系统。每个分数通过评估三个参数获得；评估肝脏边缘的钝度、表面的不规则性和实质纹理的粗糙程度，然后与组织学结果进行比较。肝脏边缘的超声评分（rs：0.6668）、肝脏表面（rs：0.9007）和肝脏实质纹理（rs：0.8853）与基于活检结果获得的纤维化阶段显著相关。然而，发现这三个参数的累积超声评分是最可靠的指标（rs：0.9524）。累积评分6.5或更高的患者均被发现患有纤维化4期，其中我们的评分系统正确预测肝硬化的准确性被发现为100%敏感。当将累积超声评分3解释为轻度纤维化（纤维化评分为0或1）时，所有42例0或1期纤维化患者的累积超声评分均为3或更低（概率为100%），53例评分3或更低的患者中有42例被发现患有0或1期纤维化（特异性为79.2%）。基于使用低频和高频探头的评分系统对肝纤维化阶段进行超声评估被发现是慢性肝病组织学分期的一种可靠且有效的替代方法。
