Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
Hepatol Int. 2007 Sep;1(3):394-7. doi: 10.1007/s12072-007-9012-7. Epub 2007 Jul 21.
Transient elastography is a novel noninvasive method to assess liver fibrosis by measuring liver stiffness. This study is a first step toward the provision of a noninvasive measurement of hepatic tumor stiffness by transient elastography.
Patients with liver tumor larger than 5 cm in diameter and located near the liver surface were enrolled between June 2004 and February 2005. Histology of each tumor was evaluated on ultrasound-guided liver biopsy specimens. Transient elastography (Fibroscan, Echosens, Paris) was used to measure tumor stiffness. Tumor stiffness was measured as follows. First, by using B-mode ultrasound, we searched for the optimal right intercostal position for tumor stiffness measurement while keeping the ultrasound probe and body surface at right angles. Then the vibrator for transient elastography was applied at the same position and angle, and stiffness was measured according to the manufacturer's instruction.
Tumor stiffness was measured in 40 patients, 17 with hepatocellular carcinoma (HCC), six with cholangiocellular carcinoma (CCC), 16 with metastatic tumors (mostly adenocarcinoma), and one with malignant lymphoma. The median value was 55 kPa in HCC, 75 kPa in CCC, 66.5 kPa in metastatic tumor, and 16.9 kPa in malignant lymphoma. The stiffness value of CCC was significantly higher than that of HCC and metastatic tumors (P = .049).
We showed that stiffness of liver tumors could be measured with transient elastography. Improvements in the device, such as smaller and variable region of interest of measurement and real-time B-mode display, may ensure wider clinical application.
瞬时弹性成像技术是一种通过测量肝脏硬度来评估肝纤维化的新型无创方法。本研究旨在首次通过瞬时弹性成像技术提供对肝肿瘤硬度的无创测量。
2004 年 6 月至 2005 年 2 月期间，我们纳入了直径大于 5 厘米且位于肝表面附近的肝肿瘤患者。每个肿瘤的组织学均通过超声引导下的肝活检标本进行评估。瞬时弹性成像（Fibroscan，Echosens，巴黎）用于测量肿瘤硬度。测量肿瘤硬度的方法如下：首先，通过 B 型超声，我们在保持超声探头和体表成直角的情况下，寻找最佳的右侧肋间位置进行肿瘤硬度测量。然后，将瞬时弹性成像的振动器应用于同一位置和角度，并按照制造商的说明测量硬度。
共对 40 例患者进行了肿瘤硬度测量，其中 17 例为肝细胞癌（HCC），6 例为胆管细胞癌（CCC），16 例为转移性肿瘤（主要为腺癌），1 例为恶性淋巴瘤。HCC 的中位数为 55kPa，CCC 的中位数为 75kPa，转移性肿瘤的中位数为 66.5kPa，恶性淋巴瘤的中位数为 16.9kPa。CCC 的硬度值明显高于 HCC 和转移性肿瘤（P =.049）。
我们表明，瞬时弹性成像可以测量肝肿瘤的硬度。设备的改进，如更小和可变的测量感兴趣区域以及实时 B 型显示，可能会确保更广泛的临床应用。
