慢性丙型肝炎患者的肝纤维化：实时组织弹性成像的无创诊断 - 测量方法的建立。
Liver fibrosis in patients with chronic hepatitis C: noninvasive diagnosis by means of real-time tissue elastography--establishment of the method for measurement.
机构信息
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
出版信息
Radiology. 2011 Feb;258(2):610-7. doi: 10.1148/radiol.10100319.
PURPOSE
To prospectively measure liver stiffness with real-time tissue elastography in patients with chronic hepatitis C and to compare the results with those of clinical assessment of fibrosis by using histologic stage as the reference standard.
MATERIALS AND METHODS
All subjects gave informed consent, and the study was approved by the institutional ethics committee. Seventy hospitalized patients (46 men, 24 women; mean age, 65.5 years ± 11.7 [standard deviation]; age range, 33-87 years) with chronic hepatitis C underwent real-time elastography between January 2009 and September 2009. Elastography was performed at four liver locations by two independent observers. The elastic ratio (ratio of the value in the intrahepatic venous small vessels divided by the value in the hepatic parenchyma) was calculated and was compared with histologic fibrosis stage at liver biopsy. The elastic ratio and clinical fibrosis markers were assessed by using receiver operating characteristic (ROC) analysis. The differences between body site and observers were assessed with κ statistics and intraclass correlation coefficients (ICCs).
RESULTS
Real-time tissue elastography cutoff values were 2.73 for F of 2 or greater, 3.25 for F of 3 or greater, and 3.93 for F of 4. No site differences were observed (κ = 0.835, ICC = 0.966), and the elastic ratio measurement was correlated between the two examiners (r(2) = 0.869, P < .0001). The areas under the ROC curves for elastic ratio, hyaluronic acid, type IV collagen, aspartate aminotransferase-to-platelet ratio index, FibroIndex, Forns score, and Hepascore were 0.95, 0.32, 0.73, 0.76, 0.76, 0.87, and 0.70, respectively; the elastic ratio performed better than the serum fibrosis markers and other scores.
CONCLUSION
Real-time tissue elastography is not invasive and could be used to evaluate liver fibrosis in patients with chronic hepatitis C.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100319/-/DC1.
目的
前瞻性地使用实时组织弹性成像技术测量慢性丙型肝炎患者的肝硬度，并将结果与组织学纤维化分期作为参考标准的临床纤维化评估进行比较。
材料与方法
所有受试者均签署了知情同意书，本研究得到了机构伦理委员会的批准。2009 年 1 月至 9 月期间，70 名住院慢性丙型肝炎患者（46 名男性，24 名女性；平均年龄 65.5 岁±11.7[标准差]；年龄范围 33-87 岁）接受了实时弹性成像检查。由两名独立观察者在四个肝脏位置进行弹性成像。计算弹性比值（肝内小静脉值除以肝实质值），并与肝活检的组织学纤维化分期进行比较。使用接收者操作特征（ROC）分析评估弹性比值和临床纤维化标志物。采用κ 统计和组内相关系数（ICC）评估体区和观察者之间的差异。
结果
实时组织弹性成像的截断值为 F2 或更高为 2.73，F3 或更高为 3.25，F4 或更高为 3.93。未观察到部位差异（κ=0.835，ICC=0.966），且两名检查者的弹性比值测量结果具有相关性（r2=0.869，P<.0001）。弹性比值、透明质酸、IV 型胶原、天门冬氨酸氨基转移酶与血小板比值指数、FibroIndex、Forns 评分和 Hepascore 的 ROC 曲线下面积分别为 0.95、0.32、0.73、0.76、0.76、0.87 和 0.70；弹性比值的表现优于血清纤维化标志物和其他评分。
结论
实时组织弹性成像技术是非侵入性的，可用于评估慢性丙型肝炎患者的肝纤维化。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100319/-/DC1.
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