Bota Simona, Sporea Ioan, Sirli Roxana, Popescu Alina, Dănilă Mirela, Sendroiu Mădălina
Simona Bota, Ioan Sporea, Roxana Şirli, Alina Popescu, Mirela Dănilă, Mădălina Şendroiu, Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, 300742, Timişoara, Romania.
World J Radiol. 2011 Aug 28;3(8):205-9. doi: 10.4329/wjr.v3.i8.205.
To assess the feasibility of performing acoustic radiation force impulse (ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ascites.
Our study included 153 patients with ascites, mean age 58.8 ± 13.1 years. One hundred and fifteen (75.2%) patients had ascites in the context of cirrhosis, 29 (18.9%) had non-cirrhotic ascites (diagnosed by clinical, ultrasound, endoscopic and/or laparoscopic criteria) and in 9 (5.9%) cases we could not establish the etiology of ascites. We performed 10 ARFI measurements and the median value was calculated and expressed in meters/second (m/s). Among the 29 patients with non-cirrhotic ascites were included: 20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation, 7 acute pancreatitis with ascites which later resolved, and one case each of lymphatic ascites and ascites in the context of a liver abscess. In 11 of the 20 patients with peritoneal carcinomatosis, the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver metastases.
We could not obtain valid ARFI measurements in 5 patients (3.2%). The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites: 3.04 ± 0.70 vs 1.45 ± 0.59 m/s (P < 0.001). For a cut-off value of 1.8 m/s for predicting cirrhosis (and ascites in the context of cirrhosis), as obtained in a previous study, ARFI had 98.1% sensitivity, 86.2% specificity, 96.4% positive predictive value, 92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic ascites. For a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.
ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.
评估对腹水患者进行声辐射力脉冲（ARFI）弹性成像的可行性及其对腹水肝硬化或非肝硬化病因的预测价值。
我们的研究纳入了153例腹水患者，平均年龄58.8±13.1岁。115例（75.2%）患者的腹水与肝硬化有关，29例（18.9%）有非肝硬化性腹水（根据临床、超声、内镜和/或腹腔镜标准诊断），9例（5.9%）病例无法确定腹水病因。我们进行了10次ARFI测量，并计算中位数，以米/秒（m/s）表示。29例非肝硬化性腹水患者包括：20例经腹腔镜证实并经组织学确诊为腹膜癌，7例急性胰腺炎伴腹水，后来腹水消退，1例淋巴性腹水和1例肝脓肿伴腹水。20例腹膜癌患者中，11例肝脏结构在超声检查中均匀，9例超声检查显示有肝转移。
5例患者（3.2%）无法获得有效的ARFI测量值。肝硬化腹水患者通过ARFI测量的平均肝脏硬度在统计学上显著高于非肝硬化腹水患者：3.04±0.70 vs 1.45±0.59 m/s（P<0.001）。根据先前研究得出的预测肝硬化（以及肝硬化背景下的腹水）的临界值为1.8 m/s，ARFI对肝硬化腹水的预测敏感性为98.1%，特异性为86.2%，阳性预测值为96.4%，阴性预测值为92.5%，准确性为95.6%。临界值为1.9 m/s时，准确性为94.9%；临界值为2 m/s时，准确性为92.8%。
ARFI弹性成像对大多数腹水患者可行，对腹水的肝硬化或非肝硬化病因具有很好的预测价值。
