Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Via Taramelli 5, Pavia 27100, Italy.
AJR Am J Roentgenol. 2012 Jul;199(1):19-25. doi: 10.2214/AJR.11.7517.
The purpose of this article is to evaluate the diagnostic performance of transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index in assessing fibrosis in patients with chronic hepatitis C by using histologic Metavir scores as reference standard.
Consecutive patients with chronic hepatitis C scheduled for liver biopsy were enrolled. Liver biopsy was performed on the same day as transient elastography and real-time strain elastography. Transient elastography and real-time strain elastography were performed in the same patient encounter by a single investigator using a medical device based on elastometry and an ultrasound machine, respectively. Diagnostic performance was assessed by using receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) analysis.
One hundred thirty patients (91 men and 39 women) were analyzed. The cutoff values for transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index were 6.9 kPa, 1.82, and 0.37, respectively, for fibrosis score of 2 or higher; 7.3 kPa, 1.86, and 0.70, respectively, for fibrosis score of 3 or higher; and 9.3 kPa, 2.33, and 0.70, respectively, for fibrosis score of 4. AUC values of transient elastography, real-time strain elastography, aspartate-to-platelet ratio index were 0.88, 0.74, and 0.86, respectively, for fibrosis score of 2 or higher; 0.95, 0.80, and 0.89, respectively, for fibrosis score of 3 or higher; and 0.97, 0.80, and 0.84, respectively, for fibrosis score of 4. A combination of the three methods, when two of three were in agreement, showed AUC curves of 0.93, 0.95, and 0.95 for fibrosis scores of 2 or higher, 3 or higher, and 4, respectively.
Transient elastography, real-time strain elastography, and aspartate-to-platelet ratio index values were correlated with histologic stages of fibrosis. Transient elastography offered excellent diagnostic performance in assessing severe fibrosis and cirrhosis. Real-time elastography does not yet have the potential to substitute for transient elastography in the assessment of liver fibrosis.
本文旨在评估瞬时弹性成像、实时应变成像和天冬氨酸转氨酶-血小板比值指数在以组织学 Metavir 评分作为参考标准的情况下，评估慢性丙型肝炎患者纤维化的诊断性能。
连续纳入计划行肝活检的慢性丙型肝炎患者。肝活检与瞬时弹性成像和实时应变成像同日进行。瞬时弹性成像和实时应变成像由同一位研究者在同一次患者就诊时，使用基于弹性能量学的医疗设备和超声机分别进行。通过接受者操作特征曲线和接受者操作特征曲线下面积（AUC）分析评估诊断性能。
共分析了 130 例患者（91 例男性和 39 例女性）。对于纤维化评分≥2 分，瞬时弹性成像、实时应变成像和天冬氨酸转氨酶-血小板比值指数的截断值分别为 6.9 kPa、1.82 和 0.37；纤维化评分≥3 分，分别为 7.3 kPa、1.86 和 0.70；纤维化评分≥4 分，分别为 9.3 kPa、2.33 和 0.70。AUC 值为 0.88、0.74 和 0.86，分别对应纤维化评分≥2 分；0.95、0.80 和 0.89，分别对应纤维化评分≥3 分；0.97、0.80 和 0.84，分别对应纤维化评分≥4 分。当三种方法中的两种方法一致时，三种方法的组合对纤维化评分≥2 分、≥3 分和≥4 分的 AUC 曲线分别为 0.93、0.95 和 0.95。
瞬时弹性成像、实时应变成像和天冬氨酸转氨酶-血小板比值指数与组织学纤维化分期相关。瞬时弹性成像在评估严重纤维化和肝硬化方面具有出色的诊断性能。实时弹性成像在评估肝纤维化方面尚未具有替代瞬时弹性成像的潜力。
