Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Hepatology. 2012 Dec;56(6):2125-33. doi: 10.1002/hep.25936. Epub 2012 Aug 31.
Real-time shear wave elastography (SWE) is a novel, noninvasive method to assess liver fibrosis by measuring liver stiffness. This single-center study was conducted to assess the accuracy of SWE in patients with chronic hepatitis C (CHC), in comparison with transient elastography (TE), by using liver biopsy (LB) as the reference standard. Consecutive patients with CHC scheduled for LB by referring physicians were studied. One hundred and twenty-one patients met inclusion criteria. On the same day, real-time SWE using the ultrasound (US) system, Aixplorer (SuperSonic Imagine S.A., Aix-en-Provence, France), TE using FibroScan (Echosens, Paris, France), and US-assisted LB were consecutively performed. Fibrosis was staged according to the METAVIR scoring system. Analyses of receiver operating characteristic (ROC) curve were performed to calculate optimal area under the ROC curve (AUROC) for F0-F1 versus F2-F4, F0- F2 versus F3-F4, and F0-F3 versus F4 for both real-time SWE and TE. Liver stiffness values increased in parallel with degree of liver fibrosis, both with SWE and TE. AUROCs were 0.92 (95% confidence interval [CI]: 0.85-0.96) for SWE and 0.84 (95% CI: 0.76-0.90) for TE (P = 0.002), 0.98 (95% CI: 0.94-1.00) for SWE and 0.96 (95% CI: 0.90-0.99) for TE (P = 0.14), and 0.98 (95% CI: 0.93-1.00) for SWE and 0.96 (95% CI: 0.91-0.99) for TE (P = 0.48), when comparing F0-F1 versus F2- F4, F0- F2 versus F3-F4, and F0 -F3 versus F4, respectively.
The results of this study show that real-time SWE is more accurate than TE in assessing significant fibrosis (≥ F2). With respect to TE, SWE has the advantage of imaging liver stiffness in real time while guided by a B-mode image. Thus, the region of measurement can be guided with both anatomical and tissue stiffness information.
实时剪切波弹性成像（SWE）是一种通过测量肝硬度来评估肝纤维化的新型无创方法。本单中心研究旨在通过肝活检（LB）作为参考标准，评估 SWE 在慢性丙型肝炎（CHC）患者中的准确性，并与瞬时弹性成像（TE）进行比较。
连续纳入由主治医生安排进行 LB 的 CHC 患者。共 121 例患者符合纳入标准。当天，连续进行实时 SWE（使用 Aixplorer 超声系统，SuperSonic Imagine S.A.，Aix-en-Provence，法国）、TE（使用 FibroScan，Echosens，巴黎，法国）和 US 辅助 LB。纤维化根据 METAVIR 评分系统分期。进行接收器操作特征（ROC）曲线分析，计算实时 SWE 和 TE 对 F0-F1 与 F2-F4、F0-F2 与 F3-F4 和 F0-F3 与 F4 的最佳 ROC 曲线下面积（AUROC）。
SWE 和 TE 的肝硬度值均随肝纤维化程度平行增加。SWE 的 AUROC 为 0.92（95%置信区间 [CI]：0.85-0.96），TE 为 0.84（95%CI：0.76-0.90）（P = 0.002），SWE 的 AUROC 为 0.98（95%CI：0.94-1.00），TE 为 0.96（95%CI：0.90-0.99）（P = 0.14），SWE 的 AUROC 为 0.98（95%CI：0.93-1.00），TE 为 0.96（95%CI：0.91-0.99）（P = 0.48），分别用于比较 F0-F1 与 F2-F4、F0-F2 与 F3-F4 和 F0-F3 与 F4。
本研究结果表明，实时 SWE 在评估显著纤维化（≥F2）方面比 TE 更准确。与 TE 相比，SWE 具有实时成像肝硬度的优势，同时在 B 型图像引导下进行。因此，测量区域可以同时使用解剖和组织硬度信息进行引导。
