Shima Hideki, Igarashi Gaku, Wakisaka Munechika, Hamano Shiho, Nagae Hideki, Koyama Mariko, Kitagawa Hiroaki
Division of Pediatric Surgery, Department of Clinical Examination Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
Pediatr Surg Int. 2012 Sep;28(9):869-72. doi: 10.1007/s00383-012-3140-4.
Liver biopsy (LB) is still considered the "gold standard" for hepatological evaluation, but recently noninvasive methods have attempted to replace this invasive procedure. Recently, acoustic radiation force impulse (ARFI) imaging has been developed as a noninvasive modality to evaluate the stiffness of tissues. ARFI imaging theoretically measures liver stiffness of all the segments independently. The aim of this study was to determine whether ARFI elastography is a reliable method for predicting the severity of fibrosis in the post-operative patients with biliary atresia.
ARFI elastography was performed 21 times in eight patients with biliary atresia over the last 2 years. At the same time, we measured serum hyaluronic acid (H value), which is one of the serum elastic makers, to compare ARFI versus values in these patients. We obtained ARFI versus values as the median of S2 to S8 by three consecutive measurements acquired with a Siemens Acuson S2000 (Siemens Medical Systems, Germany).
Histological evaluation of fibrosis is graded from F0 (normal) to F4. The normal H value is under 50 mg/dl. One patient had F0 (H value 29.2 mg/dl), four had F1 (H value 11.5-18.1 mg/dl), one had F3 (H value 61.3 mg/dl), two had F4 (H value 29.2, 112 mg/dl). One patient with F4 whose ARFI versus value (3.56 m/s) was the highest, needed liver transplantation and her liver was cirrhotic.
These findings suggest that ARFI measurement may be a reliable method for predicting the severity of fibrosis after a Kasai operation.
肝活检（LB）仍是肝脏疾病评估的“金标准”，但近年来非侵入性方法试图取代这种侵入性操作。最近，声辐射力脉冲（ARFI）成像已发展成为一种评估组织硬度的非侵入性方式。ARFI成像理论上可独立测量所有肝段的肝脏硬度。本研究的目的是确定ARFI弹性成像是否是预测胆道闭锁术后患者纤维化严重程度的可靠方法。
在过去两年中，对8例胆道闭锁患者进行了21次ARFI弹性成像检查。同时，我们测量了血清透明质酸（H值），它是血清弹性标志物之一，以比较这些患者的ARFI值。我们使用西门子Acuson S2000（德国西门子医疗系统公司）通过连续三次测量获得S2至S8的中位数作为ARFI值。
纤维化的组织学评估从F0（正常）到F4分级。正常H值低于50mg/dl。1例患者为F0（H值29.2mg/dl），4例为F1（H值11.5 - 18.1mg/dl），1例为F3（H值61.3mg/dl），2例为F4（H值29.2、112mg/dl）。1例F4患者的ARFI值（3.56m/s）最高，需要进行肝移植，其肝脏已发生肝硬化。
这些发现表明，ARFI测量可能是预测葛西手术后纤维化严重程度的可靠方法。
