慢性乙型肝炎病毒携带者肝脏纤维化和脾脏硬度的定量弹性成像：剪切波弹性成像与瞬时弹性成像与肝活检相关性的比较。
Quantitative elastography of liver fibrosis and spleen stiffness in chronic hepatitis B carriers: comparison of shear-wave elastography and transient elastography with liver biopsy correlation.
机构信息
From the Institute of Digestive Disease (J.S., V.W.W., G.L.W., A.M.C., S.H.C., H.L.C., W.C.C.), Department of Imaging and Interventional Radiology (V.Y.L., J.A., A.T.A., W.C.C.), Department of Medicine and Therapeutics (J.S., V.W.W., G.L.W., A.M.C., S.H.C., H.L.C.), and Department of Anatomical and Cellular Pathology (A.W.C., P.C.C.), Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, Hong Kong, SAR, China 852.
出版信息
Radiology. 2013 Dec;269(3):910-8. doi: 10.1148/radiol.13130128. Epub 2013 Oct 28.
PURPOSE
To document utility of shear-wave (SW) elastography for assessing liver fibrosis in chronic hepatitis B and to compare its performance with that of transient elastography.
MATERIALS AND METHODS
Ethics committee approved the study, and informed consent was obtained. Patients with liver biopsy correlation (n = 226) and healthy patients (n = 171) were analyzed. Results of SW elastography of liver, SW elastography of spleen, and transient elastography of liver were compared and correlated according to METAVIR scores. Areas under the receiver operating characteristic curve (AUCs), binary logistic regression, and Delong test were used.
RESULTS
AUC for SW elastography of liver, transient elastography of liver, and SW elastography of spleen was, respectively, 0.86, 0.80, and 0.81 for fibrosis (≥ F1 stage); 0.88, 0.78, and 0.82 for moderate fibrosis (≥ F2 stage); 0.93, 0.83, and 0.83 for severe fibrosis (≥ F3 stage); and 0.98, 0.92, and 0.84 for cirrhosis (F4 stage). SW elastography of liver showed significantly higher accuracy than transient elastography of liver and SW elastography of spleen in all fibrosis stages (P = .01-.04). SW elastography of spleen showed similar accuracy with transient elastography of liver (P = .21-.99). Combination SW elastography of liver and SW elastography of spleen to predict fibrosis staging showed diagnostic accuracy not further improved compared with SW elastography of liver alone (similar AUC; ≥ F1, P = .87; ≥ F2, P = .81; ≥ F3, P = .84; ≥ F4, P = .88). SW elastography of liver had higher successful rate than transient elastography of liver (98.9% vs 89.6%). Prevalence of discordance in at least two stages with liver histologic staging was 10.2% (23 of 226) for SW elastography of liver and 28.2% (58 of 206) for SW elastography of spleen.
CONCLUSION
SW elastography provides more accurate correlation of liver elasticity with liver fibrosis stage compared with transient elastography, especially in identification of stage F2 or greater.
目的
记录剪切波（SW）弹性成像在评估慢性乙型肝炎肝纤维化中的应用，并比较其与瞬时弹性成像的性能。
材料与方法
本研究经伦理委员会批准，并获得患者知情同意。对 226 例有肝活检相关性患者和 171 例健康患者进行分析。根据 METAVIR 评分比较 SW 肝弹性成像、SW 脾弹性成像和瞬时弹性成像的结果，并进行相关性分析。使用受试者工作特征曲线下面积（AUC）、二元逻辑回归和 Delong 检验。
结果
SW 肝弹性成像、瞬时弹性成像肝和 SW 脾弹性成像的 AUC 分别为纤维化（≥F1 期）0.86、0.80 和 0.81；中度纤维化（≥F2 期）0.88、0.78 和 0.82；重度纤维化（≥F3 期）0.93、0.83 和 0.83；肝硬化（F4 期）0.98、0.92 和 0.84。SW 肝弹性成像在所有纤维化阶段的准确性均显著高于瞬时弹性成像肝和 SW 脾弹性成像（P=.01-.04）。SW 脾弹性成像与瞬时弹性成像肝的准确性相似（P=.21-.99）。SW 肝弹性成像联合 SW 脾弹性成像预测纤维化分期的诊断准确性与单独使用 SW 肝弹性成像无显著差异（相似 AUC；≥F1，P=.87；≥F2，P=.81；≥F3，P=.84；≥F4，P=.88）。SW 肝弹性成像的成功率高于瞬时弹性成像肝（98.9% vs 89.6%）。与肝组织学分期相比，SW 肝弹性成像至少有两个阶段的不一致率为 10.2%（226 例中有 23 例），SW 脾弹性成像的不一致率为 28.2%（206 例中有 58 例）。
结论
与瞬时弹性成像相比，SW 弹性成像提供了更准确的肝弹性与肝纤维化分期的相关性，特别是在识别 F2 期或更高级别的纤维化方面。
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