Shin Na-Young, Kim Myung-Joon, Lee Mi-Jung, Han Seok Joo, Koh Hong, Namgung Ran, Park Young Nyun
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-ku, Seoul 120-752, Korea.
J Ultrasound Med. 2014 May;33(5):853-64. doi: 10.7863/ultra.33.5.853.
The purpose of this study was to assess the diagnostic performance of transient elastography and sonography for noninvasive evaluation of liver fibrosis in infants with biliary atresia.
Forty-seven infants with biliary atresia who underwent both transient elastography and sonography before surgery were included in this study. Two types of transient elastographic probes were used: an M probe, which is used for the general adult population; and an S probe, which is specific to children. Transient elastographic measurements and sonographic findings such as triangular cord thickness and hepatic artery and portal vein diameters were compared with the METAVIR histopathologic fibrosis scoring system.
Only transient elastography (ρ = 0.63; P < .001) was significantly correlated with METAVIR fibrosis stages. The areas under the receiver operating characteristic curves for transient elastography were 0.86 and 0.96 for diagnosis of severe fibrosis and cirrhosis, respectively. The cutoff value of transient elastography for diagnosis of severe fibrosis was greater than 9.6 kPa, with sensitivity of 89.5% and specificity of 75%. The cutoff value of transient elastography for diagnosis of cirrhosis was greater than 18.1 kPa, with sensitivity of 100% and specificity of 90.5%. The success rate for the S probe (100%) was significantly higher than that for the M probe (77%; P < .001).
Transient elastography may be a useful noninvasive method for diagnosis of severe fibrosis and cirrhosis and may help predict outcomes before surgery or invasive liver biopsy in infants with biliary atresia. The success rate of transient elastography in infants was improved by using the S probe.
本研究旨在评估瞬时弹性成像和超声检查对胆道闭锁婴儿肝纤维化进行无创评估的诊断性能。
本研究纳入了47例在手术前接受过瞬时弹性成像和超声检查的胆道闭锁婴儿。使用了两种类型的瞬时弹性成像探头：一种是用于一般成人的M探头；另一种是儿童专用的S探头。将瞬时弹性成像测量值和超声检查结果，如三角索厚度、肝动脉和门静脉直径，与METAVIR组织病理学纤维化评分系统进行比较。
只有瞬时弹性成像（ρ = 0.63；P <.001）与METAVIR纤维化分期显著相关。瞬时弹性成像诊断严重纤维化和肝硬化的受试者操作特征曲线下面积分别为0.86和0.96。瞬时弹性成像诊断严重纤维化的临界值大于9.6 kPa，敏感性为89.5%，特异性为75%。瞬时弹性成像诊断肝硬化的临界值大于18.1 kPa，敏感性为100%，特异性为90.5%。S探头的成功率（100%）显著高于M探头（77%；P <.001）。
瞬时弹性成像可能是诊断严重纤维化和肝硬化的一种有用的无创方法，可能有助于预测胆道闭锁婴儿手术或有创肝活检前的预后。使用S探头可提高婴儿瞬时弹性成像的成功率。
