1 Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903.
AJR Am J Roentgenol. 2014 Sep;203(3):W267-73. doi: 10.2214/AJR.13.11718.
The purpose of this study was to evaluate the diagnostic accuracy of real-time shear-wave elastography for assessment of liver fibrosis in an unselected patient population, comparing shear-wave elastography measurements obtained at and remote from the site of random liver biopsy.
In a prospective study of 50 patients (21 with and 29 without hepatitis C) referred for clinically indicated random liver biopsy for diffuse liver disease, shear-wave elastography measurements were taken from four locations before biopsy: one at the left lobe, two at the right lobe, and one at the biopsy location. The mean, minimum, maximum, and SD of shear-wave elastography were compared with pathologic grading. Steatosis and serum markers were analyzed using multiple logistic regression. Optimized shear-wave elastography thresholds were calculated using AUC analysis.
The AUC (95% CI) at the biopsy site, ipsilateral lobe, and contralateral lobe were 0.82 (0.63-1.0), 0.84 (0.67-1.0), and 0.59 (0.19-0.99) in hepatitis C patients; 0.89 (0.75-1.0), 0.88 (0.73-1.0), and 0.93 (0.80-1.0) in nonhepatitis C patients; and 0.85 (0.74-0.96), 0.89 (0.79-0.99), and 0.80 (0.67-0.93) in all patients, respectively. Optimized biopsy site shear-wave elastography values for detecting Metavir score F2 or greater were 1.87 m/s (75% sensitivity and specificity), 2.00 m/s (80% sensitivity and specificity), and 1.89 m/s (76% sensitivity and specificity) in hepatitis C, nonhepatitis C, and all patients, respectively. Steatosis and serum markers were not significant.
Real-time shear-wave elastography accurately predicted significant fibrosis (stage ≥ 2) in an unselected patient population with diffuse disease, including patients with and without hepatitis C. Shear-wave elastography best predicts pathologic grading when taken at the biopsy site or ipsilateral lobe in hepatitis C patients. Percentage steatosis was not predictive of shear-wave elastography results.
本研究旨在评估实时剪切波弹性成像在未选择患者人群中评估肝纤维化的诊断准确性，比较在肝活检部位和远离肝活检部位获得的剪切波弹性成像测量值。
在一项对 50 例（21 例丙型肝炎和 29 例非丙型肝炎）因弥漫性肝病而接受临床指征性随机肝活检的患者的前瞻性研究中，在活检前从四个部位获取剪切波弹性成像测量值：左叶一个部位、右叶两个部位和活检部位一个部位。比较剪切波弹性成像的平均值、最小值、最大值和标准差与病理分级。使用多元逻辑回归分析脂肪变性和血清标志物。使用 AUC 分析计算优化的剪切波弹性成像阈值。
在丙型肝炎患者中，活检部位、同侧叶和对侧叶的 AUC（95%CI）分别为 0.82（0.63-1.0）、0.84（0.67-1.0）和 0.59（0.19-0.99）；在非丙型肝炎患者中分别为 0.89（0.75-1.0）、0.88（0.73-1.0）和 0.93（0.80-1.0）；在所有患者中分别为 0.85（0.74-0.96）、0.89（0.79-0.99）和 0.80（0.67-0.93）。在丙型肝炎、非丙型肝炎和所有患者中，用于检测 Metavir 评分 F2 或更高的优化活检部位剪切波弹性成像值分别为 1.87m/s（75%的敏感性和特异性）、2.00m/s（80%的敏感性和特异性）和 1.89m/s（76%的敏感性和特异性）。脂肪变性和血清标志物无显著意义。
实时剪切波弹性成像在包括丙型肝炎和非丙型肝炎患者在内的弥漫性疾病未选择患者人群中准确预测显著纤维化（≥2 级）。在丙型肝炎患者中，在活检部位或同侧叶获取的剪切波弹性成像最能预测病理分级。脂肪变性百分比不能预测剪切波弹性成像结果。
