Dillman Jonathan R, Stidham Ryan W, Higgins Peter D R, Moons David S, Johnson Laura A, Keshavarzi Nahid R, Rubin Jonathan M
Departments of Radiology (J.R.D., J.M.R.), Internal Medicine, Division of Gastroenterology (R.W.S., P.D.R.H., L.A.J.), and Pathology (D.S.M.), University of Michigan Health System, Ann Arbor, Michigan USA; and Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan USA (N.R.K.).
J Ultrasound Med. 2014 Dec;33(12):2115-23. doi: 10.7863/ultra.33.12.2115.
To determine whether bowel wall fibrosis can be detected in freshly resected human intestinal specimens based on ultrasound-derived shear wave speed.
Seventeen intact (>3-cm) bowel segments (15 small and 2 large intestine) from 12 patients with known or suspected inflammatory bowel disease were procured immediately after surgical resection. Ultrasound shear wave elastography of the bowel wall was performed by two methods (Virtual Touch Quantification [VTQ] and Virtual Touch-IQ [VT-IQ]; Siemens Medical Solutions USA, Inc, Mountain View, CA). Eighteen short-axis shear wave speed measurements were acquired from each specimen: 3 from the 9-, 12-, and 3-o'clock locations for each method. Imaging was performed in two areas for specimens greater than 10 cm in length (separated by ≥5 cm). A gastrointestinal pathologist scored correlative histologic slides for inflammation and fibrosis. Differences in mean shear wave speed between bowel segments with low and high inflammation/fibrosis scores were assessed by a Student t test. Receiver operating characteristic curve analysis was performed.
High-fibrosis score (n = 11) bowel segments had a significantly greater mean shear wave speed than low-fibrosis score (n = 6) bowel segments (mean ± SD: VTQ, 1.59 ± 0.37 versus 1.18 ± 0.08 m/s; P= .004; VT-IQ, 1.87 ± 0.44 versus 1.50 ± 0.26 m/s; P= .049). There was no significant difference in mean shear wave speed between high-and low-inflammation score bowel segments (P > .05 for both VTQ and VT-IQ). Receiver operating characteristic curves showed areas under the curve of 0.91 (95% confidence interval, 0.67-0.99) for VTQ and 0.77 (95% confidence interval, 0.51-0.94) for VT-IQ in distinguishing low-from high-fibrosis score bowel segments.
Ex vivo bowel wall shear wave speed measurements increase when transmural intestinal fibrosis is present.
基于超声衍生的剪切波速度，确定在新鲜切除的人体肠道标本中是否能检测到肠壁纤维化。
从12例已知或疑似炎症性肠病患者中获取17个完整的（>3厘米）肠段（15个小肠段和2个大肠段），在手术切除后立即获取。通过两种方法（虚拟触诊定量[VTQ]和虚拟触诊智商[VT-IQ]；美国西门子医疗解决方案公司，加利福尼亚州山景城）对肠壁进行超声剪切波弹性成像。从每个标本中获取18个短轴剪切波速度测量值：每种方法在9点、12点和3点位置各取3个。对于长度大于10厘米的标本，在两个区域进行成像（相隔≥5厘米）。一位胃肠病理学家对相关组织学切片的炎症和纤维化进行评分。通过学生t检验评估炎症/纤维化评分低和高的肠段之间平均剪切波速度的差异。进行受试者操作特征曲线分析。
高纤维化评分（n = 11）的肠段平均剪切波速度显著高于低纤维化评分（n = 6）的肠段（平均值±标准差：VTQ，1.59±0.37对1.18±0.08米/秒；P = .004；VT-IQ，1.87±0.44对1.50±0.26米/秒；P = .049）。高炎症评分和低炎症评分的肠段之间平均剪切波速度无显著差异（VTQ和VT-IQ均P > .05）。受试者操作特征曲线显示，在区分低纤维化评分和高纤维化评分的肠段时，VTQ的曲线下面积为0.91（95%置信区间，0.67 - 0.99），VT-IQ的曲线下面积为0.77（95%置信区间，0.51 - 0.94）。
当存在透壁性肠纤维化时，离体肠壁剪切波速度测量值会增加。
