使用剪切波和瞬时弹性成像技术对肝硬化患者的门脉高压进行前瞻性比较脾脏和肝脏硬度检测。
Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis.
机构信息
From the Departments of Hepatology (L.E., P.E.R., C.F., A.P., F.D., D.V., D.L., L.C.) and Radiology (M.R., S.L., M.D.B., V.V.), Hôpital Beaujon-AP-HP, Université Paris Diderot, and INSERM U1149, Centre de Recherche sur l'Inflammation, 100 Boulevard du General Leclerc, 92100 Clichy, France.
出版信息
Radiology. 2015 May;275(2):589-98. doi: 10.1148/radiol.14141210. Epub 2014 Nov 28.
PURPOSE
To prospectively compare the technical success rate and accuracy of shear-wave elastography (SWE) and transient elastography (TE) for the detection of clinically significant portal hypertension (PH) in patients with advanced cirrhosis who are undergoing hepatic vein pressure gradient (HVPG) measurements.
MATERIALS AND METHODS
The institutional ethics committee approved the study, and written informed consent was obtained. Seventy-nine consecutive patients with cirrhosis who were undergoing SWE and TE at the time of HVPG measurement were studied. The technical success rate of SWE and TE was compared with the diagnostic value of liver stiffness (LS) and spleen stiffness (SS) measurements and composite scores (LS spleen-diameter-to-platelet-ratio score [LSPS] and PH risk score) by using SWE and TE to detect clinically significant PH (HVPG ≥ 10 mm Hg) and esophageal varices at high risk of bleeding. Areas under the receiver operating characteristic curve and the DeLong test were used.
RESULTS
The technical success rate of SWE was significantly better than that of TE for both LS and SS (97% and 97% vs 44% and 42%, respectively; P < .001). LS of more than 24.6 kPa with SWE had a sensitivity, specificity, and accuracy for clinically significant PH of 81%, 88%, and 82%, respectively. Diagnostic performance of LS by using SWE was significantly better than that for SS for the diagnosis of clinically significant PH (area under the receiver operating characteristic curve of 0.87 vs 0.64, P = .003). LS, SS, LSPS, and PH risk score (according to SWE or TE) did not differ between patients with and those without high-risk esophageal varices (P = .09-.42).
CONCLUSION
In patients with advanced cirrhosis who are undergoing HVPG measurements, LS measurements obtained by using SWE have a higher technical success rate and a better diagnostic value than TE for clinically significant PH.
目的
前瞻性比较剪切波弹性成像（SWE）和瞬时弹性成像（TE）检测接受肝静脉压力梯度（HVPG）测量的晚期肝硬化患者临床显著门静脉高压（PH）的技术成功率和准确性。
材料与方法
机构伦理委员会批准了该研究，并获得了书面知情同意。对 79 例同时接受 SWE 和 TE 测量的肝硬化患者进行了研究。比较了 SWE 和 TE 技术成功率与 LS 和 SS 测量值以及复合评分（LS 脾径血小板比评分 [LSPS] 和 PH 风险评分）的诊断价值，使用 SWE 和 TE 检测临床显著 PH（HVPG≥10mmHg）和高出血风险食管静脉曲张。使用受试者工作特征曲线下面积和 DeLong 检验进行评估。
结果
SWE 检测 LS 和 SS 的技术成功率明显优于 TE（分别为 97%和 97%与 44%和 42%；P<0.001）。SWE 检测 LS 超过 24.6kPa 对临床显著 PH 的敏感性、特异性和准确性分别为 81%、88%和 82%。SWE 检测 LS 对临床显著 PH 的诊断性能明显优于 SS（受试者工作特征曲线下面积为 0.87 与 0.64，P=0.003）。LS、SS、LSPS 和 PH 风险评分（根据 SWE 或 TE）在有和无高危食管静脉曲张的患者之间无差异（P=0.09-0.42）。
结论
在接受 HVPG 测量的晚期肝硬化患者中，SWE 检测 LS 具有更高的技术成功率和更好的诊断价值，可用于临床显著 PH。
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