实时剪切波弹性成像：在临床显著门脉高压中的适用性、可靠性和准确性。
Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension.
机构信息
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain.
出版信息
J Hepatol. 2015 May;62(5):1068-75. doi: 10.1016/j.jhep.2014.12.007. Epub 2014 Dec 13.
BACKGROUND & AIMS: Real-time shear wave elastography (RT-SWE) might be useful to assess the severity of portal hypertension; reliability criteria for measurement are needed.
METHODS
We prospectively included 88 consecutive patients undergoing hepatic venous pressure gradient measurement (HVPG, reference standard) for portal hypertension. Liver stiffness (LS) was measured by RT-SWE and by transient elastography (TE). Spleen stiffness (SS) was measured by RT-SWE. Reliability criteria for RT-SWE were searched, and the accuracy of these techniques to identify HVPG ⩾10mmHg (clinically significant portal hypertension, CSPH) was tested and internally validated by bootstrapping analysis.
RESULTS
LS and SS by RT-SWE were feasible respectively in 87 (99%) and 58 (66%) patients. Both correlated with HVPG (LS: R=0.611, p<0.0001 and SS: R=0.514, p<0.0001). LS performed well for diagnosing CSPH (optimism corrected AUROC=0.858). Reliability of measurements was influenced by standard deviation (SD)/median ratio and depth. SD/median ⩽0.10 and depth of measurement <5.6cm were associated to 96.3% well classified for CSPH, while when one or none of the criteria were fulfilled the rates were 76.4% and 44.4%, respectively. Measurements fulfilling at least one criterion were considered acceptable; in these patients, RT-SWE performance to detect CSPH was excellent (AUROC=0.939; 95% CI: 0.865-1.000; p<0.0001; best cut-off: 15.4kPa). LS by RT-SWE and by TE were strongly correlated (R=0.795, p<0.0001) and performed similarly both in "per protocol" and in "intention-to-diagnose" analysis after applying reliability criteria.
CONCLUSIONS
LS by RT-SWE is an accurate method to diagnose CSPH if reliability criteria (SD/median ⩽0.10 and/or depth <5.6cm) are fulfilled.
背景与目的
实时剪切波弹性成像（RT-SWE）可能有助于评估门静脉高压的严重程度；需要测量的可靠性标准。
方法
我们前瞻性地纳入了 88 例连续接受肝静脉压力梯度测量（HVPG，参考标准）的门静脉高压患者。通过 RT-SWE 和瞬时弹性成像（TE）测量肝硬度（LS）。通过 RT-SWE 测量脾硬度（SS）。寻找 RT-SWE 的可靠性标准，并通过 bootstrap 分析对内进行验证，测试这些技术识别 HVPG ⩾10mmHg（临床显著门静脉高压，CSPH）的准确性。
结果
RT-SWE 的 LS 和 SS 分别在 87（99%）和 58（66%）例患者中可行。LS 和 SS 均与 HVPG 相关（LS：R=0.611，p<0.0001 和 SS：R=0.514，p<0.0001）。LS 诊断 CSPH 的效果良好（校正后的乐观 AUC=0.858）。测量的可靠性受标准差（SD）/中位数比和深度的影响。SD/中位数 ⩽0.10 和测量深度<5.6cm 与 CSPH 分类为 96.3%有关，而当满足一个或一个标准都不满足时，分类率分别为 76.4%和 44.4%。满足至少一个标准的测量被认为是可接受的；在这些患者中，RT-SWE 检测 CSPH 的性能非常出色（AUC=0.939；95%CI：0.865-1.000；p<0.0001；最佳截断值：15.4kPa）。RT-SWE 和 TE 的 LS 高度相关（R=0.795，p<0.0001），并且在应用可靠性标准后，在“按方案”和“意向诊断”分析中表现相似。
结论
如果满足可靠性标准（SD/中位数 ⩽0.10 和/或深度<5.6cm），则通过 RT-SWE 的 LS 是一种准确的诊断 CSPH 的方法。
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