Yegin Ender Gunes, Yegin Korkut, Karatay Emrah, Kombak Erdem Faruk, Tuney Davut, Ataizi-Celikel Cigdem, Ozdogan Osman Cavit
Department of Gastroenterology, Bozyaka State Hospital, Izmir.
J Dig Dis. 2015 Apr;16(4):217-27. doi: 10.1111/1751-2980.12231.
To analyze the relationship between fibrosis staged by Ishak stage and quantified by digital image analysis (DIA), and to reveal the optimum performance of shear-wave elastography (SWE) using quantitative DIA measurements as a comparative histological standard.
The proportionate area (PA) of fibrosis was measured by DIA from images of the PA of trichrome-stain (TPA) of 168 chronic hepatitis patients. SWE was performed in 105 patients. The accuracy of SWE for predicting the fibrosis defined by quantitative PA thresholds (≥ 2.5%, ≥ 5%, ≥ 10% and ≥ 20%, respectively) and by Ishak stages was measured using the area under the receiver operating characteristic curve (AUROC).
DIA was proven to be highly reproducible (interclass correlation coefficient 0.926). The TPA range corresponding to each Ishak stage was large, widened as stages progressed, and reached its greatest extent in cirrhosis. TPA magnified at ×50 ranges 11.9-56% for Ishak stage F5-6. A good correlation between TPA and elasticity was presented for more advanced fibrosis (TPA ≥10%, rs = 0.732, P = 0.000) than milder fibrosis (TPA <10%, rs = 0.308, P = 0.006). With the advance of fibrosis either by stages or PA thresholds the discriminative accuracy of SWE gradually increased, but was less satisfactory for milder fibrosis.
DIA may serve as a reproducible and reliable quantitative standard for surrogate tests for liver fibrosis. The performance and correlation of SWE with the fibrotic extent were better for advanced fibrosis, but less satisfactory for milder fibrosis.
分析采用伊沙克分期法分期并经数字图像分析（DIA）量化的纤维化之间的关系，并以定量DIA测量结果作为比较组织学标准，揭示剪切波弹性成像（SWE）的最佳性能。
通过DIA从168例慢性肝炎患者的三色染色（TPA）图像中测量纤维化的比例面积（PA）。对105例患者进行了SWE检查。使用受试者操作特征曲线下面积（AUROC）测量SWE预测由定量PA阈值（分别为≥2.5%、≥5%、≥10%和≥20%）和伊沙克分期定义的纤维化的准确性。
DIA被证明具有高度可重复性（组内相关系数为0.926）。每个伊沙克分期对应的TPA范围较大，随着分期进展而扩大，在肝硬化时达到最大范围。在×50放大倍数下，伊沙克分期F5 - 6的TPA范围为11.9 - 56%。与较轻纤维化（TPA < 10%，rs = 0.308，P = 0.006）相比，较晚期纤维化（TPA≥10%，rs = 0.732，P = 0.000）时TPA与弹性之间呈现良好的相关性。随着纤维化分期或PA阈值的增加，SWE的鉴别准确性逐渐提高，但对较轻纤维化的效果不太理想。
DIA可作为肝纤维化替代检测的可重复且可靠的定量标准。SWE在晚期纤维化时与纤维化程度的性能及相关性较好，但对较轻纤维化不太理想。
