Zaleska-Dorobisz Urszula, Pawluś Aleksander, Kucharska Marta, Inglot Marcin
Samodzielny Publiczny Szpital Kliniczny nr 1 we Wrocławiu, Zakład Radiologii Ogólnej i Pediatrycznej.
Uniwersytet Medyczny we Wrocławiu, Katedra Chorób Zakaźnych, Chorób Wątroby i Nabytych Niedoborów Odpornościowych.
Postepy Hig Med Dosw (Online). 2015 Feb 15;69:221-6. doi: 10.5604/17322693.1140338.
Liver fibrosis is a relatively common consequence of chronic liver diseases, especially chronic viral hepatitis B and C. Biopsy still remains the gold standard in the assessment of liver fibrosis. However, due to its invasiveness and possible complications, less or even non-invasive methods are being developed, e.g. using biochemical parameters (Fibrotest) or elastography. Elastography is a new diagnostic tool that aims to evaluate stiffness of the tissues. Elastography techniques that are used in the assessment of liver fibrosis are transient elastography (TE), acoustic radiation force impulse (ARFI) and shear-wave elastography (SWE). SWE is a novel real-time two-dimensional elastography technique, which allows one to estimate stiffness quantitatively in kilopascals (kPa). Moreover, lapping elastography over regular B-mode allows precise choice of the region of interest. Therefore SWE creates the opportunity for accurate assessment of liver fibrosis. In this paper we describe processes leading to liver fibrosis as well as methods of liver fibrosis assessment, e.g. liver biopsy, biochemical tests or elastography. The main goal of this paper is to present the SWE technique, its role in liver fibrosis assessment and a short review of the most important clinical studies on SWE. We also present several examples of SWE examinations performed on patients with different stages of liver fibrosis - F0 to F4 on the METAVIR scale.
肝纤维化是慢性肝病相对常见的后果，尤其是慢性乙型和丙型病毒性肝炎。活检仍是评估肝纤维化的金标准。然而，由于其侵入性及可能的并发症，人们正在开发更少甚至非侵入性的方法，例如使用生化参数（Fibrotest）或弹性成像技术。弹性成像技术是一种旨在评估组织硬度的新型诊断工具。用于评估肝纤维化的弹性成像技术包括瞬时弹性成像（TE）、声辐射力脉冲（ARFI）和剪切波弹性成像（SWE）。SWE是一种新型的实时二维弹性成像技术，它能让人们以千帕（kPa）为单位定量估计组织硬度。此外，将弹性成像叠加在常规B超模式上可精确选择感兴趣区域。因此，SWE为准确评估肝纤维化创造了机会。在本文中，我们描述了导致肝纤维化的过程以及肝纤维化的评估方法，例如肝活检、生化检测或弹性成像技术。本文的主要目的是介绍SWE技术、其在肝纤维化评估中的作用以及对有关SWE的最重要临床研究的简要综述。我们还展示了对处于肝纤维化不同阶段（METAVIR分级为F0至F4）的患者进行SWE检查的几个实例。
