剪切波弹性成像：一种用于评估慢性肝病肝纤维化分期的准确技术。
Shear wave elastography: An accurate technique to stage liver fibrosis in chronic liver diseases.
作者信息
Guibal A, Renosi G, Rode A, Scoazec J Y, Guillaud O, Chardon L, Munteanu M, Dumortier J, Collin F, Lefort T
机构信息
Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Service de radiologie, centre hospitalier de Perpignan, 20, avenue du Languedoc, 66046 Perpignan cedex 9, France.
Service de radiologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
出版信息
Diagn Interv Imaging. 2016 Jan;97(1):91-9. doi: 10.1016/j.diii.2015.11.001. Epub 2015 Dec 3.
OBJECTIVES
The goals of this study were to assess the diagnostic accuracy of shear wave elastography (SWE) using the results of histopathological analysis as a standard of reference and compare the results of SWE and those of transient elastography (TE) to the degree of fibrosis as evaluated by histomorphometry.
PATIENTS AND METHODS
Adult patients who were scheduled to undergo liver biopsy were prospectively enrolled in the study. The diagnostic performances of SWE were assessed using AUROC curve analysis according to fibrosis thresholds defined by ≥F2 (significant fibrosis), ≥F3 (advanced fibrosis) and F4 (cirrhosis). Additional analyses using the Obuchowski measures for pairwise comparisons of fibrosis stages were performed. In a subgroup of 55 patients, the relationships between stiffness as measured using SWE and TE and the percentage of fibrosis were compared using Spearman's rank coefficient.
RESULTS
Among the initially enrolled 170 patients, 148/170 (87%) had successful SWE acquisition and formed the study population. SWE sensitivity and specificity were respectively 85.1% and 82.7% (≥F2), 88.9% and 90.3% (≥F3), 93.3% and 98.3% (F4). The AUROC curves of SWE along with their 95% confidence intervals (CI) were respectively 0.904 (95%CI: 0.845-0.946) for fibrosis ≥F2; 0.958 (95%CI: 0.912-0.984) for fibrosis ≥F3 and 0.988 (95%CI: 0.955-0.999) for fibrosis=F4. The global Obuchowski measure was 0.953±0.007. In the subgroup study, a significant correlation was found between the percentage of fibrosis and stiffness as assessed by SWE (r=0.77; 95%CI: 0.63-0.86; P<0.0001) and by TE (r=0.65; 95%CI: 0.47-0.78; P<0.01).
CONCLUSION
SWE is accurate to assess liver fibrosis in patients with chronic liver disease.
目的
本研究的目的是评估以组织病理学分析结果作为参考标准的剪切波弹性成像（SWE）的诊断准确性，并将SWE和瞬时弹性成像（TE）的结果与通过组织形态计量学评估的纤维化程度进行比较。
患者与方法
前瞻性纳入计划接受肝活检的成年患者。根据≥F2（显著纤维化）、≥F3（进展性纤维化）和F4（肝硬化）定义的纤维化阈值，使用AUROC曲线分析评估SWE的诊断性能。使用Obuchowski方法对纤维化阶段进行成对比较的额外分析。在55例患者的亚组中，使用Spearman等级系数比较SWE和TE测量的硬度与纤维化百分比之间的关系。
结果
在最初纳入的170例患者中，148/170（87%）成功获得SWE图像并形成研究人群。SWE的敏感性和特异性分别为85.1%和82.7%（≥F2）、88.9%和90.3%（≥F3）、93.3%和98.3%（F4）。SWE的AUROC曲线及其对应的95%置信区间（CI）分别为：纤维化≥F2时为0.904（95%CI：0.845 - 0.946）；纤维化≥F3时为0.958（95%CI：0.912 - 0.984）；纤维化 = F4时为0.988（95%CI：0.955 - 0.999）。整体Obuchowski测量值为0.953±0.007。在亚组研究中，通过SWE评估的纤维化百分比与硬度之间存在显著相关性（r = 0.77；95%CI：0.63 - 0.86；P < 0.0001），通过TE评估时也存在显著相关性（r = 0.65；95%CI：0.47 - 0.78；P < 0.01）。
结论
SWE在评估慢性肝病患者肝纤维化方面具有准确性。
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