Praveenraj Palanivelu, Gomes Rachel Maria, Basuraju Srikanth, Kumar Saravana, Senthilnathan Palanisamy, Parathasarathi Ramakrishnan, Rajapandian Subbiah, Palanivelu Chinnusamy
1 Department of Bariatric Surgery, GEM Hospital and Research Centre , Coimbatore, India .
2 Department of Radiology, GEM Hospital and Research Centre , Coimbatore, India .
J Laparoendosc Adv Surg Tech A. 2016 Mar;26(3):192-5. doi: 10.1089/lap.2015.0396. Epub 2016 Feb 19.
Acoustic Radiation Force Impulse (ARFI) shear wave imaging is a noninvasive method of assessment of the liver to detect fibrosis in patients with chronic hepatitis and nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective study was to investigate whether noninvasive measurement of shear wave velocity (SWV) by ARFI shear wave imaging has a potential usefulness for detection of fibrosis secondary to NAFLD in patients with morbid obesity.
Twenty-eight morbidly obese patients were included in this study. NAFLD and fibrosis were classified according to the nonalcoholic steatohepatitis (NASH) Clinical Research Network NAFLD activity score. SWV was quantified by ARFI imaging. Component steatosis, inflammation and ballooning scores, and fibrosis staging were correlated with SWV, and diagnostic accuracy of ARFI for fibrosis was assessed.
There was a decrease in mean SWV with increasing hepatic steatosis (P = .057). The SWV showed a significant negative correlation (r = -0.417, P = .011) with steatosis grade. The mean SWV was neither significantly different nor correlating with the obesity classes based on body mass index (BMI), steatosis grades, inflammation grades, ballooning grades, and fibrosis stages of NAFLD. Receiver operating characteristic analysis showed no significant area under curve for diagnosis of fibrosis using SWV. Valid SWV could be acquired in all subjects; however, only 21.42% fulfilled the interquartile range criterion.
ARFI SWV values do not correlate with fibrosis on liver biopsy in morbidly obese patients and lack accuracy for diagnosis. Discordant values may be related to higher BMI and increasing hepatic steatosis.
声辐射力脉冲（ARFI）剪切波成像技术是一种用于评估肝脏的非侵入性方法，可检测慢性肝炎和非酒精性脂肪性肝病（NAFLD）患者的肝纤维化情况。本回顾性研究旨在探讨通过ARFI剪切波成像技术对剪切波速度（SWV）进行非侵入性测量，对于检测病态肥胖患者继发于NAFLD的肝纤维化是否具有潜在的应用价值。
本研究纳入了28例病态肥胖患者。根据非酒精性脂肪性肝炎（NASH）临床研究网络的NAFLD活动评分对NAFLD和肝纤维化进行分类。通过ARFI成像对SWV进行量化。将脂肪变性、炎症和气球样变评分以及肝纤维化分期与SWV进行相关性分析，并评估ARFI对肝纤维化的诊断准确性。
随着肝脏脂肪变性程度的增加，平均SWV降低（P = 0.057）。SWV与脂肪变性分级呈显著负相关（r = -0.417，P = 0.011）。基于体重指数（BMI）、NAFLD的脂肪变性分级、炎症分级、气球样变分级和肝纤维化分期，平均SWV在不同肥胖类别之间既无显著差异，也无相关性。受试者工作特征分析显示，使用SWV诊断肝纤维化时曲线下面积无显著意义。所有受试者均可获得有效的SWV；然而，只有21.42%的受试者满足四分位数间距标准。
在病态肥胖患者中，ARFI的SWV值与肝活检的肝纤维化情况不相关，且缺乏诊断准确性。不一致的值可能与较高的BMI和肝脏脂肪变性增加有关。
