慢性肝病患者肝脏硬度测量的可靠性及其剪切波弹性成像主要决定因素。
Liver stiffness measurement reliability and main determinants of point shear-wave elastography in patients with chronic liver disease.
机构信息
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, Milan, Italy.
出版信息
Aliment Pharmacol Ther. 2016 Aug;44(4):356-65. doi: 10.1111/apt.13711. Epub 2016 Jun 30.
BACKGROUND
Liver stiffness (LS) measured by transient elastography (TE) accurately predicts the severity of chronic liver diseases (CLD). Point quantification shear-wave elastography (pSWE) is a new technique incorporated into a conventional ultrasound system for measuring LS. We evaluated pSWE feasibility, reproducibility and diagnostic accuracy in consecutively recruited CLD patients who concomitantly underwent TE and liver biopsy.
AIM
To evaluate pSWE feasibility, reproducibility and diagnostic accuracy in consecutively recruited CLD patients who concomitantly underwent TE and liver biopsy.
METHODS
Over 2 years 186 CLD patients (116 males, 132 viral hepatitis) consecutively underwent pSWE (10 valid measurements by ElastPQ) blindly performed by two raters. A further operator performed TE. Inter-observer agreement for pSWE was analysed by intraclass correlation coefficient (ICC) and correlated with histological liver fibrosis (METAVIR). Main determinants of pSWE were investigated by linear regression model.
RESULTS
Three hundred and seventy-two (100%) reliable measurements were obtained by pSWE and 184 by TE (99%). LS was 8.1 ± 4.5 kPa for pSWE with the first rater and 8.0 ± 4.2 kPa with the second one vs. 8.8 ± 3.6 kPa for TE. pSWE ICC was 0.89 (95% CI 0.85-0.91), not influenced by age, sex, BMI, liver enzymes, liver aetiology. ICC increased over time with year 1 at 0.86 and 95% CI 0.81-0.90 vs. year 2 at 0.92 and 95% CI 0.87-0.95. Liver fibrosis was the only independent determinant of LS on pSWE. The AUROCs for diagnosing F ≥ 2, F ≥ 3 and F = 4 were 0.77, 0.85 and 0.88 for pSWE vs. 0.81, 0.88 and 0.94 for TE. After 1-year training they were 0.86, 0.94 and 0.91.
CONCLUSION
Point quantification shear-wave elastography reliably and reproducibly evaluates liver stiffness, matching transient elastography for accuracy after a 1-year learning curve or 130 examinations.
背景
通过瞬时弹性成像（TE）测量的肝硬度（LS）准确预测慢性肝病（CLD）的严重程度。点量化剪切波弹性成像（pSWE）是一种新技术，它被整合到常规超声系统中，用于测量 LS。我们评估了 pSWE 在同时接受 TE 和肝活检的连续招募的 CLD 患者中的可行性、可重复性和诊断准确性。
目的
评估同时接受 TE 和肝活检的连续招募的 CLD 患者中 pSWE 的可行性、可重复性和诊断准确性。
方法
在 2 年的时间里，186 例 CLD 患者（116 名男性，132 名病毒性肝炎）连续接受了由两名评估者进行的 pSWE（ElastPQ 进行了 10 次有效测量）。另一名操作员进行了 TE。通过组内相关系数（ICC）分析 pSWE 的观察者间一致性，并与组织学肝纤维化（METAVIR）相关。通过线性回归模型研究 pSWE 的主要决定因素。
结果
通过 pSWE 获得了 372 次（100%）可靠的测量值，通过 TE 获得了 184 次（99%）。pSWE 第一次测量的 LS 为 8.1 ± 4.5 kPa，第二次测量的 LS 为 8.0 ± 4.2 kPa，而 TE 的 LS 为 8.8 ± 3.6 kPa。pSWE 的 ICC 为 0.89（95%CI 0.85-0.91），不受年龄、性别、BMI、肝酶、肝病因的影响。ICC 随着时间的推移而增加，第 1 年为 0.86，95%CI 为 0.81-0.90，第 2 年为 0.92，95%CI 为 0.87-0.95。肝纤维化是 pSWE 评估 LS 的唯一独立决定因素。pSWE 诊断 F≥2、F≥3 和 F=4 的 AUROCs 分别为 0.77、0.85 和 0.88，TE 为 0.81、0.88 和 0.94。经过 1 年的培训，AUROCs 分别为 0.86、0.94 和 0.91。
结论
点量化剪切波弹性成像能够可靠且可重复地评估肝硬度，与经过 1 年学习曲线或 130 次检查的瞬时弹性成像具有相同的准确性。
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