Kuwahara Takamichi, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Sugimoto Hiroyuki, Hayashi Daijuro, Morishima Tomomasa, Kawai Manabu, Suhara Hiroki, Takeyama Tomoaki, Yamamura Takeshi, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Shimoyama Yoshie, Nakamura Shigeo, Hashimoto Senju, Goto Hidemi
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
Pancreatology. 2016 Nov-Dec;16(6):1063-1068. doi: 10.1016/j.pan.2016.09.012. Epub 2016 Sep 23.
BACKGROUND & AIMS: There is no established non-invasive method for diagnosis of pancreatic fibrosis. Shear wave elastography (SW-EG) may be a candidate for this purpose. The aims of this study were to assess the reproducibility of SW-EG in the normal imaging pancreas (Phase 1) and to evaluate the diagnostic performance of SW-EG for pancreatic fibrosis classified histologically (Phase 2).
Phase 1: This included 127 cases that underwent SW-EG of the normal imaging pancreas. SW-EG was measured at least five times in the pancreatic parenchyma and the median of repeated measurements was defined as the pancreatic elastic modulus (PEM). Phase 2: This included 53 cases that underwent SW-EG of the pancreatic parenchyma preoperatively and in which pancreas parenchyma were evaluated histologically. Histological fibrosis was graded in 4 stages: normal, mild, moderate, and severe.
Phase 1: Median PEM in the head, body, and tail of the pancreas were 3.23, 3.17, and 2.91 kPa, respectively, with no significant difference among regions (P = 0.554). The intraclass correlation coefficient showed good reproducibility (ρ = 0.71) after 5 measurements. Phase 2: There was a significant positive correlation between PEM and the histological pancreatic fibrosis stage (r = 0.63, P < 0.001). Areas under the receiver operating characteristic curve for the accuracy of SW-EG for diagnosis of pancreatic fibrosis were 0.85 (≥mild), 0.84 (≥moderate), and 0.87 (severe).
SW-EG can be used to determine the stage of pancreatic fibrosis non-invasively with high accuracy and reproducibility.
目前尚无成熟的非侵入性方法用于诊断胰腺纤维化。剪切波弹性成像（SW-EG）可能适用于此目的。本研究的目的是评估SW-EG在正常成像胰腺中的可重复性（第1阶段），并评估SW-EG对组织学分类的胰腺纤维化的诊断性能（第2阶段）。
第1阶段：包括127例对正常成像胰腺进行SW-EG检查的病例。在胰腺实质中至少测量5次SW-EG，并将重复测量的中位数定义为胰腺弹性模量（PEM）。第2阶段：包括53例术前对胰腺实质进行SW-EG检查且对胰腺实质进行组织学评估的病例。组织学纤维化分为4期：正常、轻度、中度和重度。
第1阶段：胰腺头部、体部和尾部的PEM中位数分别为3.23、3.17和2.91kPa，各区域之间无显著差异（P = 0.554）。5次测量后组内相关系数显示出良好的可重复性（ρ = 0.71）。第2阶段：PEM与组织学胰腺纤维化分期之间存在显著正相关（r = 0.63，P < 0.001）。SW-EG诊断胰腺纤维化准确性的受试者操作特征曲线下面积分别为0.85（≥轻度）、0.84（≥中度）和0.87（重度）。
SW-EG可用于非侵入性地高精度、可重复地确定胰腺纤维化的分期。
