Simmons O, Fetzer D T, Yokoo T, Marrero J A, Yopp A, Kono Y, Parikh N D, Browning T, Singal A G
Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA.
Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
Aliment Pharmacol Ther. 2017 Jan;45(1):169-177. doi: 10.1111/apt.13841. Epub 2016 Nov 8.
Abdominal ultrasound fails to detect over one-fourth of hepatocellular carcinoma (HCC) at an early stage in patients with cirrhosis. Identifying patients in whom ultrasound is of inadequate quality can inform interventions to improve surveillance effectiveness.
To evaluate and identify predictors of ultrasound quality in patients with cirrhosis.
We performed a retrospective cohort study among patients who underwent ultrasound examination for a cirrhosis-related indication between April 2015 and October 2015. Three fellowship-trained abdominal radiologists collectively reviewed all ultrasound exams and categorised exam quality as definitely adequate, likely adequate, likely inadequate and definitely inadequate to exclude liver lesions. We performed multivariable logistic regression to determine characteristics associated with inadequate ultrasound quality.
Among 941 patients, 191 (20.3%) ultrasounds were inadequate for excluding HCC- 134 definitely inadequate and 57 likely inadequate. In multivariable analysis, inadequate quality was associated with male gender (OR 1.68, 95% CI 1.14-2.48), body mass index category (OR 1.67, 95% CI 1.45-1.93), Child-Pugh B or C cirrhosis (OR 1.93, 95% CI 1.32-2.81), alcohol-related cirrhosis (OR 2.11, 95% CI 1.33-3.37), NASH cirrhosis (OR 2.87, 95% CI 1.71-4.80), and in-patient status (OR 1.55, 95% CI 1.01-2.37). Ultrasounds were inadequate in over one-third of patients with Child-Pugh C cirrhosis, BMI >35, or NASH cirrhosis.
One in five ultrasounds in patients with cirrhosis are inadequate for exclusion of HCC, which can contribute to surveillance failure. Alternative surveillance modalities are needed in subgroups prone to inadequate ultrasounds including obese patients, those with Child Pugh B or C cirrhosis, and those with alcohol- or NASH-related cirrhosis.
腹部超声无法在超过四分之一的肝硬化患者中早期检测出肝细胞癌（HCC）。识别超声质量欠佳的患者可为改善监测效果的干预措施提供依据。
评估并识别肝硬化患者超声质量的预测因素。
我们对2015年4月至2015年10月期间因肝硬化相关指征接受超声检查的患者进行了一项回顾性队列研究。三名经过专科培训的腹部放射科医生共同回顾了所有超声检查，并将检查质量分类为肯定足够、可能足够、可能不足和肯定不足，以排除肝脏病变。我们进行了多变量逻辑回归分析，以确定与超声质量不足相关的特征。
在941例患者中，191例（20.3%）超声检查不足以排除HCC，其中134例肯定不足，57例可能不足。在多变量分析中，质量不足与男性（比值比1.68，95%置信区间1.14 - 2.48）、体重指数类别（比值比1.67，95%置信区间1.45 - 1.93）、Child-Pugh B或C级肝硬化（比值比1.93，95%置信区间1.32 - 2.81）、酒精性肝硬化（比值比2.11，95%置信区间1.33 - 3.37）、非酒精性脂肪性肝炎（NASH）肝硬化（比值比2.87，95%置信区间1.71 - 4.80）以及住院状态（比值比1.55，95%置信区间1.01 - 2.37）相关。在超过三分之一的Child-Pugh C级肝硬化、体重指数>35或NASH肝硬化患者中，超声检查不足。
肝硬化患者中有五分之一的超声检查不足以排除HCC，这可能导致监测失败。在容易出现超声检查不足的亚组中，包括肥胖患者、Child-Pugh B或C级肝硬化患者以及酒精性或NASH相关肝硬化患者，需要采用替代监测方式。
