Pfeifer Lukas, Adler Werner, Zopf Steffen, Siebler Jürgen, Wildner Dane, Goertz Ruediger S, Schellhaas Barbara, Neurath Markus F, Strobel Deike
aDepartment of Internal Medicine 1bInstitute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany.
Eur J Gastroenterol Hepatol. 2017 May;29(5):524-530. doi: 10.1097/MEG.0000000000000827.
The aim of this study was to compare acoustic radiation force impulse (ARFI) elastography with other noninvasive tests and to develop a new score for the assessment of liver fibrosis/cirrhosis.
B-mode ultrasound (including high-frequency liver surface evaluation), routine blood tests, ARFI quantification, and mini-laparoscopic liver evaluation were obtained in compensated patients scheduled for mini-laparoscopic biopsy. Our new cirrhosis score (CS) for the assessment of liver cirrhosis, based on a linear combination of ARFI, platelet (PLT), liver surface, and prothrombin index (PI), was calculated by linear discriminant analysis. Its performance was compared with ARFI-elastography, APRI, FIB-4, alanine aminotransferase (ALT)/aspartate aminotransferase (AST)-ratio, PLT, and PI. For the diagnosis of cirrhosis, a combined gold standard (cirrhosis at histology and/or at macroscopic liver evaluation) was used.
In total, 171 patients, of whom 38 had compensated cirrhosis, were included. The CS was significantly better for the diagnosis of cirrhosis compared with ARFI (P=0.028), APRI (P=0.012), PLTs (P=0.013), PI (P=0.025), and ALT/AST ratio (P=0.001), but not the FIB-4 score (P=0.207), with an area under the receiver operating characteristic curve of 0.92 [95% confidence interval (CI): 0.87-0.97], 0.86 (95% CI:0.79-0.93), 0.80 (95% CI: 0.72-0.87), 0.79 (95% CI: 0.7-0.87), 0.81 (95% CI: 0.73-0.89), 0.72 (95% CI:0.64-0.81), and 0.86 (95% CI: 0.8-0.93), respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for CS were 87%, 86%, 63%, and 96%, respectively. The FIB-4 score was significantly superior to the APRI score (P=0.041) and the ALT/AST ratio (P=0.011), with no significant difference from ARFI elastography (P=0.88) for the diagnosis of cirrhosis.
Combining ARFI elastography with other noninvasive tests that are used routinely in the workup of patients with suspected liver disease can improve diagnostic accuracy for compensated liver cirrhosis as compared with ARFI elastography alone. The FIB-4 score showed an overall comparable diagnostic accuracy to ARFI-elastography for compensated cirrhosis.
本研究旨在比较声辐射力脉冲（ARFI）弹性成像与其他非侵入性检查，并开发一种新的评分系统用于评估肝纤维化/肝硬化。
对计划进行迷你腹腔镜活检的代偿期患者进行B超检查（包括高频肝脏表面评估）、常规血液检查、ARFI定量分析以及迷你腹腔镜肝脏评估。基于ARFI、血小板（PLT）、肝脏表面和凝血酶原指数（PI）的线性组合，通过线性判别分析计算我们用于评估肝硬化的新肝硬化评分（CS）。将其性能与ARFI弹性成像、APRI、FIB-4、丙氨酸氨基转移酶（ALT）/天冬氨酸氨基转移酶（AST）比值、PLT和PI进行比较。对于肝硬化的诊断，采用联合金标准（组织学检查和/或宏观肝脏评估显示为肝硬化）。
共纳入171例患者，其中38例为代偿期肝硬化患者。与ARFI（P = 0.028）、APRI（P = 0.012）、PLT（P = 0.
