弹性PQ在评估B型和C型慢性肝病患者肝硬度方面的价值。

The value of ElastPQ for the evaluation of liver stiffness in patients with B and C chronic hepatopathies.

作者信息

Mare Ruxandra, Sporea Ioan, Lupuşoru Raluca, Şirli Roxana, Popescu Alina, Danila Mirela, Pienar Corina

机构信息

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, 156, Liviu Rebreanu Bv. 300723, Timişoara, Romania.

出版信息

Ultrasonics. 2017 May;77:144-151. doi: 10.1016/j.ultras.2017.02.005. Epub 2017 Feb 9.

DOI:10.1016/j.ultras.2017.02.005

PMID:28231488

Abstract

UNLABELLED

The aim of this study was to evaluate the diagnostic performance of a point shear wave elastography using ARFI technique - ElastPQ, in patients with B and C chronic hepatopathies, using Transient Elastography (TE) as the reference method, since it is a validated method for liver fibrosis assessment.

SUBJECTS AND METHODS

the study included 228 consecutive subjects with chronic hepatopathies (26% HBV, 74% HCV) from whom 51% had liver cirrhosis. Liver stiffness (LS) was evaluated in the same session by means of 2 elastographic methods: TE (FibroScan, EchoSens) and ElastPQ (Affinity, Philips) techniques. For TE 10 valid LS measurements were performed for each patient and the median value was calculated. Reliable LS measurements by TE (M or XL probe) were considered the median value of 10LS measurements with a success rate ≥60% and an interquartile range <30%. For ElastPQ we calculated the median value of 10LS measurements in the liver parenchyma, at least 1cm below the capsule, avoiding large vessels. For differentiating between stages of liver fibrosis we used the TE cut-off values published in the Tsochatzis meta-analysis: significant fibrosis (F≥2)- 7.0kPa, severe fibrosis (F≥3)- 9.5kPa and for liver cirrhosis (F=4)-12kPa (Tsochatzis et al., 2011). The areas under the receiver operating characteristic curve (AUROCs) were used to assess the diagnostic performance of ElastPQ, correlations between ElastPQ and TE were evaluated.

RESULTS

Valid LS measurements were obtained in 90.7% (207/228) cases by means of TE and in 98.7% (225/228) cases with ElastPQ. In the final analysis 205 patients were included. The ElastPQ values ranged from 2.32 to 44.07kPa (median=10.42kPa). Based on TE cut-off values (Tsochatzis et al., 2011) we divided our cohort into 4 groups: F0-F1:61/205 (29.8%); F2: 14/205 (6.8%); F3: 15/205 (7.3%); F=4: 115/205 (56.1%). The best cut-off values for discriminating, significant, severe fibrosis and cirrhosis were 7.2, 8.5 and 8.9kPa, respectively. The AUROCs were calculated considering TE as the reference method: 0.94 for significant fibrosis (F≥2), 0.97 for severe fibrosis (F≥3) and 0.97 for cirrhosis (F=4). In our cohort there was a strong correlation between measurements obtained by Transient Elastography and ElastPQ (r=0.85, p<0.001).

CONCLUSIONS

ElastPQ seems to have a good diagnostic accuracy for staging liver fibrosis.

摘要

未标注

本研究的目的是使用基于增强辐射力成像（ARFI）技术的点剪切波弹性成像——ElastPQ，以瞬时弹性成像（TE）作为参考方法，评估慢性乙型和丙型肝病患者的诊断性能，因为TE是一种经过验证的肝纤维化评估方法。

对象与方法

本研究纳入了228例连续的慢性肝病患者（26%为乙肝病毒感染，74%为丙肝病毒感染），其中51%患有肝硬化。在同一次检查中，通过两种弹性成像方法评估肝脏硬度（LS）：TE（FibroScan，EchoSens）和ElastPQ（Affinity，飞利浦）技术。对于TE，为每位患者进行10次有效的LS测量，并计算中位数。TE（M或XL探头）获得的可靠LS测量值被认为是10次LS测量的中位数，成功率≥60%且四分位间距<(30%)。对于ElastPQ，我们计算肝实质中10次LS测量的中位数，测量位置在肝包膜下方至少1厘米处，避开大血管。为了区分肝纤维化阶段，我们使用了Tsochatzis荟萃分析中公布的TE临界值：显著纤维化（F≥2）——(7.0)kPa，严重纤维化（F≥3）——(9.5)kPa，肝硬化（F = 4）——(12)kPa（Tsochatzis等人，2011年）。使用受试者操作特征曲线下面积（AUROCs）评估ElastPQ的诊断性能，评估ElastPQ与TE之间的相关性。

结果

通过TE在(90.7%)（207/228）的病例中获得了有效的LS测量值，通过ElastPQ在(98.7%)（225/228）的病例中获得了有效的LS测量值。最终分析纳入了205例患者。ElastPQ值范围为(2.32)至(44.07)kPa（中位数=(10.42)kPa）。根据TE临界值（Tsochatzis等人，2011年），我们将研究队列分为4组：F0 - F1：6(1)/205（29.8%）；F2：14/205（6.8%）；F3：15/205（7.3%）；F = 4：115/205（56.1%）。区分显著纤维化、严重纤维化和肝硬化的最佳临界值分别为(7.2)、(8.5)和(8.9)kPa。以TE作为参考方法计算AUROCs：显著纤维化（F≥2）为(0.94)，严重纤维化（F≥3）为(0.97)，肝硬化（F = 4）为(0.97)。在我们的队列中，瞬时弹性成像和ElastPQ获得的测量值之间存在很强的相关性（r = 0.85，p<0.001）。