Zhang G Y, Tang Y, Niu N N, Wu H T
Department of Ultrasound, Tianjin First Center Hospital, Tianjin 300193, China.
Zhonghua Yi Xue Za Zhi. 2017 Feb 21;97(7):525-528. doi: 10.3760/cma.j.issn.0376-2491.2017.07.011.
To investigate the clinical value of acoustic radiation force impulse (ARFI)technique in predicting esophageal and gastric varices in patients with biliary atresia after Kasai portoenterostomy. A total of 42 patients with biliary atresia after Kasai portoenterostomy were collected from September 2015 to May 2016 in Tianjin First Central Hospital.ARFI technique was used to measure the stiffness of liver and spleen, and 28 healthy children as control.According to the result of CT examination , patients with biliary atresia were divided into two groups , twenty-three patients with esophageal and gastric varices(A group) and nineteen patients without esophageal and gastric varices (B group), Comparing the difference of liver and spleen stiffness between the two groups.The ROC curve analysis was carried out to test the diagnostic power of effective parameter. The ARFI value of liver (2.98±0.80) m/s and spleen (3.00±0.33) m/s of patients with biliary atresia was significantly higher than that of control group((1.10±0.16) m/s, (2.12±0.32) m/s), the differences had statistical significance (both <0.01). Between group A and group B, the spleen ARFI value of group A(3.16±0.26) m/s was higher than group B(2.83±0.32) m/s, the difference had statistical significance (<0.01), whereas there was no statistical difference of liver ARFI value between two group((2.93±0.65), (3.02±0.96) m/s)(>0.05). The cut-off ARFI value of spleen to diagnose esophageal and gastric varices in biliary atresia was 3.02 m/s, and the biggest area under the ROC curve, sensitivity, and specificity were 0.81, 78.6% and 84.5%, respectively. ARFI can be used as a noninvasive method to predict the presence of esophageal and gastric varices in patients with biliary atresia after Kasai portoenterostomy.
探讨声学辐射力脉冲（ARFI）技术在预测Kasai肝门空肠吻合术后胆道闭锁患者食管和胃静脉曲张中的临床价值。2015年9月至2016年5月，天津市第一中心医院共收集了42例Kasai肝门空肠吻合术后的胆道闭锁患者。采用ARFI技术测量肝脏和脾脏硬度，并选取28例健康儿童作为对照。根据CT检查结果，将胆道闭锁患者分为两组，23例有食管和胃静脉曲张患者（A组）和19例无食管和胃静脉曲张患者（B组），比较两组肝脏和脾脏硬度的差异。进行ROC曲线分析以检验有效参数的诊断能力。胆道闭锁患者肝脏的ARFI值为（2.98±0.80）m/s，脾脏为（3.00±0.33）m/s，明显高于对照组（（1.10±0.16）m/s，（2.12±0.32）m/s），差异具有统计学意义（均<0.01）。A组和B组之间，A组脾脏ARFI值（3.16±0.26）m/s高于B组（2.83±0.32）m/s，差异具有统计学意义（<0.01），而两组肝脏ARFI值无统计学差异（（2.93±0.65），（3.02±0.96）m/s）（>0.05）。诊断胆道闭锁患者食管和胃静脉曲张的脾脏ARFI临界值为3.02 m/s，ROC曲线下最大面积、灵敏度和特异性分别为0.81、78.6%和84.5%。ARFI可作为一种无创方法预测Kasai肝门空肠吻合术后胆道闭锁患者食管和胃静脉曲张的存在。
