Lee Sang Min, Lee Jeong Min, Kang Hyo-Jin, Yang Hyung Kung, Yoon Jeong Hee, Chang Won, An Su Joa, Lee Kyoung Bun, Baek Seung Yon
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2017 May 16;12(5):e0177264. doi: 10.1371/journal.pone.0177264. eCollection 2017.
To evaluate the applicability, reproducibility, and diagnostic performance of a new 2D-shear wave elastography (SWE) using the comb-push technique (2D CP-SWE) for detection of hepatic fibrosis, using histopathology as the reference standard.
This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. The liver stiffness (LS) measurements were obtained from 140 patients, using the new 2D-SWE, which uses comb-push excitation to produce shear waves and a time-aligned sequential tracking method to detect shear wave signals. The applicability rate of 2D CP-SWE was estimated, and factors associated with its applicability were identified. Intraobserver reproducibility was evaluated in the 105 patients with histopathologic diagnosis, and interobserver reproducibility was assessed in 20 patients. Diagnostic performance of the 2D CP-SWE for hepatic fibrosis was evaluated by receiver operating characteristic (ROC) curve analysis.
The applicability rate of 2D CP-SWE was 90.8% (109 of 120). There was a significant difference in age, presence or absence of ascites, and the distance from the transducer to the Glisson capsule between the patients with applicable LS measurements and patients with unreliable measurement or technical failure. The intraclass correlation of interobserver agreement was 0.87, and the value for the intraobserver agreement was 0.95. The area under the ROC curve of LS values for stage F2 fibrosis or greater, stage F3 or greater, and stage F4 fibrosis was 0.874 (95% confidence interval [CI]: 0.794-0.930), 0.905 (95% CI: 0.832-0.954), and 0.894 (95% CI: 0.819-0.946), respectively.
2D CP-SWE can be employed as a reliable method for assessing hepatic fibrosis with a reasonably good diagnostic performance, and its applicability might be influenced by age, ascites, and the distance between the transducer and Glisson capsule.
以组织病理学为参考标准，评估一种采用梳推技术的新型二维剪切波弹性成像（SWE）（二维梳推SWE）在检测肝纤维化方面的适用性、可重复性及诊断性能。
本前瞻性研究经机构审查委员会批准，所有患者均签署知情同意书。对140例患者采用新型二维SWE测量肝脏硬度（LS），该技术利用梳推激励产生剪切波，并采用时间对齐的序列跟踪方法检测剪切波信号。评估二维梳推SWE的适用率，并确定与其适用性相关的因素。对105例有组织病理学诊断的患者评估观察者内可重复性，对20例患者评估观察者间可重复性。采用受试者操作特征（ROC）曲线分析评估二维梳推SWE对肝纤维化的诊断性能。
二维梳推SWE的适用率为90.8%（120例中的109例）。在LS测量适用的患者与测量不可靠或技术失败的患者之间，年龄、有无腹水以及换能器与肝门管区包膜的距离存在显著差异。观察者间一致性的组内相关系数为0.87，观察者内一致性的值为0.95。F2期及以上、F3期及以上和F4期肝纤维化的LS值ROC曲线下面积分别为0.874（95%置信区间[CI]：0.794 - 0.930）、0.905（95% CI：0.832 - 0.954）和0.894（95% CI：0.819 - 0.946）。
二维梳推SWE可作为评估肝纤维化的可靠方法，具有较好的诊断性能，其适用性可能受年龄、腹水及换能器与肝门管区包膜距离的影响。
