Ferraioli Giovanna, Maiocchi Laura, Lissandrin Raffaella, Tinelli Carmine, De Silvestri Annalisa, Filice Carlo
Infectious Diseases Department, Fondazione IRCCS Policlinico S. Matteo, Medical School University of Pavia, Italy.
Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
J Gastrointestin Liver Dis. 2017 Jun;26(2):139-143. doi: 10.15403/jgld.2014.1121.262.fer.
To prospectively assess the cutoff values of a point shear wave measurement (SWM) method for ruling-in and ruling-out significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard.
Consecutive patients with chronic hepatitis C were enrolled. Liver stiffness was assessed with the SWM method implemented on the HI VISION Ascendus ultrasound system (Hitachi Ltd, Japan) and with the TE method of the FibroScan® device (Echosens, France). For staging significant fibrosis (F>/=2) and cirrhosis (F=4) we used the TE cutoffs of 7.0 and 12.0 kiloPascal (kPa), respectively. The diagnostic performance of SWM was assessed by calculating the area under the receiver operating characteristic (AUROC) curve. Cutoffs with specificity or sensitivity > 90% were chosen to rule-in or rule-out F>/=2 and F=4.
445 individuals [235 males, 210 females; mean age, 61.1 (13.3) years] were studied: 190 (42.7%) individuals had F0-F1 fibrosis stage, 82 (18.4%) F2, 46 (10.3%) F3, and 127 (28.6%) F4 fibrosis stage. For ruling-in F>/=2 the SWM cutoff was 6.78 kPa [sensitivity, 76.9%(70.6-82.4); specificity, 90.3% (85.0-94.3)] and for ruling-out it was 5.55 kPa [sensitivity, 90.6% (85.8-94.1); specificity, 72.2% (64.9-78.6)]. For ruling-in F=4 the SWM cutoff was 9.15 kPa [sensitivity, 83.3% (74.4-90.2); specificity, 90.1% (86.0-93.2)] and for ruling-out it was 8.41 kPa [sensitivity, 90.6% (82.9-95.6); specificity, 82.2% (77.3-86.4)]. AUROCs were 0.92 (0.89-0.94) for F>/=2 and 0.94 (0.91-0.96) for F=4.
In clinical practice, the use of a dual cutoff of SWM may increase the confidence in staging liver fibrosis with a non-invasive shear wave elastography technique.
以前瞻性方式评估一种点剪切波测量（SWM）方法用于判定显著肝纤维化和肝硬化的临界值，以瞬时弹性成像（TE）作为参考标准。
纳入连续的丙型肝炎患者。使用在HI VISION Ascendus超声系统（日本日立公司）上实施的SWM方法以及FibroScan®设备（法国Echosens公司）的TE方法评估肝脏硬度。对于判定显著肝纤维化（F≥2）和肝硬化（F = 4），我们分别采用TE临界值7.0千帕斯卡（kPa）和12.0 kPa。通过计算受试者工作特征（AUROC）曲线下面积评估SWM的诊断性能。选择特异性或敏感性> 90%的临界值来判定或排除F≥2和F = 4。
研究了445例个体[235例男性，210例女性；平均年龄61.1（13.3）岁]：190例（42.7%）个体处于F0 - F1纤维化阶段，82例（18.4%）处于F2阶段，46例（10.3%）处于F3阶段，127例（28.6%）处于F4纤维化阶段。判定F≥2时，SWM临界值为6.78 kPa[敏感性，76.9%（70.6 - 82.4）；特异性，90.3%（85.0 - 94.3）]，排除时临界值为5.55 kPa[敏感性，90.6%（85.8 - 94.1）；特异性，72.2%（64.9 - 78.6）]。判定F = 4时，SWM临界值为9.15 kPa[敏感性，83.3%（74.4 - 90.2）；特异性，90.1%（86.0 - 93.2）]，排除时临界值为8.41 kPa[敏感性，90.6%（82.9 - 95.6）；特异性，82.2%（77.3 - 86.4）]。F≥2时AUROC为0.92（0.89 - 0.94），F = 4时为0.94（0.91 - 0.96）。
在临床实践中，使用SWM的双重临界值可能会增加使用非侵入性剪切波弹性成像技术进行肝纤维化分期的信心。
