Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
Abdom Radiol (NY). 2017 Dec;42(12):2864-2873. doi: 10.1007/s00261-017-1213-5.
To evaluate the diagnostic accuracy of shear wave elastography (SWE) and transient elastography (TE) in the evaluation of liver fibrosis in chronic hepatitis B (CHB) and C (CHC) patients taking liver biopsy as gold standard.
Ethics committee approved this prospective cross-sectional study. Between October 2012 and December 2014, consecutive CHB/CHC patients fulfilling the inclusion criteria were included-age more than 18 years, informed written consent, willing and suitable for liver biopsy. SWE, TE, and biopsy were performed the same day. Liver stiffness measurement (LSM) cut-offs for various stages of fibrosis were generated for SWE and TE. AUC, sensitivity, specificity, and positive/negative predictive values were estimated individually or in combination.
CH patients (n = 240, CHB 172, CHC 68), 176 males, 64 females, mean age 32.6 ± 11.6 years were enrolled. Mean LSM of patients with no histological fibrosis (F0) was 5.0 ± 0.7 and 5.1+1.4 kPa on SWE and TE, respectively. For differentiating F2 and F3-4 fibrosis on SWE, at 7.0 kPa cut-off, the sensitivity was 81.3% and specificity 77.6%. For TE, at 8.3 kPa cut-off, sensitivity was 81.8% and specificity 83.1%. For F3 vs. F4, SWE sensitivity was 83.3% and specificity 90.7%. At 14.8 kPa cut-off, TE showed similar sensitivity (83.3%) but specificity increased to 96.5%. Significant correlation between SWE and TE was observed (r = 0.33, p < 0.001). On combining SWE and TE, a drop in sensitivity with increased specificity for all stages of liver fibrosis occured.
SWE is an accurate technique for evaluating liver fibrosis. SWE compares favorably with TE especially for predicting advanced fibrosis/cirrhosis. Combining SWE and TE further improves specificity.
以肝活检为金标准，评估剪切波弹性成像（SWE）和瞬时弹性成像（TE）在评估慢性乙型肝炎（CHB）和丙型肝炎（CHC）患者肝纤维化中的诊断准确性。
本研究为前瞻性横断面研究，经伦理委员会批准。2012 年 10 月至 2014 年 12 月，连续纳入符合纳入标准的 CHB/CHC 患者，年龄大于 18 岁，知情同意，愿意并适合进行肝活检。SWE、TE 和肝活检同日进行。为 SWE 和 TE 生成各种纤维化阶段的肝硬度测量（LSM）截断值。分别或联合评估 AUC、敏感性、特异性和阳性/阴性预测值。
共纳入 240 例 CH 患者（CHB 172 例，CHC 68 例），男性 176 例，女性 64 例，平均年龄 32.6±11.6 岁。无组织学纤维化（F0）患者的平均 LSM 分别为 SWE 上的 5.0±0.7kPa 和 TE 上的 5.1+1.4kPa。对于区分 F2 和 F3-4 纤维化，SWE 上 7.0kPa 截断值时，敏感性为 81.3%，特异性为 77.6%。对于 TE，8.3kPa 截断值时，敏感性为 81.8%，特异性为 83.1%。对于 F3 与 F4，SWE 的敏感性为 83.3%，特异性为 90.7%。14.8kPa 截断值时，TE 显示出相似的敏感性（83.3%），但特异性增加至 96.5%。SWE 和 TE 之间存在显著相关性（r=0.33，p<0.001）。联合 SWE 和 TE 时，所有阶段肝纤维化的敏感性下降，特异性增加。
SWE 是评估肝纤维化的一种准确技术。SWE 与 TE 相比具有优势，尤其适用于预测晚期纤维化/肝硬化。联合 SWE 和 TE 可进一步提高特异性。
