Huang Zhongxi, Zheng Wei, Zhang Yao-Jun, Xu Li, Chen Jin-Bin, Chen Jian-Cong, Chen Min-Shan, Zhou Zhongguo
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
Ultrasound Med Biol. 2017 Nov;43(11):2522-2529. doi: 10.1016/j.ultrasmedbio.2017.07.003. Epub 2017 Aug 12.
The purpose of this study was to investigate the diagnostic performance of 2-D shear wave elastography (2-D-SWE) in evaluations of liver stiffness in patients with liver tumors before resection. A total of 121 consecutive patients with hepatocellular carcinoma (HCC) (n = 93), intra-hepatic cholangiocarcinoma (n = 6), mixed hepatocellular carcinoma and intra-hepatic cholangiocarcinoma (n = 6), liver metastases (n = 10) and benign tumors (n = 6) were prospectively enrolled in this study from June 2015 to March 2016. Three valid 2-D-SWE measurements for each patient and median liver stiffness values were calculated. Fibrosis staging was evaluated according to the METAVIR scoring system. A receiver operating characteristic curve analysis was used to assess diagnostic performance. In this study, we found that median liver stiffness values were significantly higher in patients with primary liver tumors than in those with liver metastases and benign tumors (11.80 kPa vs. 5.85 kPa, p < 0.001). In addition, liver stiffness, assessed using 2-D-SWE, was highly correlated with pathologically confirmed liver fibrosis stage. Liver fibrosis stage and liver stiffness values were analyzed using Spearman's correlation (0.708, p < 0.001). The median liver stiffness values were as follows: F1, 6.7 kPa; F2, 6.33 kPa; F3, 9.2 kPa; F4, 13.7 kPa. The area under the receiver operating characteristic curves of the liver stiffness values that predicted significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 83.5%, 91.6% and 88.1%, respectively. According to the Youden index, the optimal cutoff values for predicting significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 7.05 kPa (sensitivity = 74.6%, specificity = 100.0%), 9.45 kPa (sensitivity = 78.8%, specificity = 100.0%) and 11.1 kPa (sensitivity = 83.1%, specificity = 89.3%), respectively. We conclude that 2-D-SWE is a useful, accurate and non-invasive method for evaluating hepatic fibrosis in patients with liver tumors adapted to hepatectomy (ClinicalTrials.gov ID: NCT02958592).
本研究旨在探讨二维剪切波弹性成像（2-D-SWE）在评估肝肿瘤患者术前肝脏硬度方面的诊断性能。2015年6月至2016年3月，本研究前瞻性纳入了121例连续的患者，包括肝细胞癌（HCC）患者93例、肝内胆管癌患者6例、肝细胞癌合并肝内胆管癌患者6例、肝转移瘤患者10例和良性肿瘤患者6例。计算每位患者的三次有效二维剪切波弹性成像测量值及肝脏硬度中位数。根据METAVIR评分系统评估纤维化分期。采用受试者工作特征曲线分析评估诊断性能。在本研究中，我们发现原发性肝肿瘤患者的肝脏硬度中位数显著高于肝转移瘤和良性肿瘤患者（11.80kPa对5.85kPa，p<0.001）。此外，二维剪切波弹性成像评估的肝脏硬度与病理证实的肝纤维化分期高度相关。采用Spearman相关性分析肝纤维化分期与肝脏硬度值（0.708，p<0.001）。肝脏硬度中位数如下：F1为6.7kPa；F2为6.33kPa；F3为9.2kPa；F4为13.7kPa。预测显著纤维化（≥F2）、严重纤维化（≥F3）和肝硬化（=F4）的肝脏硬度值的受试者工作特征曲线下面积分别为83.5%、91.6%和88.1%。根据约登指数，预测显著纤维化（≥F2）、严重纤维化（≥F3）和肝硬化（=F4）的最佳截断值分别为7.05kPa（灵敏度=74.6%，特异性=100.0%）、9.45kPa（灵敏度=78.8%，特异性=100.0%）和11.1kPa（灵敏度=83.1%，特异性=89.3%）。我们得出结论，二维剪切波弹性成像对于评估适合肝切除术的肝肿瘤患者的肝纤维化是一种有用、准确且无创的方法（ClinicalTrials.gov标识符：NCT02958592）。
