Grgurevic Ivica, Bokun Tomislav, Bozin Tonci, Matic Vladimir, Haberle Sara, Sporea Ioan
Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
University of Zagreb School of Medicine, Zagreb, Croatia.
Med Ultrason. 2017 May 3;19(3):310-317. doi: 10.11152/mu-1019.
Liver stiffness measurement (LSM) by ultrasound-based elastography may be used to non-invasively discriminate between the stages of liver fibrosis, rule out cirrhosis and follow its evolution, including the prediction of the presence of oesophageal varices. The same is possible in order to diagnose clinically significant portal hypertension, referring primarilyto transient elastography and LSM values ≥20-25 kPa. The same approach may be used to reliably rule out the presence ofoesophageal varices (LSM <20 kPa + platelets >150x109/L). These recommendations refer primarily to patients with viral aetiology of chronic liver disease (hepatitis C), while additional studies are required for other aetiologies. While spleen stiffness measurement (SSM) also poses a logical choice in this indication, controversial results have nevertheless been published on this issue. It should be emphasized, however, that more recent data indicate that this parameter should be included in the diagnostic algorithm for portal hypertension, if not as the sole then as a part of a sequential algorithm, combined with LSM. Until now, transient elastography has been most extensively studied and founded on scientific evidence, although the results of other ultrasound-based elastography techniques demonstrate the same trend for the non-invasive assessment of portal hypertension.
基于超声弹性成像的肝脏硬度测量（LSM）可用于非侵入性地区分肝纤维化的阶段，排除肝硬化并跟踪其进展，包括预测食管静脉曲张的存在。同样，通过主要参考瞬时弹性成像和LSM值≥20-25 kPa，也可用于诊断具有临床意义的门静脉高压症。相同的方法可用于可靠地排除食管静脉曲张的存在（LSM <20 kPa + 血小板>150x109/L）。这些建议主要适用于慢性肝病（丙型肝炎）病毒病因的患者，而其他病因则需要更多的研究。虽然脾脏硬度测量（SSM）在该适应症中也是一个合理的选择，但关于这个问题仍有争议性的结果发表。然而，应该强调的是，最近的数据表明，如果不作为唯一参数，那么作为顺序算法的一部分，结合LSM，该参数应纳入门静脉高压的诊断算法中。到目前为止，瞬时弹性成像得到了最广泛的研究且有科学证据支持，尽管其他基于超声的弹性成像技术的结果在门静脉高压的非侵入性评估中也显示出相同的趋势。
