Yada Norihisa, Tamaki Nobuhura, Koizumi Yohei, Hirooka Masashi, Nakashima Osamu, Hiasa Yoichi, Izumi Namiki, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Dig Dis. 2017;35(6):515-520. doi: 10.1159/000480140. Epub 2017 Oct 17.
Performing shear wave imaging is simple, but can be difficult when inflammation, jaundice, and congestion are present. Therefore, the correct diagnosis of liver fibrosis using shear wave imaging alone might be difficult in mild-to-moderate fibrosis cases. Strain imaging can diagnose liver fibrosis without the influence of inflammation. Therefore, the combined use of strain and shear wave imaging (combinational elastography) for cases without jaundice and congestion might be useful for evaluating fibrosis and inflammation.
We enrolled consecutive patients with liver disease, without jaundice or liver congestion. Strain and shear wave imaging, blood tests, and liver biopsy were performed on the same day. The liver fibrosis index (LF index) was calculated by strain imaging; real-time tissue elastography, and the shear wave velocity (Vs) was calculated by shear wave imaging. Fibrosis index (F index) and activity index (A index) were calculated as a multiple regression equation for determining hepatic fibrosis and inflammation using histopathological diagnosis as the gold standard. The diagnostic ability of F index for fibrosis and A index for inflammation were compared using LF index and Vs.
The total number of enrolled cases was 388. The area under the receiver operating characteristic (AUROC) was 0.87, 0.80, 0.83, and 0.80, at diagnosis of fibrosis stage with an F index of F1 or higher, F2 or higher, F3 or higher, and F4, respectively. The AUROC was 0.94, 0.74, and 0.76 at diagnosis of activity grade with an A index of A1 or higher, A2 or higher, and A3, respectively. The diagnostic ability of F index for liver fibrosis and A index for inflammation was higher than for other conventional diagnostic values.
The combined use of strain and shear wave imaging (combinational elastography) might increase the positive diagnosis of liver fibrosis and inflammation.
进行剪切波成像操作简单，但在存在炎症、黄疸和充血的情况下可能会有困难。因此，仅使用剪切波成像对轻度至中度纤维化病例进行肝纤维化的正确诊断可能会有困难。应变成像可在不受炎症影响的情况下诊断肝纤维化。因此，对于无黄疸和充血的病例，联合使用应变和剪切波成像（联合弹性成像）可能有助于评估纤维化和炎症。
我们纳入了连续的肝病患者，这些患者无黄疸或肝充血。在同一天进行应变和剪切波成像、血液检查以及肝活检。通过应变成像计算肝纤维化指数（LF指数）；通过实时组织弹性成像，并通过剪切波成像计算剪切波速度（Vs）。以组织病理学诊断为金标准，计算纤维化指数（F指数）和活动指数（A指数）作为确定肝纤维化和炎症的多元回归方程。使用LF指数和Vs比较F指数对纤维化的诊断能力以及A指数对炎症的诊断能力。
纳入病例总数为388例。在诊断纤维化分期时，F指数为F1及以上、F2及以上、F3及以上和F4时，受试者操作特征曲线下面积（AUROC）分别为0.87、0.80、0.83和0.80。在诊断活动分级时，A指数为A1及以上、A2及以上和A3时，AUROC分别为0.94、0.74和0.76。F指数对肝纤维化的诊断能力以及A指数对炎症的诊断能力高于其他传统诊断值。
联合使用应变和剪切波成像（联合弹性成像）可能会提高肝纤维化和炎症的阳性诊断率。
