Takeuchi Hirohito, Sugimoto Katsutoshi, Oshiro Hisashi, Iwatsuka Kunio, Kono Shin, Yoshimasu Yu, Kasai Yoshitaka, Furuichi Yoshihiro, Sakamaki Kentaro, Itoi Takao
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Pathology, Jichi Medical University, Tochigi, Japan.
J Med Ultrason (2001). 2018 Apr;45(2):243-249. doi: 10.1007/s10396-017-0840-3. Epub 2017 Nov 11.
Shear wave elastography (SWE) has been validated in chronic hepatitis C and B; however, limited data are available in non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the accuracy of SWE and FIB4 index for the diagnosis of fibrosis in a cohort of consecutive patients with biopsy-proven NAFLD, and to evaluate the effects of other histologic parameters on SWE measurement.
Written informed consent was obtained from all patients, and this study was approved by our internal review board and ethics committee. Seventy-one patients with histologically proven NAFLD (mean age 50.8 years ± 15.7) were examined. All patients underwent SWE (Aixplorer™; SuperSonic Imagine) and FIB4 index (based on age, aspartate aminotransferase and alanine aminotransferase levels, and platelet counts) measurements. SWE measurements were compared with the histologic features based on the NAFLD activity score and FIB4 index.
The area under the ROC curve for the diagnosis of hepatic fibrosis stage 3 or higher was 0.821 (optimal cut-off value 13.1 kPa, sensitivity 62.5%, specificity 57.4%) for SWE and 0.822 (optimal cut-off value 1.41, sensitivity 71.9%, specificity 53.9%) for FIB4 index. The median liver stiffness values measured using SWE showed a stepwise increase with increasing hepatic fibrosis stage (P < 0.001), inflammation score (P = 0.018), and ballooning score (P < 0.001), and showed a stepwise decrease with increasing hepatic steatosis stage (P = 0.046).
SWE and FIB4 index are useful noninvasive tools for estimating the severity of fibrosis in NAFLD patients. However, the presence of severe steatosis may affect the liver stiffness measurement, resulting in underestimations of liver fibrosis.
剪切波弹性成像（SWE）已在慢性丙型肝炎和乙型肝炎中得到验证；然而，关于非酒精性脂肪性肝病（NAFLD）的数据有限。本研究旨在评估SWE和FIB4指数在一组经活检证实的NAFLD连续患者中诊断肝纤维化的准确性，并评估其他组织学参数对SWE测量的影响。
获得所有患者的书面知情同意，本研究经我们的内部审查委员会和伦理委员会批准。对71例经组织学证实的NAFLD患者（平均年龄50.8岁±15.7）进行检查。所有患者均接受SWE（Aixplorer™；SuperSonic Imagine）和FIB4指数（基于年龄、天冬氨酸转氨酶和丙氨酸转氨酶水平以及血小板计数）测量。将SWE测量结果与基于NAFLD活动评分和FIB4指数的组织学特征进行比较。
SWE诊断肝纤维化3期或更高分期的ROC曲线下面积为0.821（最佳截断值13.1 kPa，敏感性62.5%，特异性57.4%），FIB4指数为0.822（最佳截断值1.41，敏感性71.9%，特异性53.9%）。使用SWE测量的肝脏硬度中位数随肝纤维化分期（P<0.001）、炎症评分（P=0.018）和气球样变评分（P<0.001）的增加而逐步升高，随肝脂肪变性分期的增加而逐步降低（P=0.046）。
SWE和FIB4指数是评估NAFLD患者肝纤维化严重程度的有用非侵入性工具。然而，严重脂肪变性的存在可能会影响肝脏硬度测量，导致对肝纤维化的低估。
