Rattansingh Anand, Amooshahi Hosein, Menezes Ravi J, Wong Florence, Fischer Sandra, Kirsch Richard, Atri Mostafa
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Clin Ultrasound. 2018 Jun;46(5):311-318. doi: 10.1002/jcu.22583. Epub 2018 Mar 6.
To determine the accuracy of shear-wave elastography (SWE) to differentiate low from advanced degrees of liver fibrosis in hepatitis C patients.
MATERIAL & METHOD: Consented native/transplant hepatitis C patients underwent SWE using a C1-6 MHz transducer before ultrasound (US)-guided liver biopsy. Five interpretable SWE samples were obtained from the right lobe of the liver immediately before US-guided random biopsy of the right lobe. Average kilopascal (kPa) values were compared to the meta-analysis of histological data in viral hepatitis (METAVIR) fibrosis grading. SWE values were correlated with the degree of inflammation and fatty infiltration.
Study population consisted of 115 patients (63 with transplant, and 52 with native liver) including 29 women and 86 men, with a mean ± SD age of 56 ± 8.7 years. Mean ± SD SWE values were 7.9 ± 3 kPa in 83 patients with METAVIR scores of 0-2 and 13.2 ± 5.9 kPa in 32 patients with METAVIR scores of 3 or 4 (P < .001). Area under curve (AUC) of a Receiver Operating Characteristics curve for advanced degrees of fibrosis was 0.81 (95% CI: 0.71, 0.90) (P < .001). AUCs of transplant versus native livers (0.78 [CI:0.62, 0.94] versus 0.85 [CI: 0.73, 0.96]), degree of inflammation (0.81 [CI: 0.65, 0.97] versus 0.72 [0.56, 0.88]), or degree of fat deposition (0.81 [CI:0.70, 0.92] versus 0.80 [CI:0.61, 1]) were not statistically different (P > .05). for kPa threshold of SWE value of 10.67 kPa to differentiate advanced from low degree of fibrosis had a sensitivity of 59% (CI: 41%-76%) and specificity of 90% (CI: 82%-96%).
Liver stiffness evaluated by SWE can differentiate low from advanced liver fibrosis.
确定剪切波弹性成像（SWE）在区分丙型肝炎患者低度和高度肝纤维化方面的准确性。
经同意的丙型肝炎患者（包括原发性/移植性患者）在超声（US）引导下进行肝脏活检前，使用C1 - 6 MHz探头接受SWE检查。在US引导下对右叶进行随机活检前，立即从肝脏右叶获取5个可解释的SWE样本。将平均千帕（kPa）值与病毒性肝炎组织学数据的荟萃分析（METAVIR）纤维化分级进行比较。SWE值与炎症程度和脂肪浸润相关。
研究人群包括115例患者（63例移植患者和52例原发性肝脏患者），其中女性29例，男性86例，平均年龄±标准差为56±8.7岁。83例METAVIR评分为0 - 2的患者的平均±标准差SWE值为7.9±3 kPa，32例METAVIR评分为3或4的患者的平均±标准差SWE值为13.2±5.9 kPa（P <.001）。晚期纤维化程度的受试者操作特征曲线的曲线下面积（AUC）为0.81（95%置信区间：0.71, 0.90）（P <.001）。移植肝与原发性肝的AUC（0.78 [置信区间：0.62, 0.94] 与0.85 [置信区间：0.73, 0.96]）、炎症程度（0.81 [置信区间：0.65, 0.97] 与0.72 [0.56, 0.88]）或脂肪沉积程度（0.81 [置信区间：0.70, 0.92] 与0.80 [置信区间：0.61, 1]）无统计学差异（P >.05）。SWE值为10.67 kPa的kPa阈值区分晚期和低度纤维化的敏感性为59%（置信区间：41% - 76%），特异性为90%（置信区间：82% - 96%）。
通过SWE评估的肝脏硬度可区分低度和高度肝纤维化。
