Kim Dong Wook, Yoon Hee Mang, Jung Ah Young, Lee Jin Seong, Oh Seak Hee, Kim Kyung Mo, Cho Young Ah
Department of Radiology, Taean-gun Health Center and County Hospital, Pyeongcheon-ri, Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
J Ultrasound Med. 2019 Mar;38(3):747-759. doi: 10.1002/jum.14764. Epub 2018 Aug 16.
To assess the diagnostic performance of ultrasound (US) elastography in evaluating portal hypertension in children and compare the liver and spleen stiffness values between the portal hypertension and control groups.
Studies in the MEDLINE and Embase databases were selected that investigated the diagnostic performance of US elastography in children with portal hypertension up to December 21, 2017. Pooled sensitivity and specificity data were assessed by hierarchical logistic regression modeling.
Eleven studies were included in the systematic review, and a meta-analysis could be conducted in 7 of these publications to evaluate the diagnostic performance of US elastography. The summary sensitivity and specificity of this method for liver stiffness were 90% (95% confidence interval [CI], 83%-94%) and 79% (95% CI, 73%-84%), respectively, and the area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90-0.94). A subgroup analysis of 5 transient elastographic studies revealed similar diagnostic performance (sensitivity, 90%; specificity, 78%). In 10 of the 11 studies that investigated liver stiffness and 2 of the 3 studies that also measured spleen stiffness, patients in the portal hypertension group had a significantly higher stiffness value than the control group (P < .05).
Ultrasound elastography shows good performance in diagnosing portal hypertension and can identify significant differences in liver and spleen stiffness in children with this condition. This method thus has considerable potential as a noninvasive tool for screening portal hypertension-related complications in children with chronic liver disease.
评估超声弹性成像在评估儿童门静脉高压症中的诊断性能，并比较门静脉高压症组与对照组的肝脏和脾脏硬度值。
选取MEDLINE和Embase数据库中截至2017年12月21日调查超声弹性成像在儿童门静脉高压症中诊断性能的研究。通过分层逻辑回归模型评估汇总的敏感性和特异性数据。
系统评价纳入了11项研究，其中7篇文献可进行荟萃分析以评估超声弹性成像的诊断性能。该方法对肝脏硬度的汇总敏感性和特异性分别为90%（95%置信区间[CI]，83%-94%）和79%（95%CI，73%-84%），分层汇总受试者工作特征曲线下面积为0.92（95%CI，0.90-0.94）。对5项瞬时弹性成像研究的亚组分析显示出相似的诊断性能（敏感性90%；特异性78%）。在11项研究中的10项研究调查了肝脏硬度，3项研究中的2项研究也测量了脾脏硬度，门静脉高压症组患者的硬度值明显高于对照组（P<0.05）。
超声弹性成像在诊断门静脉高压症方面表现良好，能够识别患有这种疾病的儿童肝脏和脾脏硬度的显著差异。因此，该方法作为一种无创工具，在筛查慢性肝病儿童门静脉高压相关并发症方面具有相当大的潜力。
