Hepatology Department, Angers University Hospital, Angers, France.
Radiology Department, Angers University Hospital, Angers, France.
Eur J Radiol. 2018 Nov;108:133-139. doi: 10.1016/j.ejrad.2018.09.019. Epub 2018 Sep 19.
Advanced chronic liver disease is frequent yet largely underdiagnosed. Doppler-US is a common examination and we recently identified three simple Doppler-US signs associated with severe liver fibrosis. Recent Doppler-US devices include elastography modules, allowing for liver stiffness measurement (LSM). Our aim was to assess whether the use of elastography following positive simple Doppler-US signs improves the detection of severe liver fibrosis in a single Doppler-US examination.
514 patients with chronic liver disease who consecutively underwent percutaneous liver biopsy were included in the study. All patients had a Doppler-US examination and LSM with Virtual Touch Quantification (VTQ) on the same day as a liver biopsy. A subset of 326 patients also had LSM with 2D shear wave elastography (SSI). Severe fibrosis was defined as Metavir F ≥ 3 on liver biopsy.
Multivariate analysis confirmed our three simple Doppler-US signs (liver surface irregularity, splenomegaly ≥110 mm, and demodulation of hepatic veins) as independently associated with severe fibrosis. The presence of at least one of these three signs showed 85.6% sensitivity and 36.1% specificity for the diagnosis of severe liver fibrosis. Using VTQ (≥1.59 m/s) where there was a positive Doppler-US sign increased the specificity to 80.8%, at the cost of a decrease in sensitivity (73.7%). Similar results were obtained with SSI (≥9.5 kPa), with 73.3% specificity and 81.5% sensitivity.
Elastography improves the accuracy of Doppler-US in the detection of severe fibrosis. This two-step procedure will help radiologists to accurately identify patients who need to be referred to specialist hepatologists during routine Doppler-US examinations.
慢性肝病晚期较为常见，但往往诊断不足。多普勒超声检查较为常见，我们最近发现三种与严重肝纤维化相关的简单多普勒超声征象。最近的多普勒超声设备包括弹性成像模块，可进行肝脏硬度测量（LSM）。我们的目的是评估在阳性多普勒超声征象后使用弹性成像是否能提高单次多普勒超声检查中严重肝纤维化的检出率。
本研究纳入了 514 例连续接受经皮肝活检的慢性肝病患者。所有患者均在同一天接受了多普勒超声检查和 LSM（使用虚拟触诊定量技术（VTQ）），其中一部分 326 例患者还进行了 LSM（使用二维剪切波弹性成像（SSI））。严重纤维化定义为肝活检中 Metavir F≥3。
多变量分析证实了我们的三种简单多普勒超声征象（肝脏表面不规则、脾肿大≥110mm 和肝静脉调制）与严重纤维化独立相关。这些三种征象中的至少一种的存在对严重肝纤维化的诊断具有 85.6%的敏感性和 36.1%的特异性。在存在阳性多普勒超声征象时使用 VTQ（≥1.59m/s）可将特异性提高至 80.8%，但敏感性降低（73.7%）。使用 SSI（≥9.5kPa）也得到了类似的结果，特异性为 73.3%，敏感性为 81.5%。
弹性成像提高了多普勒超声检测严重纤维化的准确性。这种两步法将有助于放射科医生在常规多普勒超声检查中准确识别需要转介给专科肝科医生的患者。
