应用瞬时弹性成像作为参考检测时，基于超声弹性成像点触诊量化技术的肝脏硬度值测量存在依赖性差异。
Magnitude dependent discordance in liver stiffness measurements using elastography point quantification with transient elastography as the reference test.
机构信息
Department of Gastroenterology, Hepatology and Clinical Nutrition; Department of Medicine, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Avenija Gojka Suska 6, 10000, Zagreb, Croatia.
Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
出版信息
Eur Radiol. 2019 May;29(5):2448-2456. doi: 10.1007/s00330-018-5831-2. Epub 2018 Nov 28.
OBJECTIVES
To investigate diagnostic performance of point shear wave elastography by elastography point quantification (ElastPQ) for non-invasive assessment of liver fibrosis in patients with chronic liver diseases (CLD).
METHODS
Liver stiffness measurement (LSM) by transient elastography (TE) and ElastPQ was performed in patients with CLD and healthy volunteers. The stage of liver fibrosis was defined by TE which served as the reference. We compared two methods by using correlation, area under the receiver operating characteristics curve (AUC) analysis, Bland and Altman plot and Passing-Bablok regression.
RESULTS
A total of 185 subjects (20 healthy volunteers and 165 patients with CLD (128 non-alcoholic fatty liver disease), 83 (44.9%) females, median age 53 years, BMI 27.3 kg/m) were evaluated. There were 24.3%, 13.5% and 11.4% patients in ≥ F2, ≥ F3 and F4 stage, respectively. The best performing cutoff LSM values by ElastPQ were 5.5 kPa for F ≥ 2 (AUC = 0.96), 8.1 kPa for F ≥ 3 (AUC = 0.98) and 9.9 kPa for F4 (AUC = 0.98). Mean (SD) difference between TE and ElastPQ measurements was 0.98 (3.27) kPa (95% CI 0.51-1.45, range 4.99-21.60 kPa). Two methods correlated significantly (r = 0.86; p < 0.001), yet Bland and Altman plot demonstrated difference between measurements, especially with TE values > 10 kPa. Passing and Bablok regression analysis yielded significant constant and proportional difference between ElastPQ and TE.
CONCLUSION
ElastPQ is reliable method for assessment of liver fibrosis but LSM values are not interchangeable with TE, especially above 10 kPa. Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should therefore be furtherly investigated.
KEY POINTS
• ElastPQ appears to be reliable method for assessment of liver fibrosis, with data presented here mostly applicable to NAFLD. • LSM values produced by TE and ElastPQ are NOT interchangeable-in values < 10 kPa, they are similar, but in values > 10 kPa, they appear to be increasingly and significantly different. • Diagnostic performance of ElastPQ for sub-classification of patients with compensated advanced chronic liver disease should be furtherly investigated.
目的
通过弹性点量化（ElastPQ）研究剪切波弹性成像在慢性肝病（CLD）患者肝纤维化无创评估中的诊断性能。
方法
对 CLD 患者和健康志愿者进行瞬时弹性成像（TE）和 ElastPQ 的肝硬度测量（LSM）。TE 定义的纤维化分期为参考，比较两种方法的相关性、受试者工作特征曲线（ROC）下面积（AUC）分析、Bland 和 Altman 图和 Passing-Bablok 回归。
结果
共评估了 185 名受试者（20 名健康志愿者和 165 名 CLD 患者（128 名非酒精性脂肪性肝病），83 名女性（44.9%），中位年龄 53 岁，BMI 27.3kg/m）。≥F2、≥F3 和 F4 期患者分别占 24.3%、13.5%和 11.4%。ElastPQ 最佳截断 LSM 值为 F≥2 时为 5.5kPa（AUC=0.96），F≥3 时为 8.1kPa（AUC=0.98），F4 时为 9.9kPa（AUC=0.98）。TE 和 ElastPQ 测量值之间的平均（SD）差异为 0.98（3.27）kPa（95%CI 0.51-1.45，范围 4.99-21.60kPa）。两种方法相关性显著（r=0.86；p<0.001），但 Bland 和 Altman 图显示测量值之间存在差异，尤其是在 TE 值>10kPa 时。Passing 和 Bablok 回归分析显示 ElastPQ 和 TE 之间存在显著的常数和比例差异。
结论
ElastPQ 是评估肝纤维化的可靠方法，但 LSM 值与 TE 不具有互换性，尤其是在 10kPa 以上时。因此，应进一步研究 ElastPQ 在代偿性晚期慢性肝病患者亚分类中的诊断性能。
关键点
ElastPQ 似乎是一种可靠的肝纤维化评估方法，此处提供的数据主要适用于非酒精性脂肪性肝病。
TE 和 ElastPQ 产生的 LSM 值不可互换-在<10kPa 时，它们相似，但在>10kPa 时，它们似乎越来越明显且显著不同。
应进一步研究 ElastPQ 在代偿性晚期慢性肝病患者亚分类中的诊断性能。
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