Zayed Naglaa, Darweesh Samar K, Mousa Shereef, Atef Mira, Ramzy Eman, Yosry Ayman
Department of Hepato-gastroenetrology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur J Gastroenterol Hepatol. 2019 Apr;31(4):520-527. doi: 10.1097/MEG.0000000000001327.
Transient elastography (TE) and acoustic radiation force impulse (ARFI) imaging enable a noninvasive assessment of liver stiffness measurement (LSM) and liver fibrosis/cirrhosis staging. However, their use in cholestatic diseases is still scarce.
The aim of this study was to evaluate the performance of TE and ARFI for the initial assessment of hepatic fibrosis in intrahepatic cholestatic (IHC) diseases and assess LSM changes after 3 months of specific therapy.
This prospective study was carried out on 50 IHC patients. Assessment at baseline and after 3 months of LSM by TE and ARFI was performed.
Overall, 60% of the patients were women (36.5±9.2 years). IHC etiologies were 23 (46%) autoimmune hepatitis, eight (16%) primary sclerosing cholangitis, eight (16%) drug induced, and five (10%) primary biliary cirrhosis. TE could diagnose ≥F2, ≥F3, and F4 stages at cutoffs of at least 6.7, 9.4, and 14.0 kPa, sensitivity/specificity were 100/50% for ≥F2, 88.2/83% for ≥F3, and 90/100% for F4. Moreover, the sensitivity and specificity of ARFI were 93/50% for ≥F2 (cutoff: 1.53 m/s); 71/67% for ≥F3 (cutoff 1.77 m/s); and 90/100% for F4 (cutoff: 2.43 m/s).Follow-up showed a significant decrease in TE and ARFI values by 27 and 22.3% (P<0.001 and <0.001, respectively) and, accordingly, fibrosis stages decreased significantly by both TE and ARFI (P=0.002 and <0.001, respectively).
TE and ARFI represent noninvasive methods with adequate diagnostic performance for the assessment of fibrosis, and monitoring disease progression and treatment response in intrahepatic cholestasis.
瞬时弹性成像（TE）和声辐射力脉冲（ARFI）成像可对肝脏硬度测量（LSM）及肝纤维化/肝硬化分期进行无创评估。然而，它们在胆汁淤积性疾病中的应用仍较少。
本研究旨在评估TE和ARFI在肝内胆汁淤积（IHC）性疾病中对肝纤维化初步评估的性能，并评估特异性治疗3个月后LSM的变化。
本前瞻性研究纳入了50例IHC患者。通过TE和ARFI在基线及3个月后对LSM进行评估。
总体而言，60%的患者为女性（36.5±9.2岁）。IHC的病因包括23例（46%）自身免疫性肝炎、8例（16%）原发性硬化性胆管炎、8例（16%）药物性、5例（10%）原发性胆汁性肝硬化。TE在截断值至少为6.7、9.4和14.0kPa时可诊断≥F2、≥F3和F4期，≥F2期的敏感度/特异度为100/50%，≥F3期为88.2/83%，F4期为90/100%。此外，ARFI在≥F2期（截断值：1.53m/s）的敏感度和特异度为93/50%；≥F3期（截断值1.77m/s）为71/67%；F4期（截断值：2.43m/s）为90/100%。随访显示TE和ARFI值分别显著降低了27%和22.3%（P分别<0.001和<0.001），相应地，TE和ARFI评估的纤维化分期均显著降低（P分别为0.002和<0.001）。
TE和ARFI是评估肝内胆汁淤积纤维化、监测疾病进展及治疗反应的具有足够诊断性能的无创方法。
