Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., Room M391, Box 0628, San Francisco, CA, 94143, USA.
Lifespan Biostatistics Core, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA.
Abdom Radiol (NY). 2019 Oct;44(10):3285-3294. doi: 10.1007/s00261-019-02183-0.
The objective was to evaluate the accuracy of 2D shear wave elastography (SWE) in predicting stages of liver fibrosis using five individual versus grouped measurements and different reliability criteria.
This is a prospective study of 109 patients who underwent hepatic 2D SWE (Canon Aplio 500) prior to liver biopsy for varied indications. Liver fibrosis was staged using the METAVIR scoring system (F = 0-4). Propagation mapping was used to guide ten SWE measurements from the liver parenchyma: five individual measurements and five grouped measurements. IQR/median, SD/median, and SD/mean were examined as quality criteria for patient inclusion at various thresholds (IQR/median ≤ 0.15, 0.2, 0.3, 0.4, 0.5; SD/median ≤ 0.15, 0.2, 0.3; SD/mean ≤ 0.2, 0.3, 0.5). Threshold for clinically significant fibrosis (F ≥ 2) was determined with receiver operating characteristic (ROC) analysis.
There was high agreement between individual and grouped measurements without statistically significant differences (intraclass correlation coefficient = 0.82; p = 0.26-0.96). When no quality criterion was used (n = 103), the optimal threshold was 11.3 kPa [AUROC 0.78, 95% CI (0.69, 0.88)] with sensitivity and specificity of 80% and 66%, respectively. All quality criteria were associated with equal or higher AUROC ranging from 0.78 to 0.87. IQR/median ≤ 0.5 (n = 88) achieved the highest sensitivity of 85% and only excluded a small subset of patients. The AUROC and specificity were 0.83 [95% CI (0.74, 0.92)] and 72%, respectively.
Quality criterion IQR/median ≤ 0.5 increases sensitivity and specificity in prediction of clinically significant liver fibrosis while excluding only a small subset of patients. Grouped measurements are comparable to individual measurements and may help increase procedural efficiency.
本研究旨在评估二维剪切波弹性成像（SWE）通过 5 个个体测量值和不同可靠性标准对肝纤维化分期的预测准确性，以及评估组内和组间测量值的差异。
本前瞻性研究纳入了 109 名因不同适应证行肝脏二维 SWE（佳能 Aplio 500）检查后行肝活检的患者。采用 METAVIR 评分系统（F=0-4）对肝纤维化进行分期。传播映射用于引导从肝实质进行 10 次 SWE 测量：5 个个体测量值和 5 个组内测量值。以 IQR/中位数、SD/中位数和 SD/均值作为患者纳入的质量标准，纳入标准的阈值分别为 IQR/中位数≤0.15、0.2、0.3、0.4、0.5；SD/中位数≤0.15、0.2、0.3；SD/均值≤0.2、0.3、0.5。采用受试者工作特征（ROC）分析确定有临床意义的纤维化（F≥2）的临界值。
个体测量值和组内测量值之间具有高度一致性，无统计学差异（组内相关系数=0.82；p=0.26-0.96）。当不使用任何质量标准（n=103）时，最佳临界值为 11.3kPa[AUROC 0.78，95%置信区间（0.69，0.88)]，其灵敏度和特异性分别为 80%和 66%。所有质量标准的 AUROC 均为 0.78 至 0.87，与 0.78 相当或更高。IQR/中位数≤0.5（n=88）的灵敏度最高，为 85%，且仅排除一小部分患者。AUROC 和特异性分别为 0.83[95%置信区间（0.74，0.92)]和 72%。
质量标准 IQR/中位数≤0.5 可提高预测临床显著肝纤维化的灵敏度和特异性，同时仅排除一小部分患者。组内测量值与个体测量值具有可比性，可提高操作效率。
