超声剪切波弹性成像评估肝脏硬度能准确预测晚期慢性肝病患者的临床显著门静脉高压。
Liver Stiffness Assessed by Ultrasound Shear Wave Elastography from General Electric Accurately Predicts Clinically Significant Portal Hypertension in Patients with Advanced Chronic Liver Disease.
机构信息
Hepatology Department, Regional Institute of Gastroenterology and Hepatology, Cluj Napoca, Romania.
Liver Research Club, Cluj-Napoca, Romania.
出版信息
Ultraschall Med. 2020 Oct;41(5):526-533. doi: 10.1055/a-0965-0745. Epub 2019 Sep 2.
PURPOSE
Clinically significant portal hypertension (CSPH) is responsible for most of the complications in patients with cirrhosis. Liver stiffness (LS) measurement by vibration-controlled transient elastography (VCTE) is currently used to evaluate CSPH. Bi-dimensional shear wave elastography from General Electric (2D-SWE.GE) has not yet been validated for the diagnosis of PHT. Our aims were to test whether 2D-SWE.GE-LS is able to evaluate CSPH, to determine the reliability criteria of the method and to compare its accuracy with that of VCTE-LS in this clinical setting.
MATERIALS AND METHODS
Patients with chronic liver disease referred to hepatic catheterization (HVPG) were consecutively enrolled. HVPG and LS by both VCTE and 2D-SWE.GE were performed on the same day. The diagnostic performance of each LS method was compared against HVPG and between each other.
RESULTS
2D-SWE.GE-LS was possible in 123/127 (96.90 %) patients. The ability to record at least 5 LS measurements by 2D-SWE.GE and IQR < 30 % were the only features associated with reliable results. 2D-SWE.GE-LS was highly correlated with HVPG (r = 0.704; p < 0.0001), especially if HVPG < 10 mmHg and was significantly higher in patients with CSPH (15.52 vs. 8.14 kPa; p < 0.0001). For a cut-off value of 11.3 kPa, the AUROC of 2D-SWE.GE-LS to detect CSPH was 0.91, which was not inferior to VCTE-LS (0.92; p = 0.79). The diagnostic accuracy of LS by 2D-SWE.GE-LS to detect CSPH was similar with the one of VCTE-LS (83.74 % vs. 85.37 %; p = 0.238). The diagnostic accuracy was not enhanced by using different cut-off values which enhanced the sensitivity or the specificity. However, in the subgroup of compensated patients with alcoholic liver disease, 2D-SWE.GE-LS classified CSPH better than VCTE-LS (93.33 % vs. 85.71 %, p = 0.039).
CONCLUSION
2D-SWE.GE-LS has good accuracy, not inferior to VCTE-LS, for the diagnosis of CSPH.
目的
临床上显著的门静脉高压症（CSPH）是导致肝硬化患者大多数并发症的原因。目前，采用振动控制瞬态弹性成像（VCTE）来测量肝脏硬度（LS）以评估 CSPH。通用电气的二维剪切波弹性成像（2D-SWE.GE）尚未经过验证可用于诊断 PHT。我们的目的是检验 2D-SWE.GE-LS 是否能够评估 CSPH，确定该方法的可靠性标准，并在此临床环境中比较其与 VCTE-LS 的准确性。
材料和方法
连续招募患有慢性肝病并接受肝导管插入术（HVPG）的患者。当天对 VCTE 和 2D-SWE.GE 进行 HVPG 和 LS 测量。比较每种 LS 方法与 HVPG 的诊断性能，并比较彼此之间的诊断性能。
结果
在 127 例患者中有 123 例（96.90％）可以进行 2D-SWE.GE-LS 测量。能够记录至少 5 次 2D-SWE.GE 的 LS 测量值且 IQR＜30％是唯一与可靠结果相关的特征。2D-SWE.GE-LS 与 HVPG 高度相关（r＝0.704；p＜0.0001），尤其是 HVPG＜10mmHg 时，并且在 CSPH 患者中明显更高（15.52 vs. 8.14kPa；p＜0.0001）。当截断值为 11.3kPa 时，2D-SWE.GE-LS 检测 CSPH 的 AUROC 为 0.91，并不劣于 VCTE-LS（0.92；p＝0.79）。2D-SWE.GE-LS 检测 CSPH 的 LS 诊断准确性与 VCTE-LS 相似（83.74％ vs. 85.37％；p＝0.238）。使用不同的截断值提高了灵敏度或特异性，但并未提高诊断准确性。但是，在酒精性肝病的代偿性患者亚组中，2D-SWE.GE-LS 比 VCTE-LS 更好地对 CSPH 进行分类（93.33％ vs. 85.71％，p＝0.039）。
结论
2D-SWE.GE-LS 对 CSPH 的诊断准确性良好，不劣于 VCTE-LS。
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