超声剪切波弹性成像斜率值：肝移植术后移植物损伤的检测。
Shear-Wave Dispersion Slope from US Shear-Wave Elastography: Detection of Allograft Damage after Liver Transplantation.
机构信息
From the Departments of Radiology (D.H.L., J.Y.L., J.S.B., J.K.H.), Surgery (N.J.Y., K.W.L., K.S.S.), and Pathology (H.K., K.B.L.), Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.Y.L., J.K.H.).
出版信息
Radiology. 2019 Nov;293(2):327-333. doi: 10.1148/radiol.2019190064. Epub 2019 Sep 10.
Background Allograft damage (hepatic parenchymal damage) after liver transplant is associated with the degree of necroinflammation in graft liver. According to a recent animal study, shear-wave dispersion slope obtained at US shear-wave elastography (SWE) is associated with necroinflammatory activity in the liver. Purpose To evaluate the role of shear-wave dispersion slope in detecting allograft damage after liver transplant. Materials and Methods In this prospective study, 104 liver transplant recipients underwent percutaneous liver biopsy for allograft evaluation from December 2017 to November 2018. All participants underwent allograft SWE examination just before liver biopsy, and liver stiffness and shear-wave dispersion slope were obtained. Allograft damage was diagnosed by histopathologic analysis. Clinical and imaging factors related to liver stiffness and shear-wave dispersion slope were determined by multivariable linear regression analysis. Diagnostic performance of each variable in detecting allograft damage was evaluated by comparing area under the receiver operating curve (AUC) values. Results There were 104 study participants (35 women); median age was 56 years (interquartile range, 50-62 years). Allograft damage was found in 46 of 104 (44.2%) of participants. The median liver stiffness (8.2 kPa vs 6.3 kPa; < .01) and shear-wave dispersion slope (14.4 [m/sec]/kHz vs 10.4 [m/sec]/kHz; < .01) were higher in participants with allograft damage than in those without damage, respectively. Fibrosis stage was the only determinant factor for liver stiffness (coefficient, 1.8 kPa per fibrosis stage; 95% confidence interval: 0.1, 3.5; = .03), whereas both fibrosis stage (coefficient, 1.4 [m/sec]/kHz per fibrosis stage; 95% confidence interval: 0.3, 2.6; = .02) and necroinflammatory activity (coefficient, 1.6 [m/sec]/kHz per necroinflammatory activity grade; 95% confidence interval: 0.5, 2.7; < .01) affected shear-wave dispersion slope. The AUC for shear-wave dispersion slope in detecting allograft damage was 0.86, which was higher than that of liver stiffness (AUC, 0.75; < .01). Conclusion Shear-wave dispersion slope determined at US shear-wave elastography may help in detecting allograft damage after liver transplant. © RSNA, 2019
背景 肝移植后同种异体移植物损伤（肝实质损伤）与供体肝的坏死性炎症程度有关。根据最近的一项动物研究，超声剪切波弹性成像（SWE）获得的剪切波弥散斜率与肝脏的坏死性炎症活动有关。目的 评估剪切波弥散斜率在检测肝移植后同种异体移植物损伤中的作用。材料与方法 本前瞻性研究纳入 2017 年 12 月至 2018 年 11 月期间 104 例接受肝移植的患者，这些患者因同种异体移植物评估而行经皮肝活检。所有患者在肝活检前均行同种异体 SWE 检查，并获得肝脏硬度和剪切波弥散斜率。通过组织病理学分析诊断同种异体移植物损伤。采用多元线性回归分析确定与肝脏硬度和剪切波弥散斜率相关的临床和影像学因素。通过比较受试者工作特征曲线（AUC）下面积值来评估各变量在检测同种异体移植物损伤中的诊断性能。结果 本研究共纳入 104 例患者（35 例女性），中位年龄为 56 岁（四分位距，5062 岁）。104 例患者中，46 例（44.2%）存在同种异体移植物损伤。与无同种异体移植物损伤者相比，损伤者的肝脏硬度（8.2 kPa 比 6.3 kPa；<.01）和剪切波弥散斜率（14.4[m/sec]/kHz 比 10.4[m/sec]/kHz；<.01）更高。纤维化分期是肝脏硬度的唯一决定因素（系数，每纤维化分期 1.8 kPa；95%置信区间：0.13.5；=.03），而纤维化分期（系数，每纤维化分期 1.4[m/sec]/kHz；95%置信区间：0.32.6；=.02）和坏死性炎症活动（系数，每坏死性炎症活动分级 1.6[m/sec]/kHz；95%置信区间：0.52.7；<.01）均影响剪切波弥散斜率。剪切波弥散斜率检测同种异体移植物损伤的 AUC 为 0.86，高于肝脏硬度（AUC，0.75；<.01）。结论 超声剪切波弹性成像测定的剪切波弥散斜率有助于检测肝移植后同种异体移植物损伤。 ©RSNA，2019
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