Fang Cheng, Virdee Sanjiv, Jacob Joseph, Rufai Olivia, Agarwal Kosh, Quaglia Alberto, Quinlan Daniel J, Sidhu Paul S
Department of Radiology, King's College Hospital, London, UK.
Centre for Medical Imaging Computing, University College London, UK.
Ultrasound. 2019 Nov;27(4):262-271. doi: 10.1177/1742271X19862836. Epub 2019 Jul 23.
The aim of this study was to prospectively evaluate the diagnostic performance of strain elastography for the assessment of liver fibrosis in patients with chronic liver disease using Ishak (0-6) histology stage as a reference standard. Ninety-eight consecutive patients with suspected chronic liver disease scheduled for liver biopsy (n = 78) or histologically confirmed cirrhosis (n = 20) were enrolled. Liver fibrosis Index (LF Index) calculated by strain elastography, liver stiffness by transient elastography and serum fibrosis markers (aspartate aminotransferase-to-platelet ratio index and King's Score) were measured. Spearman's correlation coefficient between the LF Index, liver stiffness, serum fibrosis markers and fibrosis stage were calculated and compared using areas under the receiver-operating characteristics (AUROCs) curves. Among 73 patients who underwent strain elastography, there was weak correlation between fibrosis stage and the LF Index (Spearman's: ρ = 0.385 for Ishak score; = 0.001). Among 52 patients who underwent strain elastography and transient elastography, the AUROC values using LF Index, transient elastography, aspartate aminotransferase-to-platelet ratio index and King's Score for diagnosing significant fibrosis (Ishak score ≥ 3) were 0.79, 0.87, 0.86 and 0.85, respectively (0.0001) and for diagnosing severe fibrosis/cirrhosis (Ishak score ≥ 5) were 0.83, 0.94, 0.92 and 0.92, respectively ( < 0.0001). When comparing the diagnostic performance using LF Index, transient elastography, aspartate aminotransferase-to-platelet ratio index and King's Score, transient elastography shows a significantly higher AUROC value than LF Index in detecting severe fibrosis ( = 0.0149). The diagnostic performance of LF Index calculated by strain elastography was not statistically significantly different to the other noninvasive tests for the assessment of significant liver fibrosis but inferior to transient elastography for the assessment of severe fibrosis/cirrhosis.
本研究旨在以Ishak（0 - 6）组织学分期作为参考标准，前瞻性评估应变弹性成像在慢性肝病患者肝纤维化评估中的诊断性能。连续纳入98例计划进行肝活检的疑似慢性肝病患者（n = 78）或经组织学证实为肝硬化的患者（n = 20）。测量通过应变弹性成像计算的肝纤维化指数（LF指数）、瞬时弹性成像测量的肝脏硬度以及血清纤维化标志物（天冬氨酸转氨酶与血小板比值指数和King评分）。计算LF指数、肝脏硬度、血清纤维化标志物与纤维化分期之间的Spearman相关系数，并使用受试者操作特征曲线下面积（AUROCs）进行比较。在73例行应变弹性成像的患者中，纤维化分期与LF指数之间存在弱相关性（Spearman相关性：Ishak评分为ρ = 0.385；P = 0.001）。在52例行应变弹性成像和瞬时弹性成像的患者中，使用LF指数、瞬时弹性成像、天冬氨酸转氨酶与血小板比值指数和King评分诊断显著纤维化（Ishak评分≥3）的AUROC值分别为0.79、0.87、0.86和0.85（P < 0.0001），诊断重度纤维化/肝硬化（Ishak评分≥5）的AUROC值分别为0.83、0.94、0.92和0.92（P < 0.0001）。当比较使用LF指数、瞬时弹性成像、天冬氨酸转氨酶与血小板比值指数和King评分的诊断性能时，瞬时弹性成像在检测重度纤维化方面的AUROC值显著高于LF指数（P = 0.0149）。通过应变弹性成像计算的LF指数在评估显著肝纤维化方面的诊断性能与其他非侵入性检查无统计学显著差异，但在评估重度纤维化/肝硬化方面不如瞬时弹性成像。
