Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy Timişoara, Romania.
Med Ultrason. 2020 Mar 1;22(1):13-19. doi: 10.11152/mu-2179.
To evaluate the feasibility of two elastographic methods, point Shear Wave Elastography (pSWE) and two dimensional Shear Wave Elastography (2D-SWE), integrated in the same ultrasound machine, for liver fibrosis (LF) assessment, using Transient Elastography (TE) as the reference method.
We included in the study 115 subjects in which LF was evaluated in the same session by TE (FibroScan, EchoSens), pSWE and 2D-SWE (Samsung-Medison RS85). Reliable liver stiffness (LS) measurements were defined: for TE the median value of 10 measurements with interquartile range (IQR/M)≤30%,while for pSWE and 2D-SWE the median value of 10 measurements, with a reliability measurement index (RMI)≥0.5 and IQR/M≤30%. For classification of LF severity we used TE as the reference method with the following cut-offs: F2≥7kPa, F3≥9.5kPa and F4≥12kPa.
Reliable measurements by TE were obtained in 98.2% of cases (113/115), by pSWE in 93.9% of cases (108/115) and by 2D-SWE in 92.1% of cases (106/115), so the final analysis included 101 patients. We divided the cohort into 3 groups: fibrosis 5.9 kPa [AUROC=0.95, 95%CI(0.89;0.98), p<0.0001, Se=94.1%, Sp=89.5%, PPV=82.1%, NPV=96.8%]; F4 LS >8 kPa [AUROC=0.98, 95%CI(0.94;0.99), p<0.0001, Se=94.4%, Sp=95.1%, PPV=81%, NPV=98.7%], while for 2D-SWE they were: F≥2 LS >6.1 kPa [AUROC=0.93, 95%CI(0.86;0.97), p<0.0001, Se=91.1%, Sp=80.6%, PPV=70.5%, NPV=94.7%]; F4 LS >7.6 kPa [AUROC=0.98, 95%CI(0.93;0.99), p<0.0001, Se=100%, Sp=91.5%, PPV=72%, NPV=100%]. We observed strong correlations between LS values obtained by TE and 2D-SWE (r=0.85), between TE and pSWE (r=0.88) and between pSWE and 2D-SWE (r=0.90) (p=0.37), respectively. There were no significant differences between the mean values obtained by pSWE and 2D-SWE (p=0.96).
The pSWE and 2D-SWE are feasible methods for assessing liver fibrosis, both techniques strongly correlating with TE results.
评估两种弹性成像方法，即点剪切波弹性成像（pSWE）和二维剪切波弹性成像（2D-SWE），在同一台超声机器中的可行性，使用瞬时弹性成像（TE）作为参考方法，用于评估肝纤维化（LF）。
我们纳入了 115 名患者，这些患者在同一时段内通过 TE（FibroScan、EchoSens）、pSWE 和 2D-SWE（Samsung-Medison RS85）评估 LF。可靠的肝硬度（LS）测量定义为：对于 TE，中位数 10 次测量的 IQR/M 值≤30%，而对于 pSWE 和 2D-SWE，中位数 10 次测量的 IQR/M 值≤30%，同时可靠性测量指数（RMI）≥0.5。对于 LF 严重程度的分类，我们使用 TE 作为参考方法，以下为临界值：F2≥7kPa，F3≥9.5kPa，F4≥12kPa。
TE 获得可靠测量的比例为 98.2%（113/115），pSWE 为 93.9%（108/115），2D-SWE 为 92.1%（106/115），因此最终分析纳入了 101 名患者。我们将队列分为 3 组：纤维化 5.9kPa[AUROC=0.95，95%CI（0.89；0.98），p<0.0001，Se=94.1%，Sp=89.5%，PPV=82.1%，NPV=96.8%]；F4 LS >8kPa[AUROC=0.98，95%CI（0.94；0.99），p<0.0001，Se=94.4%，Sp=95.1%，PPV=81%，NPV=98.7%]，而对于 2D-SWE，其结果为：F≥2 LS >6.1kPa[AUROC=0.93，95%CI（0.86；0.97），p<0.0001，Se=91.1%，Sp=80.6%，PPV=70.5%，NPV=94.7%]；F4 LS >7.6kPa[AUROC=0.98，95%CI（0.93；0.99），p<0.0001，Se=100%，Sp=91.5%，PPV=72%，NPV=100%]。我们观察到 TE 和 2D-SWE（r=0.85）、TE 和 pSWE（r=0.88）以及 pSWE 和 2D-SWE（r=0.90）之间 LS 值的相关性较强（p=0.37）。pSWE 和 2D-SWE 之间的平均值没有显著差异（p=0.96）。
pSWE 和 2D-SWE 是评估肝纤维化的可行方法，两种技术与 TE 结果具有较强的相关性。
