Cho Young Seo, Jeong Woo Kyoung, Kim Yongsoo
Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ultrasonography. 2020 Jul;39(3):272-280. doi: 10.14366/usg.20009. Epub 2020 Feb 29.
This study investigated the impact of liver stiffness measurements (LSM) made using 2-dimensional (2D) shear wave elastography (SWE) on the diagnosis and grading of hepatic fibrosis and liver cirrhosis (LC) using grayscale ultrasonography (US).
This retrospective study included 46 patients who underwent liver biopsy for chronic liver disease and 33 non-biopsied subjects with no or mild fibrosis (an aspartate aminotransferase-to-platelet ratio index <0.50 and a Forns score <4.21). Two abdominal radiologists reviewed randomized grayscale hepatic sonogram sets with and without LSM, separated by a 4-week interval. They graded the features of echogenicity, echotexture, surface nodularity, and edge blunting and classified patients by fibrosis grade. Interobserver agreement and correlations with the fibrosis grades were compared before and after the reviewers were informed regarding LSM, and the impact of LSM on diagnostic performance was evaluated.
The standard diagnoses were no or mild fibrosis (F0-1, n=39), moderate to advanced fibrosis (F2-3, n=23), or LC (n=17). The correlations between US and the diagnostic reference standard increased significantly with LSM incorporation (0.499 and 0.312 to 0.782 and 0.804, P<0.01 for both reviewers), as did interobserver agreement (0.318 to 0.753, P<0.01). The areas under the receiver operating characteristic curve (AUCs) for the diagnosis of significant fibrosis increased when LSM was included (0.682 and 0.591 to 0.855 and 0.907, P<0.01 for both reviewers), while the AUCs for the diagnosis of LC did not change significantly (0.891 and 0.783 to 0.904 and 0.900, P=0.849 and P=0.166).
Incorporating LSM values obtained by 2D-SWE improved the diagnostic accuracy and interobserver agreement of grayscale US for hepatic fibrosis.
本研究探讨了使用二维（2D）剪切波弹性成像（SWE）进行肝脏硬度测量（LSM）对采用灰阶超声（US）诊断肝纤维化和肝硬化（LC）及其分级的影响。
这项回顾性研究纳入了46例因慢性肝病接受肝活检的患者以及33例未进行活检、无纤维化或纤维化程度较轻的受试者（天冬氨酸转氨酶与血小板比值指数<0.50且Forns评分<4.21）。两名腹部放射科医生对随机分组的有和没有LSM的灰阶肝脏超声图像集进行回顾，间隔4周。他们对回声性、回声纹理、表面结节性和边缘钝圆等特征进行分级，并根据纤维化程度对患者进行分类。在告知审阅者有关LSM前后，比较观察者间的一致性以及与纤维化程度的相关性，并评估LSM对诊断性能的影响。
标准诊断为无纤维化或轻度纤维化（F0 - 1，n = 39）、中度至重度纤维化（F2 - 3，n = 23）或LC（n = 17）。纳入LSM后，US与诊断参考标准之间的相关性显著增加（两位审阅者的相关性分别从0.499和0.312提高到0.782和0.804，P均<0.01），观察者间的一致性也显著提高（从0.318提高到0.753，P<0.01）。纳入LSM后，诊断显著纤维化的受试者工作特征曲线下面积（AUC）增加（两位审阅者的AUC分别从0.682和0.591提高到0.855和0.907，P均<0.01），而诊断LC的AUC没有显著变化（从0.891和0.783分别提高到0.904和0.900，P = 0.849和P = 0.166）。
纳入二维SWE获得的LSM值可提高灰阶US诊断肝纤维化的准确性和观察者间的一致性。
