声辐射力脉冲成像技术虚拟触诊定量法与瞬时弹性成像技术用于慢性乙型或丙型肝炎患者肝纤维化的无创评估：以肝活检为金标准。
Virtual Touch Quantification using Acoustic Radiation Force Impulse Imaging Technology versus Transient Elastography for the Noninvasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B or C using Liver Biopsy as the Gold Standard.
机构信息
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania. .
Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania.
出版信息
J Gastrointestin Liver Dis. 2020 Jun 3;29(2):181-190. doi: 10.15403/jgld-2256.
AIMS
Our aim was to assess the diagnostic performance of transient elastography (TE) and Virtual Touch Quantification (VTQ), a point Shear Wave Elastography (pSWE) technique, using Acoustic Radiation Force Impulse (ARFI) technology, for liver fibrosis assessment, as compared to percutaneous liver biopsy (LB), in patients with chronic hepatitis B or C.
METHODS
We analyzed 157 patients (80 with chronic hepatitis B and 77 with chronic hepatitis C) with reliable liver stiffness (LS) measurements, in whom we compared TE and VTQ to the LB performed during the same session (evaluated according to the Metavir scoring system: F0-F4). LS was assessed by TE (FibroScan, EchoSens, Paris, France) and VTQ using the Siemens Acuson S2000TM ultrasound system (Siemens AG, Erlangen, Germany). We defined reliable LS measurements as the median value of 10 measurements with an IQR/M <30% for both TE (obtained using the M probe) and VTQ. The areas under receiver operating characteristic curves (AUROCs) were used to assess the diagnostic performance of TE and VTQ. Correlation analysis determined the relationship between LSM values and liver histology.
RESULTS
On LB 31 (19.7%) patients had no fibrosis, 35 (22.3%) had F1, 43 (27.4%) had F2, 28 (17.8%) had F3 and 20 (12.7%) had cirrhosis. The mean size of the liver specimen in LB was 27 mm. A strong, linear correlation (Spearman ρ=0.826; p<0.001) with 95% confidence interval for rho (0.769- 0.870), was found between the TE and VTQ measurements. By comparing the AUROC curves, TE and VTQ had similar predictive values for the presence of F≥1 Metavir: AUROC TE=0.876, AUROC VTQ=0.832, p=0.358, for F≥2 Metavir: AUROC TE=0.826, AUROC VTQ=0.862, p=0.313, for F≥3 Metavir: AUROC TE=0.907, AUROC VTQ=0.880, p=0.434 and for F=4 Metavir: AUROC TE=0.981, AUROC VTQ=0.974, p= 0.423.
CONCLUSIONS
Both methods, TE and VTQ (pSWE) offer excellent diagnostic accuracy for liver fibrosis assessment in patients with chronic hepatitis B or C with similar performance.
目的
本研究旨在评估瞬时弹性成像（TE）和虚拟触诊定量（VTQ），一种基于声辐射力脉冲（ARFI）技术的单点剪切波弹性成像（pSWE）技术，在慢性乙型或丙型肝炎患者中，与经皮肝活检（LB）相比，用于评估肝纤维化的诊断性能。
方法
我们分析了 157 例（80 例慢性乙型肝炎和 77 例慢性丙型肝炎）具有可靠肝硬度（LS）测量值的患者，我们比较了 TE 和 VTQ 与同一时间段进行的 LB（根据 Metavir 评分系统进行评估：F0-F4）。LS 通过 TE（FibroScan，EchoSens，法国巴黎）和使用 Siemens Acuson S2000TM 超声系统（德国西门子 AG）进行的 VTQ 进行评估。我们将 TE（M 探头）和 VTQ 的 10 次测量的中位数值和 IQR/M <30%定义为可靠的 LS 测量值。使用接收者操作特征曲线（AUROCs）下的面积来评估 TE 和 VTQ 的诊断性能。相关性分析确定了 LSM 值与肝脏组织学之间的关系。
结果
在 LB 中，31 例（19.7%）患者无纤维化，35 例（22.3%）患者为 F1，43 例（27.4%）患者为 F2，28 例（17.8%）患者为 F3，20 例（12.7%）患者为肝硬化。LB 中肝组织样本的平均大小为 27mm。我们发现 TE 和 VTQ 测量值之间存在很强的线性相关性（Spearman ρ=0.826;p<0.001），95%置信区间的 rho 值为 0.769-0.870。通过比较 AUROC 曲线，TE 和 VTQ 对存在 F≥1 Metavir 的预测值相似：AUROC TE=0.876，AUROC VTQ=0.832，p=0.358，对于 F≥2 Metavir：AUROC TE=0.826，AUROC VTQ=0.862，p=0.313，对于 F≥3 Metavir：AUROC TE=0.907，AUROC VTQ=0.880，p=0.434，对于 F=4 Metavir：AUROC TE=0.981，AUROC VTQ=0.974，p=0.423。
结论
在慢性乙型或丙型肝炎患者中，TE 和 VTQ（pSWE）两种方法均具有出色的肝纤维化评估诊断准确性，性能相似。
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