Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Chung-Ang University Hospital, Seoul, Korea.
Korean J Radiol. 2020 Dec;21(12):1317-1325. doi: 10.3348/kjr.2019.0978. Epub 2020 Jul 27.
The aim of this study was to prospectively evaluate whether liver stiffness (LS) assessments, obtained by two-dimensional (2D)-shear wave elastography (SWE) with a propagation map, can evaluate liver fibrosis stage using histopathology as the reference standard.
We prospectively enrolled 123 patients who had undergone percutaneous liver biopsy from two tertiary referral hospitals. All patients underwent 2D-SWE examination prior to biopsy, and LS values (kilopascal [kPa]) were obtained. On histopathologic examination, fibrosis stage (F0-F4) and necroinflammatory activity grade (A0-A4) were assessed. Multivariate linear regression analysis was performed to determine the significant factors affecting the LS value. The diagnostic performance of the LS value for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis, and the optimal cut-off value was determined by the Youden index.
Reliable measurements of LS values were obtained in 114 patients (92.7%, 114/123). LS values obtained from 2D-SWE with the propagation map positively correlated with the progression of liver fibrosis reported from histopathology ( < 0.001). According to the multivariate linear regression analysis, fibrosis stage was the only factor significantly associated with LS ( < 0.001). The area under the ROC curve of LS from 2D-SWE with the propagation map was 0.773, 0.865, 0.946, and 0.950 for detecting F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The optimal cut-off LS values were 5.4, 7.8, 9.4, and 12.2 kPa for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The corresponding sensitivity and specificity of the LS value for detecting cirrhosis were 90.9% and 88.4%, respectively.
The LS value obtained from 2D-SWE with a propagation map provides excellent diagnostic performance in evaluating liver fibrosis stage, determined by histopathology.
本研究旨在前瞻性评估二维（2D）-剪切波弹性成像（SWE）的传播图是否可以通过组织病理学作为参考标准来评估肝纤维化分期。
我们前瞻性纳入了 123 名来自两家三级转诊医院的经皮肝活检患者。所有患者均在活检前进行 2D-SWE 检查，并获得肝硬度（kPa）值。在组织病理学检查中，评估纤维化分期（F0-F4）和坏死性炎症活动度（A0-A4）。采用多元线性回归分析确定影响 LS 值的显著因素。采用受试者工作特征（ROC）分析评估 LS 值对纤维化分期的诊断性能，并通过约登指数确定最佳截断值。
在 114 例患者（92.7%，114/123）中获得了可靠的 LS 值测量值。2D-SWE 传播图获得的 LS 值与组织病理学报告的肝纤维化进展呈正相关（<0.001）。根据多元线性回归分析，纤维化分期是唯一与 LS 显著相关的因素（<0.001）。2D-SWE 传播图的 LS 的 ROC 曲线下面积分别为 0.773、0.865、0.946 和 0.950，用于检测 F≥1、F≥2、F≥3 和 F=4。最佳截断 LS 值分别为 5.4、7.8、9.4 和 12.2kPa，用于检测 F≥1、F≥2、F≥3 和 F=4。LS 值检测肝硬化的灵敏度和特异性分别为 90.9%和 88.4%。
传播图的 2D-SWE 获得的 LS 值在通过组织病理学评估肝纤维化分期方面具有优异的诊断性能。
