瞬时弹性成像和声辐射力脉冲成像技术检测肝外胆汁淤积患者肝硬度的变化。
Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis.
机构信息
Hepato-gastroenterology and Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
出版信息
Eur J Gastroenterol Hepatol. 2021 Aug 1;33(8):1097-1103. doi: 10.1097/MEG.0000000000001881.
BACKGROUND
Transient elastography and acoustic radiation force impulse (ARFI) imaging are noninvasive tools for liver stiffness measurement (LSM), which may be influenced by cholestasis.
AIM
The aim of the study was to evaluate the performance of transient elastography and ARFI in extrahepatic cholestasis and correlate changes in LSM with biochemical activity.
MATERIALS AND METHODS
A total of 38 patients with extrahepatic cholestasis prospectively underwent transient elastography and ARFI. Changes in LSM by transient elastography/ARFI were evaluated after 1 week of ERCP and correlated with biochemical parameters. The optimal ARFI cutoffs according to stages of clinical interest were analyzed.
RESULTS
Biliary obstruction was calcular in 21 (55.3%) and noncalcular in 17 (44.7%) (benign n = 15, malignant n = 2). After 1 week, adequate biliary drainage reduced total bilirubin from 7.7 to 2.2 mg/dL (P < 0.001) which significantly correlated with reduction of LSM by transient elastography from 12.38 ± 6.68 kPa to 8.08 ± 3.21 kPa (P < 0.001), and by ARFI from 1.73 ± 0.51 m/s to 1.56 ± 0.70 m/s (P = 0.014). The LSM percentage change showed a decrease (nonsignificant, P = 0.843) by 25.83% using transient elastography and a significant decrease (P < 0.001) by 18.42% using ARFI in the improved patients. At initial visit, transient elastography positively correlated with ARFI, bilirubin and platelets, also, transient elastography had a positive correlation with ARFI, bilirubin, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT) in follow-up visit. LSM by ARFI (visit 1) negatively correlated with ALT, while in (visit 2), ARFI positively correlated with bilirubin, ALP, GGT and negatively correlated with albumin.
CONCLUSION
The increased LSM in patients with extrahepatic cholestasis is reduced after adequate biliary drainage, implying that increased values are not solely due to liver fibrosis, but due to biliary congestion leading temporarily to increased elasticity.
背景
瞬时弹性成像和声辐射力脉冲（ARFI）成像都是用于测量肝硬度（LSM）的非侵入性工具，它们可能受到胆汁淤积的影响。
目的
本研究旨在评估瞬时弹性成像和 ARFI 在肝外胆汁淤积症中的性能，并将 LSM 的变化与生化活性相关联。
材料和方法
总共 38 例肝外胆汁淤积症患者前瞻性接受瞬时弹性成像和 ARFI 检查。在 ERCP 后 1 周评估瞬时弹性成像/ARFI 的 LSM 变化，并与生化参数相关联。根据临床感兴趣的阶段分析了最佳的 ARFI 截断值。
结果
21 例（55.3%）为胆管阻塞，17 例（44.7%）为非胆管阻塞（良性 n=15，恶性 n=2）。1 周后，充分的胆道引流使总胆红素从 7.7 降至 2.2mg/dL（P<0.001），这与瞬时弹性成像的 LSM 从 12.38±6.68kPa 降至 8.08±3.21kPa（P<0.001）显著相关，与 ARFI 的 LSM 从 1.73±0.51m/s 降至 1.56±0.70m/s（P=0.014）显著相关。使用瞬时弹性成像，LSM 百分比变化显示下降（无统计学意义，P=0.843），下降 25.83%，使用 ARFI 显著下降（P<0.001），下降 18.42%。在改善的患者中，初始就诊时，瞬时弹性成像与 ARFI、胆红素和血小板呈正相关，在随访就诊时，瞬时弹性成像与 ARFI、胆红素、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）也呈正相关。ARFI 的 LSM（就诊 1）与 ALT 呈负相关，而在就诊 2 时，ARFI 与胆红素、ALP、GGT 呈正相关，与白蛋白呈负相关。
结论
充分的胆道引流后，肝外胆汁淤积症患者的 LSM 升高得到降低，这表明升高的值不仅仅是由于肝纤维化，而是由于胆汁淤积导致暂时的弹性增加。
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