二维剪切波技术与瞬时弹性成像测量肝脏硬度的比较：来自欧洲前瞻性多中心研究的结果。
Comparison of liver stiffness measurements by a 2D-shear wave technique and transient elastography: results from a European prospective multi-centre study.
机构信息
Department of Radiology, Beaujon University Hospital, APHP.Nord, Clichy, France.
Université de Paris, Paris, France.
出版信息
Eur Radiol. 2021 Mar;31(3):1578-1587. doi: 10.1007/s00330-020-07212-x. Epub 2020 Sep 9.
OBJECTIVES
To compare liver stiffness measurement (LSM) provided by Canon 2D-shear wave elastography (2D-SWE) and transient elastography (TE), the latter being the reference method.
METHODS
Prospective study conducted in four European centres from 2015 to 2016 including patients with various chronic liver diseases who had LSMs with both 2D-SWE and TE on the same day. Median of 10 valid measurements (in kPa) was used for comparison using paired t test, Pearson correlation, intraclass correlation coefficient (ICC) and Bland-Altman plot. The ability of 2D-SWE to stratify patient according to recognised LSM-TE thresholds was assessed by ROC curve analysis.
RESULTS
Six hundred forty patients were scanned, where 593 (92.7%), 572 (89.4%) and 537 (83.9%) had reliable LSMs by TE, 2D-SWE and both combined, respectively. In the latter (n = 537, 310 [57.7%] male, mean 55.3 ± 14.8 years), median LSM-TE and LSM-2D-SWE had a mean of 10.1 ± 9.4 kPa (range 2.4-75) and 9.1 ± 6.1 kPa (range 3.6-55.7) (paired t test: p < 0.001), respectively. These were significantly correlated (Pearson r = 0.932, p < 0.001, ICC 0.850 (0.825-0.872), bias 0.99 ± 4.33 kPa [95% limits of agreement - 9.48 to + 7.49] with proportional error towards higher LSM values). LSM-2D-SWE values significantly increased with TE categories (ANOVA: p < 0.001). AUROCs ranged from 0.935 ± 0.010 (95% CI 0.910-0.954) to 0.973 ± 0.009 (95% CI 0.955-0.985), resulting in correct classification of 390/537 (73%) patients. Three 2D-SWE measurements were sufficient for reliable LSMs.
CONCLUSION
LSM using 2D-SWE correlates well with TE. It tends to underestimate higher stages of liver fibrosis but correctly classifies the majority of patients. It may be used in TE-derived algorithms to manage patients.
KEY POINTS
• Liver stiffness measurement (LSM) by 2D-shear wave elastography (2D-SWE) and transient elastography (TE) are strongly correlated. • 2D-SWE shows proportionately lower LSM values compared to TE, particularly with the higher LSM range. • Three individual measurements by 2D-SWE are sufficient to assess LSM reliably.
目的
比较佳能二维剪切波弹性成像（2D-SWE）和瞬时弹性成像（TE）提供的肝硬度测量值（LSM），后者为参考方法。
方法
2015 年至 2016 年在欧洲的四个中心进行了一项前瞻性研究，纳入了患有各种慢性肝病的患者，这些患者在同一天接受了 2D-SWE 和 TE 的 LSM 检查。使用配对 t 检验、皮尔逊相关分析、组内相关系数（ICC）和 Bland-Altman 图比较 10 次有效测量（kPa）的中位数。通过 ROC 曲线分析评估 2D-SWE 根据公认的 LSM-TE 阈值对患者进行分层的能力。
结果
共对 644 名患者进行了扫描，其中 593 名（92.7%）、572 名（89.4%）和 537 名（83.9%）分别通过 TE、2D-SWE 和两者联合获得了可靠的 LSM。在后一组（n=537，310 名[57.7%]男性，平均 55.3±14.8 岁），LSM-TE 和 LSM-2D-SWE 的中位数分别为 10.1±9.4 kPa（范围 2.4-75）和 9.1±6.1 kPa（范围 3.6-55.7）（配对 t 检验：p<0.001），两者具有显著相关性（Pearson r=0.932，p<0.001，ICC 0.850（0.825-0.872），偏倚 0.99±4.33 kPa[95%置信区间 -9.48 至 +7.49]，与较高 LSM 值呈比例误差）。2D-SWE 值随 TE 类别显著增加（方差分析：p<0.001）。AUROC 范围为 0.935±0.010（95%置信区间 0.910-0.954）至 0.973±0.009（95%置信区间 0.955-0.985），这导致 537 名患者中的 390 名（73%）得到正确分类。三次 2D-SWE 测量足以获得可靠的 LSM。
结论
使用 2D-SWE 的 LSM 与 TE 相关性良好。它往往低估了较高阶段的肝纤维化，但能正确分类大多数患者。它可用于 TE 衍生的算法来管理患者。
关键要点
二维剪切波弹性成像（2D-SWE）和瞬时弹性成像（TE）的肝硬度测量值（LSM）密切相关。
2D-SWE 显示的 LSM 值与 TE 相比呈比例降低，尤其是在较高的 LSM 范围内。
三次 2D-SWE 测量足以可靠地评估 LSM。
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