肝脏的内源性运动与门静脉高压的严重程度相关。
Endogenous motion of liver correlates to the severity of portal hypertension.
机构信息
Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas 44307, Lithuania.
Biomedical Engineering Institute, Kaunas University of Technology, Kaunas 51423, Lithuania.
出版信息
World J Gastroenterol. 2020 Oct 14;26(38):5836-5848. doi: 10.3748/wjg.v26.i38.5836.
BACKGROUND
Degree of portal hypertension (PH) is the most important prognostic factor for the decompensation of liver cirrhosis and death, therefore adequate care for patients with liver cirrhosis requires timely detection and evaluation of the presence of clinically significant PH (CSPH) and severe PH (SPH). As the most accurate method for the assessment of PH is an invasive direct measurement of hepatic venous pressure gradient (HVPG), the search for non-invasive methods to diagnose these conditions is actively ongoing.
AIM
To evaluate the feasibility of parameters of endogenously induced displacements and strain of liver to assess degree of PH.
METHODS
Of 36 patients with liver cirrhosis and measured HVPG were included in the case-control study. Endogenous motion of the liver was characterized by derived parameters of region average tissue displacement signal ( , , ) and results of endogenous tissue strain imaging using specific radiofrequency signal processing algorithm. Average endogenous strain and standard deviation of strain were assessed in the regions of interest (ROI) (1 cm × 1 cm and 2 cm × 2 cm in size) and different frequency subbands of endogenous motion (0-10 Hz and 10-20 Hz).
RESULTS
Four parameters showed statistically significant ( < 0.05) correlation with HVPG measurement. The strongest correlation was obtained for the standard deviation of strain (estimated at 0-10 Hz and 2 cm × 2 cm ROI size). Three parameters showed statistically significant differences between patient groups with CSPH, but only showed significant results in SPH analysis. According to ROC analysis area under the curve (AUC) of the parameter reached 0.71 ( = 0.036) for the diagnosis of CSPH; with a cut-off value of 1.28 μm/cm providing 73% sensitivity and 70% specificity. AUC for the diagnosis of CSPH for was 0.78 ( = 0.0024); with a cut-off value of 3.92 μm/cm providing 73% sensitivity and 80% specificity. parameter had an AUC of 0.86 ( = 0.0001) for the diagnosis of CSPH and 0.84 ( = 0.0001) for the diagnosis of SPH. A cut-off value of -132.34 μm yielded 100% sensitivity for both conditions, whereas specificity was 80% and 72% for CSPH and SPH respectively.
CONCLUSION
The parameters of endogenously induced displacements and strain of the liver correlated with HVPG and might be used for non-invasive diagnosis of PH.
背景
门静脉高压（PH）程度是肝硬化失代偿和死亡的最重要预后因素，因此，为肝硬化患者提供充分的护理需要及时发现和评估存在临床显著 PH（CSPH）和严重 PH（SPH）。由于评估 PH 的最准确方法是肝静脉压力梯度（HVPG）的直接有创测量，因此积极寻找非侵入性方法来诊断这些情况。
目的
评估内源性肝位移和应变参数评估 PH 程度的可行性。
方法
纳入 36 例肝硬化患者并测量 HVPG，进行病例对照研究。通过衍生的区域平均组织位移信号（ ， ， ）参数和使用特定射频信号处理算法的内源性组织应变成像的结果来描述肝内源性运动。在感兴趣区域（ROI）（1cm×1cm 和 2cm×2cm 大小）和内源性运动的不同频率子带（0-10Hz 和 10-20Hz）中评估平均内源性应变 和应变标准差 。
结果
四项参数与 HVPG 测量值具有统计学显著相关性（ < 0.05）。应变标准差的相关性最强（估计在 0-10Hz 和 2cm×2cm ROI 大小）。两组患者在 CSPH 组之间有三个参数具有统计学显著差异，但只有 显示 SPH 分析中的显著结果。根据 ROC 分析， 参数的曲线下面积（AUC）达到 0.71（ = 0.036），用于诊断 CSPH；截断值为 1.28μm/cm 时，敏感性为 73%，特异性为 70%。对于 的诊断，CSPH 的 AUC 为 0.78（ = 0.0024）；截断值为 3.92μm/cm 时，敏感性为 73%，特异性为 80%。 参数的 AUC 为 0.86（ = 0.0001），用于诊断 CSPH，0.84（ = 0.0001）用于诊断 SPH。截断值为-132.34μm 时，两种情况下的敏感性均为 100%，而特异性分别为 80%和 72%。
结论
内源性肝位移和应变参数与 HVPG 相关，可用于 PH 的非侵入性诊断。
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