慢性乙型肝炎肝癌患者肝纤维化的术前无创评估：二维剪切波弹性成像与血清肝纤维化模型的比较。
Preoperative noninvasive assessment for liver fibrosis in hepatocellular carcinoma patients with chronic hepatitis B: Comparison of two-dimensional shear-wave elastography with serum liver fibrosis models.
机构信息
Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
出版信息
Eur J Radiol. 2020 Dec;133:109386. doi: 10.1016/j.ejrad.2020.109386. Epub 2020 Nov 2.
PURPOSE
To investigate the diagnostic performance of two-dimensional shear-wave elastography (2D-SWE) in hepatocellular carcinoma patients with chronic hepatitis B adapted to hepatectomy comparing to serum liver fibrosis models.
METHOD
100 patients with chronic hepatitis B who first diagnosed with hepatocellular carcinoma and had undergone 2D-SWE measurements before the hepatectomy were included. The performance of 2D-SWE and serum models in the diagnosis of liver fibrosis was assessed using receiver operating characteristic (ROC) analyses.
RESULTS
The areas under ROC (AUCs) for 2D-SWE, Forns score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis 4 Score (FIB-4) were 0.983, 0.757, 0.745, 0.710 in the diagnosis of significant fibrosis (F ≥ 2) respectively, and 0.896, 0.718, 0.626, 0.575 in the diagnosis of cirrhosis (F = 4) respectively. The AUCs for 2D-SWE in the diagnosis of significant fibrosis and cirrhosis were significantly higher than those for the serum fibrosis models (p < 0.05). The AUCs of Forns in the diagnosis of significant fibrosis (F ≥ 2) showed no statistical differences (p > 0.05) with those of APRI and FIB-4 while in the diagnosis of cirrhosis (F = 4), they are significantly higher (p < 0.05).
CONCLUSIONS
2D-SWE is a reliable method for preoperative noninvasive assessment of liver fibrosis in HCC patients with CHB, with notably higher diagnostic accuracy than serum liver fibrosis models.
目的
研究二维剪切波弹性成像（2D-SWE）在适应肝切除术的慢性乙型肝炎肝细胞癌患者中的诊断性能，与血清肝纤维化模型相比。
方法
纳入 100 例首次诊断为肝细胞癌并在肝切除术前接受 2D-SWE 测量的慢性乙型肝炎患者。使用受试者工作特征（ROC）分析评估 2D-SWE 和血清模型在诊断肝纤维化中的性能。
结果
2D-SWE、Forns 评分、天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化 4 评分（FIB-4）在诊断显著纤维化（F≥2）时的 ROC 曲线下面积（AUCs）分别为 0.983、0.757、0.745、0.710，在诊断肝硬化（F=4）时的 AUCs 分别为 0.896、0.718、0.626、0.575。2D-SWE 在诊断显著纤维化和肝硬化中的 AUC 明显高于血清纤维化模型（p<0.05）。Forns 在诊断显著纤维化（F≥2）时的 AUC 与 APRI 和 FIB-4 无统计学差异（p>0.05），而在诊断肝硬化（F=4）时，其 AUC 明显更高（p<0.05）。
结论
2D-SWE 是一种可靠的术前非侵入性评估 CHB 合并 HCC 患者肝纤维化的方法，其诊断准确性明显高于血清肝纤维化模型。
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