基于剪切波的声触诊弹性成像技术在自身免疫性肝病患者肝纤维化评估中的应用
Shear wave-based sound touch elastography in liver fibrosis assessment for patients with autoimmune liver diseases.
作者信息
Yang Lulu, Ling Wenwu, He Du, Lu Changli, Ma Lin, Tang Lin, Luo Yan, Chen Shigao
机构信息
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China.
Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
出版信息
Quant Imaging Med Surg. 2021 Apr;11(4):1532-1542. doi: 10.21037/qims-20-521.
BACKGROUND
Shear wave-based ultrasonic elastography (USE) has been widely used for the assessment of liver fibrosis in patients with chronic liver diseases (CLD). However, diagnostic criteria and accuracy vary between different etiologies and specific elastography techniques. We aimed to evaluate the tissue stiffness measured by shear wave-based sound touch elastography (STE) in staging liver fibrosis in patients with autoimmune liver diseases (AILD).
METHODS
One hundred and two AILD patients who had undergone STE liver stiffness measurements (LSMs) by using a Resona 7 ultrasound system were retrospectively studied. With the Scheuer liver fibrosis staging system as the reference, we investigated the diagnostic performance and cutoff values of STE measured liver stiffness in staging liver fibrosis through receiver operating characteristic (ROC) curve analysis. Moreover, comparisons of areas under the curve (AUCs) were made between LSMs and calculated biomarker scores, including the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index.
RESULTS
Median LSMs increased with the advancing fibrosis stages with values of 6.89 kPa (1.51 m/s), 8.00 kPa (1.63 m/s), 9.60 kPa (1.79 m/s), 11.37 kPa (1.95 m/s) and 14.50 kPa (2.20 m/s), from stage 0 to stage 4 respectively. The cutoff values of STE for identifying significant fibrosis (≥ stage 2), severe fibrosis (≥ stage 3) and cirrhosis (stage 4) were 9.07 kPa (1.74 m/s), 9.97 kPa (1.82 m/s) and 10.48 kPa (1.87 m/s), respectively, with corresponding sensitivity of 79.1%, 93.3%, and 100%; specificity of 80.0%, 70.8% and 71.8%. The AUCs of LSMs in identifying fibrosis ≥ stage 2, ≥ stage 3 and stage 4 (0.82, 0.87, and 0.91, respectively) were significantly higher than that of APRI (0.67, 0.64, and 0.72, respectively) and FIB-4 (0.70, 0.68, and 0.75, respectively) (all P<0.05).
CONCLUSIONS
LSM obtained by STE exhibited its good capability to evaluate liver fibrosis stages in patients with AILD. As a noninvasive modality for liver fibrosis staging, STE is superior to APRI and FIB-4 biomarker scores.
背景
基于剪切波的超声弹性成像（USE）已广泛用于评估慢性肝病（CLD）患者的肝纤维化。然而，不同病因和特定弹性成像技术之间的诊断标准和准确性有所不同。我们旨在评估通过基于剪切波的声触诊弹性成像（STE）测量的组织硬度在自身免疫性肝病（AILD）患者肝纤维化分期中的作用。
方法
回顾性研究了102例使用Resona 7超声系统进行STE肝脏硬度测量（LSM）的AILD患者。以Scheuer肝纤维化分期系统为参考，我们通过受试者操作特征（ROC）曲线分析研究了STE测量的肝脏硬度在肝纤维化分期中的诊断性能和临界值。此外，还比较了LSM与计算得到的生物标志物评分之间的曲线下面积（AUC），包括天冬氨酸转氨酶（AST）与血小板比值指数（APRI）和纤维化-4（FIB-4）指数。
结果
LSM中位数随纤维化阶段的进展而增加，从0期到4期分别为6.89 kPa（1.51 m/s）、8.00 kPa（1.63 m/s）、9.60 kPa（1.79 m/s）、11.37 kPa（1.95 m/s）和14.50 kPa（2.20 m/s）。STE识别显著纤维化（≥2期）、严重纤维化（≥3期）和肝硬化（4期）的临界值分别为9.07 kPa（1.74 m/s）、9.97 kPa（1.82 m/s）和10.48 kPa（1.87 m/s），相应的敏感性分别为79.1%、93.3%和100%；特异性分别为80.0%、70.8%和71.8%。LSM识别≥2期、≥3期和4期纤维化的AUC（分别为0.82、0.87和0.91）显著高于APRI（分别为0.67、0.64和0.72）和FIB-4（分别为0.70、0.68和0.75）（均P<0.05）。
结论
STE获得的LSM在评估AILD患者肝纤维化阶段方面表现出良好的能力。作为一种用于肝纤维化分期的非侵入性方法，STE优于APRI和FIB-4生物标志物评分。
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