术前二维剪切波弹性成像与吲哚菁绿清除试验预测肝切除术后肝衰竭的比较。
Comparison between preoperative two-dimensional shear wave elastography and indocyanine green clearance test for prediction of post-hepatectomy liver failure.
作者信息
Qiu Tingting, Fu Rong, Ling Wenwu, Li Jiawu, Song Jiulin, Wu Zhenru, Shi Yujun, Zhou Yuqing, Luo Yan
机构信息
Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China.
Department of Hepatology, West China Hospital of Sichuan University, Chengdu, China.
出版信息
Quant Imaging Med Surg. 2021 May;11(5):1692-1700. doi: 10.21037/qims-20-640.
BACKGROUND
Post-hepatectomy liver failure (PHLF) is one of the most serious complications and major causes of liver resection mortality. The purpose of this study is to investigate and compare the performance of preoperative two-dimensional shear wave elastography (2D-SWE) and the indocyanine green (ICG) clearance test for the prediction of PHLF.
METHODS
A total of 172 consecutive patients who were undergoing major liver resection were prospectively identified. Patients were evaluated by preoperative 2D-SWE and ICG clearance test. According to the International Study Group of Liver Surgery (ISGLS) recommendations, No PHLF, PHLF A, PHLF B, and PHLF C group classifications were defined. The differences in liver stiffness value (LSV) and ICG retention rate at 15 minutes (ICGR15) among the different PHLF classifications were investigated. The performance of LSV and ICGR15 for diagnosing different classifications of PHLF was compared.
RESULTS
PHLF occurred in 43 (25.0%) patients, and 24 (14.0%) patients were grade A, 14 (8.1%) were grade B, and 5 (2.9%) were grade C. Both LSV and ICGR15 of the PHLF C group were significantly higher than those of the No PHLF group (P=0.025, P=0.001, respectively). According to univariate and multivariate logistic regression analysis, LSV and ICGR15 were significantly related to PHLF (P=0.051, P=0.084, respectively). For diagnosis of ≥ PHLF A, ≥ PHLF B, and ≥ PHLF C, the areas under the receiver operating characteristic curve (AUCs) for 2D-SWE were 0.624 [95% confidence interval (CI): 0.536-0.712, P=0.015], 0.699 (95% CI: 0.576-0.821, P=0.005), and 0.831 (95% CI: 0.737-0.925, P=0.01), respectively. The AUCs of the ICG clearance test were 0.631 (95% CI: 0.542-0.721, P=0.01), 0.570 (95% CI: 0.436-0.704, P=0.32), and 0.717 (95% CI: 0.515-0.920, P=0.098), respectively. The AUC of LSV for the diagnosis of ≥ PHLF A was comparable to that of ICGR15 (P=0.17). The AUCs of LSV were significantly higher than those of ICGR15 for the diagnosis of ≥ PHLF B (P=0.002) and C (P=0.038).
CONCLUSIONS
2D-SWE demonstrates the potential to aid in the prediction of the severity of PHLF. Our findings also suggest that the performance of 2D-SWE is better than the ICG clearance test.
背景
肝切除术后肝衰竭（PHLF）是肝切除术后最严重的并发症之一，也是导致肝切除术后死亡的主要原因。本研究旨在探讨并比较术前二维剪切波弹性成像（2D-SWE）和吲哚菁绿（ICG）清除试验预测PHLF的效能。
方法
前瞻性纳入172例接受大肝切除术的连续患者。患者均接受术前2D-SWE和ICG清除试验评估。根据国际肝外科研究组（ISGLS）的建议，定义无PHLF、PHLF A级、PHLF B级和PHLF C级组分类。研究不同PHLF分类之间肝硬度值（LSV）和15分钟时ICG滞留率（ICGR15）的差异。比较LSV和ICGR15诊断不同分类PHLF的效能。
结果
43例（25.0%）患者发生PHLF，其中24例（14.0%）为A级，14例（8.1%）为B级，5例（2.9%）为C级。PHLF C级组的LSV和ICGR15均显著高于无PHLF组（分别为P = 0.025，P = 0.001）。根据单因素和多因素逻辑回归分析，LSV和ICGR15与PHLF显著相关（分别为P = 0.051，P = 0.084）。对于诊断≥PHLF A级、≥PHLF B级和≥PHLF C级，2D-SWE的受试者工作特征曲线下面积（AUC）分别为0.624 [95%置信区间（CI）：0.536 - 0.712，P = 0.015]、0.699（95% CI：0.576 - 0.821，P = 0.005）和0.831（95% CI：0.737 - 0.925，P = 0.01）。ICG清除试验的AUC分别为0.631（95% CI：0.542 - 0.721，P = 0.01）、0.570（95% CI：0.436 - 0.704，P = 0.32）和0.717（95% CI：0.515 - 0.920，P = 0.098）。LSV诊断≥PHLF A级的AUC与ICGR15相当（P = 0.17）。对于诊断≥PHLF B级（P = 0.002）和C级（P = 0.038），LSV的AUC显著高于ICGR15。
结论
2D-SWE显示出有助于预测PHLF严重程度的潜力。我们的研究结果还表明，2D-SWE的效能优于ICG清除试验。
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