二维剪切波弹性成像测量的肝硬度与组织病理学相比，主要落在严重肝纤维化上。

Liver stiffness measured with two-dimensional shear wave elastography comparable to histopathology falls dominantly on the severe liver fibrosis.

机构信息

Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China.

出版信息

Clin Hemorheol Microcirc. 2021;79(4):587-596. doi: 10.3233/CH-211223.

DOI:10.3233/CH-211223

PMID:34334386

Abstract

BACKGROUND

Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems.

OBJECTIVE

This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB.

METHODS

A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity were calculated.

RESULTS

The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P = 0.0001, P < 0.0001, P = 0.0139, and P = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.1232 and P = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P = 0.002 and P = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.233 and P = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P = 0.003; F1 and F4, P = 0.007; F2 and F3, P = 0.013; F2 and F4, P = 0.015).

CONCLUSION

2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis.

摘要

背景

二维剪切波弹性成像（2D-SWE）多年来一直用于评估慢性乙型肝炎（CHB）患者的肝脏，但在不同人群和使用不同超声系统时，其有效性仍不清楚。

目的

本研究旨在探讨 2D-SWE 在评估 CHB 患者肝纤维化中的有效性。

方法

经机构伦理委员会批准后进行前瞻性研究，纳入 133 例 CHB 患者中 116 例进行肝活检，50 例健康肝脏患者作为对照。比较 2D-SWE 肝脏硬度测量（LSM）与组织病理学结果。设定 LSM 的临界值以确定纤维化程度，并计算受试者工作特征（ROC）曲线下面积（AUROC）、敏感度和特异度。

结果

区分健康肝脏和 CHB 肝脏及任何程度肝纤维化的最佳 LSM 临界值为 6.485 kPa，AUROC 为 0.927，敏感度为 94%，特异度为 19.8%。区分 F1、F2、F3 和 F4 的最佳 LSM 临界值分别为 6.19 kPa、6.485 kPa、7.46 kPa 和 9.62 kPa，相应的 AUROC 分别为 0.516、0.625、0.779 和 0.881。F1 与 F3、F1 与 F4、F2 与 F3 和 F2 与 F4 之间的 AUROC 比较均有统计学差异（P=0.0001、P<0.0001、P=0.0139 和 P=0.0003）；F1 与 F2 和 F3 与 F4 之间的 AUROC 比较无统计学差异（P=0.1232 和 P=0.2462）。健康肝脏与 F0 之间及健康肝脏与 F0 和 F1 组合之间的 LSM 比较有统计学差异（P=0.002 和 P=0.001）。F1 与 F2 和 F3 与 F4 之间的 LSM 比较无统计学差异（P=0.233 和 P=0.072）。其他纤维化评分组之间的比较有统计学差异（F1 与 F3，P=0.003；F1 与 F4，P=0.007；F2 与 F3，P=0.013；F2 与 F4，P=0.015）。