应用单点及二维剪切波弹性成像技术预测慢性肝病患者食管静脉曲张高危风险：系统评价和荟萃分析。
Prediction of high-risk esophageal varices in patients with chronic liver disease with point and 2D shear wave elastography: a systematic review and meta-analysis.
机构信息
Department of Ultrasonography, The Second Affiliated Hospital of Zhengzhou University, 2 Jing 8th Road, ZhengZhou, 450000, China.
Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, 150080, China.
出版信息
Eur Radiol. 2022 Jul;32(7):4616-4627. doi: 10.1007/s00330-022-08601-0. Epub 2022 Feb 15.
OBJECTIVE
To assess the diagnostic performance of liver stiffness (LS) and spleen stiffness (SS) measured by point shear wave elastography (pSWE) and 2D shear wave elastography (2D-SWE) in the detection of high-risk esophageal varices (HREV) and to compare their diagnostic accuracy.
METHODS
Through systematic search of PubMed, Embase, and Web of Science databases, we included 17 articles reporting the diagnostic performance of LS or SS measured by pSWE or 2D-SWE for HREV. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under summary receiver operator characteristic curve (AUSROC), and diagnostic odds ratio (DOR).
RESULTS
For LS, there was no significant difference between the pooled sensitivity, 0.89 (95% confidence interval CI, 0.81-0.94) vs. 0.8 (95% CI, 0.72-0.86) (p = 0.13), and specificity, 0.81 (95% CI, 0.73-0.87) vs. 0.73 (95% CI, 0.65-0.79) (p = 0.07) of pSWE and 2D-SWE. The AUSROC and DOR of pSWE were higher than those of 2D-SWE: 0.92 (95% CI, 0.89-0.94) vs. 0.84 (95% CI, 0.80-0.87), p = 0.03, 33 (95% CI, 25-61) vs. 11 (95% CI, 5-22), (p < 0.01). For SS, there was no significant difference between the pooled sensitivity 0.91 (95% CI, 0.78-0.96) vs. 0.89 (95% CI, 0.80-0.94) (p = 0.43); specificity, 0.79 (95% CI, 0.72-0.84) vs. 0.72 (95% CI, 0.63-0.79) (p = 0.06); and DOR, 35 (95% CI, 13-100) vs. 20 (95% CI, 8-50) (p = 0.16) of pSWE and 2D-SWE.
CONCLUSION
LS and SS measured by pSWE and 2D-SWE have good accuracy in predicting HREV.
KEY POINTS
• There is modest difference between the diagnostic performance of LS and SS measured by pSWE and 2D-SWE. • LS and SS measured by pSWE and 2D-SWE both have high sensitivity, specificity, and AUSROC for the evaluation of HREV in patients with CLD. • pSWE and 2D-SWE are promising tools for noninvasive monitoring risk of esophageal varices bleeding of CLD patients.
目的
评估经皮剪切波弹性成像（pSWE）和二维剪切波弹性成像（2D-SWE）测量的肝硬度（LS）和脾硬度（SS）在检测高危食管静脉曲张（HREV）中的诊断性能，并比较其诊断准确性。
方法
通过系统检索 PubMed、Embase 和 Web of Science 数据库，纳入了 17 篇报告 pSWE 或 2D-SWE 测量 LS 或 SS 用于 HREV 的诊断性能的文章。我们使用双变量随机效应模型估计汇总受试者工作特征曲线（AUSROC）下的敏感度、特异度、阳性似然比（PLR）、阴性似然比（NLR）、曲线下面积（AUC）和诊断比值比（DOR）。
结果
对于 LS，pSWE 和 2D-SWE 的汇总敏感度差异无统计学意义，分别为 0.89（95%置信区间 CI，0.81-0.94）和 0.8（95% CI，0.72-0.86）（p = 0.13），汇总特异度差异亦无统计学意义，分别为 0.81（95% CI，0.73-0.87）和 0.73（95% CI，0.65-0.79）（p = 0.07）。pSWE 的 AUSROC 和 DOR 高于 2D-SWE：0.92（95% CI，0.89-0.94）和 0.84（95% CI，0.80-0.87），p = 0.03，33（95% CI，25-61）和 11（95% CI，5-22），（p < 0.01）。对于 SS，汇总敏感度差异无统计学意义，分别为 0.91（95% CI，0.78-0.96）和 0.89（95% CI，0.80-0.94）（p = 0.43）；汇总特异度差异亦无统计学意义，分别为 0.79（95% CI，0.72-0.84）和 0.72（95% CI，0.63-0.79）（p = 0.06）；DOR 差异无统计学意义，分别为 35（95% CI，13-100）和 20（95% CI，8-50）（p = 0.16）。
结论
pSWE 和 2D-SWE 测量的 LS 和 SS 对预测 HREV 具有良好的准确性。
关键点
pSWE 和 2D-SWE 测量的 LS 和 SS 的诊断性能存在一定差异。
pSWE 和 2D-SWE 对评估 CLD 患者的 HREV 具有较高的敏感度、特异度和 AUSROC。
pSWE 和 2D-SWE 是监测 CLD 患者食管静脉曲张出血风险的有前途的非侵入性工具。
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