Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.
Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria.
Ultraschall Med. 2023 Apr;44(2):169-178. doi: 10.1055/a-1724-7289. Epub 2022 Feb 28.
Since nonalcoholic fatty liver disease (NAFLD) has become the leading cause of liver disease in the Western world, clinicians need reliable noninvasive tools for the identification of NAFLD-associated fibrosis. Limited evidence on the performance of the novel shear wave elastography technique Elast-PQ (EPQ) in NAFLD is available.
In this prospective, European multinational study we assessed the diagnostic accuracy of EPQ using vibration-controlled transient elastography (VCTE) as a reference standard.
Among 353 NAFLD patients, 332 (94.1%) fulfilled reliability criteria of VCTE and EPQ (defined by IQR/median ≤0.3; 41.3% female, mean age: 59 [IQR: 16.5], mean BMI: 29.0 (7.1)). 4/353 (1.1%) and 17/353 (4.8%) had unreliable VCTE and EPQ measurements, respectively. VCTE-based NAFLD fibrosis stages were F0/F1: 222(66.9%), F2: 41 (12.3%), F3: 30 (9.1%), F4: 39 (11.7%). We found a strong correlation (Pearson R=0.87; p<0.0001) and concordance (Lin's concordance correlation coefficient =0.792) of EPQ with VCTE. EPQ was able to identify NAFLD-fibrosis risk with the following EPQ cutoffs: ≥6.5 kPa for significant fibrosis (≥F2) (≥1.47 m/s; sensitivity: 78%; specificity: 95%; AUROC: 0.94), ≥6.9 kPa for advanced fibrosis (≥F3) (≥1.52 m/s; sens.: 88%, spec.: 89%; AUROC: 0.949), and ≥10.4 kPa for cirrhosis (F4) (≥1.86 m/s; sens.: 87%; spec.: 94%; AUROC: 0.949).
The point shear wave elastography technique EPQ shows excellent correlation to and concordance with VCTE. EPQ can reliably exclude NAFLD fibrosis <6.0 kPa (<1.41 m/s) and indicate a high risk of advanced fibrosis ≥10.4 kPa (≥1.86 m/s).
由于非酒精性脂肪性肝病（NAFLD）已成为西方世界主要的肝病病因，临床医生需要可靠的非侵入性工具来识别与 NAFLD 相关的纤维化。目前有关新型剪切波弹性成像技术 Elast-PQ（EPQ）在 NAFLD 中表现的有限证据可用。
在这项前瞻性、多中心的欧洲研究中，我们使用振动控制瞬态弹性成像（VCTE）作为参考标准，评估了 EPQ 的诊断准确性。
在 353 名 NAFLD 患者中，有 332 名（94.1%）符合 VCTE 和 EPQ 的可靠性标准（定义为 IQR/中位数≤0.3；41.3%女性，平均年龄：59[IQR：16.5]，平均 BMI：29.0[7.1]）。4/353（1.1%）和 17/353（4.8%）的 VCTE 和 EPQ 测量结果不可靠。VCTE 基于 NAFLD 纤维化分期为 F0/F1：222（66.9%），F2：41（12.3%），F3：30（9.1%），F4：39（11.7%）。我们发现 EPQ 与 VCTE 之间存在很强的相关性（Pearson R=0.87；p<0.0001）和一致性（Lin 的一致性相关系数=0.792）。EPQ 能够通过以下 EPQ 临界值识别 NAFLD 纤维化风险：≥6.5kPa 用于显著纤维化（≥F2）（≥1.47m/s；敏感性：78%；特异性：95%；AUROC：0.94），≥6.9kPa 用于进展性纤维化（≥F3）（≥1.52m/s；敏感性：88%，特异性：89%；AUROC：0.949），≥10.4kPa 用于肝硬化（F4）（≥1.86m/s；敏感性：87%；特异性：94%；AUROC：0.949）。
点剪切波弹性成像技术 EPQ 与 VCTE 具有极好的相关性和一致性。EPQ 可可靠地排除＜6.0kPa（＜1.41m/s）的 NAFLD 纤维化，并提示≥10.4kPa（≥1.86m/s）的进展性纤维化风险较高。
