声触诊组织量化技术测量脾脏和肝脏硬度诊断不同天门冬氨酸氨基转移酶水平肝硬化的比较：一项前瞻性多中心研究。
Comparison between spleen and liver stiffness measurements by sound touch elastography for diagnosing cirrhosis at different aminotransferase levels: a prospective multicenter study.
机构信息
Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
出版信息
Eur Radiol. 2022 Jul;32(7):4980-4990. doi: 10.1007/s00330-022-08569-x. Epub 2022 Feb 28.
OBJECTIVES
To compare the performance of spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) by sound touch elastography (STE) for the diagnosis of cirrhosis at different alanine aminotransferase (ALT) levels, and to compare the applicability and repeatability of SSM with LSM performed by STE, a new two-dimensional shear wave elastography technology.
METHODS
This prospective multicenter study included 25 centers and recruited chronic hepatitis B (CHB) patients with liver biopsy between May 2018 and November 2019. All patients underwent LSM and SSM by STE. Success and reliability rates were calculated and compared. Intra-observer agreement was assessed using intraclass correlation coefficients (ICCs). Differences between areas under the receiver operating characteristic curves (AUCs) of LSMs and SSMs at different ALT levels were compared using the Delong test.
RESULTS
Among 603 CHB patients, the success and reliability rates of SSM were 94.53% (570/603) and 85.74% (517/603), respectively, which were similar to those of LSM (p > 0.05), respectively. The ICC for intra-observer agreements of SSM was 0.964 (p < 0.001). In the total cohort, ALT ≤ 2 × upper limit of normal (ULN) group, and A0-1 group, the AUCs of SSMs were significantly lower than those of LSMs for the diagnosis of cirrhosis (p < 0.001). In the ALT > 2 × ULN group and A2-3 group, the AUC of SSM improved and was not significantly different from that of LSM (p = 0.342, p = 0.510, respectively).
CONCLUSIONS
SSM by STE achieved applicability and repeatability equivalent to those of LSM. SSM might be a good substitute to LSM in patients with high ALT levels.
KEY POINTS
• Spleen stiffness measurement performed by sound touch elastography was proven to have similar applicability and repeatability to liver stiffness measurement in this prospective multicenter study. • Spleen stiffness measurement demonstrated a poorer diagnostic performance for cirrhosis compared with liver stiffness measurement in the total cohort and low ALT level group, yet it showed a similar diagnostic performance to liver stiffness measurement in patients with high ALT levels.
目的
比较声触诊组织量化技术（STE）测量脾脏硬度（SSM）和肝脏硬度（LSM）在不同丙氨酸氨基转移酶（ALT）水平下诊断肝硬化的性能，并比较 STE 测量 SSM 和 LSM 的适用性和可重复性，STE 是一种新的二维剪切波弹性成像技术。
方法
本前瞻性多中心研究纳入了 2018 年 5 月至 2019 年 11 月间进行肝活检的慢性乙型肝炎（CHB）患者，共 25 个中心。所有患者均接受了 STE 下的 LSM 和 SSM。计算并比较成功率和可靠性。采用组内相关系数（ICC）评估观察者内一致性。采用 DeLong 检验比较不同 ALT 水平下 LSM 和 SSM 的受试者工作特征曲线（ROC）下面积（AUC）的差异。
结果
在 603 例 CHB 患者中，SSM 的成功率和可靠性分别为 94.53%（570/603）和 85.74%（517/603），与 LSM 相似（p>0.05）。SSM 观察者内一致性的 ICC 为 0.964（p<0.001）。在总队列中，ALT≤2×正常值上限（ULN）组和 A0-1 组中，SSM 对肝硬化的诊断 AUC 明显低于 LSM（p<0.001）。在 ALT>2×ULN 组和 A2-3 组中，SSM 的 AUC 改善，与 LSM 无显著差异（p=0.342，p=0.510）。
结论
STE 下的 SSM 具有与 LSM 相同的适用性和可重复性。在 ALT 水平较高的患者中，SSM 可能是 LSM 的良好替代方法。
关键要点
本前瞻性多中心研究证实，声触诊组织量化技术测量脾脏硬度具有与肝脏硬度测量相似的适用性和可重复性。
在总队列和低 ALT 水平组中，SSM 对肝硬化的诊断性能较 LSM 差，但在 ALT 水平较高的患者中，SSM 与 LSM 的诊断性能相似。
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