Zhou Jie, Yan Feng, Xu Jinshun, Lu Qiang, Zhu Xianglan, Gao Binyang, Zhang Huan, Yang Rui, Luo Yan
Ultrasound Department of West China Hospital of Sichuan University, Chengdu, China.
Laboratory of Ultrasound Imaging of West China Hospital of Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2022 Mar;12(3):1800-1814. doi: 10.21037/qims-21-700.
The aim of this retrospective study was to evaluate the accuracy of two-dimension real-time shear wave elastography (2D-SWE) for the diagnosis of steatohepatitis and fibrosis in a cohort patients confirmed nonalcoholic fatty liver diseases (NAFLD) by liver biopsy, and compare with four noninvasive fibrotic biomarker scores (NFS, FIB-4, BARD and APRI).
116 NAFLD patients and 23 normal control group were enrolled. The diagnostic performance of 2D-SWE and four noninvasive fibrotic biomarker scores was evaluated based on histopathological inflammation grades and fibrosis stages (F) according to Kleiner/Brunt et al.'s criteria classification. 5-fold cross validation and receiver operating characteristics curve (ROC) analyses were used to obtain an assessment of 2D-SWE and four noninvasive fibrotic biomarker scores; then cross validated area under the curves (AUCs) were compared using the test of Delong. Meanwhile, influence of steatosis on liver stiffness measurement (LSM) of 2D-SWE was also studied.
Liver stiffness measured by 2D-SWE proved to be an excellent diagnostic indicator for detecting steatohepatitis (AUROC =0.88), and fibrosis: ≥F2 stage (AUROC =0.86), ≥F3 stage (AUROC =0.89) and =F4 stage (AUROC =0.90) with the cutoff values were 7.3, 10.0, 11.6 and 12.6 kPa, respectively. Compared with fibrotic scores, 2D-SWE had the highest AUROC for predicting ≥F2, ≥F3, =F4 by Delong test (all P<0.05). No statistic differences of LSM were found among different steatosis levels (P=0.97).
The stiffness measured by 2D-SWE could be used to noninvasively identify steatohepatitis and stage fibrosis in NAFLD patients. Moreover, the diagnosis efficiency of the stiffness measured by 2D-SWE could not be influenced by steatosis.
本回顾性研究旨在评估二维实时剪切波弹性成像（2D-SWE）对经肝活检确诊为非酒精性脂肪性肝病（NAFLD）的患者队列中脂肪性肝炎和肝纤维化的诊断准确性，并与四种无创纤维化生物标志物评分（NFS、FIB-4、BARD和APRI）进行比较。
纳入116例NAFLD患者和23例正常对照组。根据Kleiner/Brunt等人的标准分类，基于组织病理学炎症分级和纤维化分期（F）评估2D-SWE和四种无创纤维化生物标志物评分的诊断性能。采用5折交叉验证和受试者操作特征曲线（ROC）分析来评估2D-SWE和四种无创纤维化生物标志物评分；然后使用Delong检验比较交叉验证曲线下面积（AUC）。同时，还研究了脂肪变性对2D-SWE肝脏硬度测量（LSM）的影响。
2D-SWE测量的肝脏硬度被证明是检测脂肪性肝炎（AUROC =0.88）和肝纤维化的优秀诊断指标：≥F2期（AUROC =0.86）、≥F3期（AUROC =0.89）和=F4期（AUROC =0.90），截断值分别为7.3、10.0、11.6和12.6 kPa。通过Delong检验，与纤维化评分相比，2D-SWE在预测≥F2、≥F3、=F4方面具有最高的AUROC（所有P<0.05）。不同脂肪变性水平之间的LSM无统计学差异（P=0.97）。
2D-SWE测量的硬度可用于无创识别NAFLD患者的脂肪性肝炎和纤维化分期。此外，2D-SWE测量的硬度的诊断效率不受脂肪变性的影响。
