Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Eur J Radiol. 2022 May;150:110248. doi: 10.1016/j.ejrad.2022.110248. Epub 2022 Mar 12.
To assess and compare the value of liver stiffness measurement (LSM) by two-dimensional shear wave elastography (2D-SWE) with the diagnosis of clinically significant portal hypertension (CSPH) and pathological examination in predicting symptomatic posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC).
A total of 130 patients who underwent liver resection for HCC between August 2018 and July 2021 were enrolled. Preoperative assessments for LSM and other clinicopathological tests were performed in all patients. The performance of LSM, CSPH and fibrosis stage in predicting symptomatic PHLF was assessed and compared. Univariate and multivariate analyses were conducted on the risk factors for symptomatic PHLF.
Symptomatic PHLF occurred in 40 patients (30.8%). The best LSM cutoff value for predicting symptomatic PHLF was 9.5 kPa. The areas under the receiver operating characteristic curve (AUCs) of LSM ≥ 9.5 kPa, fibrosis stage and CSPH for predicting symptomatic PHLF were 0.732 (95% CI: 0.638-0.826, p < 0.001), 0.655 (95% CI: 0.553-0.758, p = 0.005) and 0.594 (95% CI: 0.484-0.705, p = 0.086), respectively. The AUC of LSM ≥ 9.5 kPa was significantly higher than that of CSPH (p = 0.010), and was comparable to that of fibrosis stage (p = 0.073). Multivariate analysis identified LSM ≥ 9.5 kPa (p = 0.001), major hepatectomy (p = 0.007) and CSPH diagnosis (p = 0.040) as independent predictors of symptomatic PHLF.
LSM by 2D-SWE was promising for predicting symptomatic PHLF in HCC patients. The predictive performance was higher than that of CSPH and comparable to that of pathological fibrosis stage.
评估并比较二维剪切波弹性成像（2D-SWE）测量的肝硬度值（LSM）与临床显著门静脉高压（CSPH）和病理检查在预测肝细胞癌（HCC）患者肝切除术后症状性肝衰竭（PHLF）中的诊断价值。
本研究共纳入 2018 年 8 月至 2021 年 7 月期间因 HCC 接受肝切除术的 130 例患者。所有患者均进行了 LSM 和其他临床病理检查的术前评估。评估并比较了 LSM、CSPH 和纤维化分期在预测症状性 PHLF 中的表现。对症状性 PHLF 的危险因素进行了单因素和多因素分析。
40 例（30.8%）患者发生症状性 PHLF。预测症状性 PHLF 的最佳 LSM 截断值为 9.5kPa。LSM≥9.5kPa、纤维化分期和 CSPH 预测症状性 PHLF 的受试者工作特征曲线（AUCs）面积分别为 0.732（95%CI：0.638-0.826，p<0.001）、0.655（95%CI：0.553-0.758，p=0.005）和 0.594（95%CI：0.484-0.705，p=0.086）。LSM≥9.5kPa 的 AUC 明显高于 CSPH（p=0.010），与纤维化分期相当（p=0.073）。多因素分析发现，LSM≥9.5kPa（p=0.001）、大范围肝切除术（p=0.007）和 CSPH 诊断（p=0.040）是症状性 PHLF 的独立预测因素。
2D-SWE 测量的 LSM 对预测 HCC 患者的症状性 PHLF 有一定的预测价值。其预测性能高于 CSPH，与病理纤维化分期相当。
