Department of Radiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey.
BMC Med Imaging. 2022 Mar 18;22(1):50. doi: 10.1186/s12880-022-00777-7.
The aims of this study were to evaluate liver fibrosis with two-dimensional (2D) shear wave elastography (SWE) in patients with chronic hepatitis B (CHB), to compare 2D-SWE with histopathology and to determine the change in liver stiffness values after antiviral therapy.
A total of 253 patients with CHB were included in this prospective study. 2D-SWE with propagation map guidance to measure liver stiffness, fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scoring and additional liver biopsy were performed in patients with CHB. Liver stiffness was measured again at 24 and 48 weeks in all patients. The Spearman rank correlation test was used to analyse the correlation between variables, and receiver operating curve analysis was used to evaluate the diagnostic performance in terms of fibrosis.
Liver stiffness measurements made with 2D-SWE demonstrated a significant positive correlation with the fibrosis stage and FIB-4 score (r = 0.774 and 0.337, respectively, p < 0.001 for both). The area under the curve value for kPa for the prediction of significant fibrosis was 0.956 (95% CI) (0.920-0.991), and the optimal cut-off value was 8.2 kPa (sensitivity: 92.7% and specificity: 78.9%); these values were 0.978 (95% CI, 0.945-1.000) and 10.1 kPa (sensitivity: 92.9% and specificity: 96.4%) for the prediction of severe fibrosis. After antiviral treatment, a decrease in liver stiffness values measured by 2D-SWE was detected (mean kPa values at 0 and 48 weeks; 9.24 and 7.36, respectively, p < 0.001).
In conclusion, the measurement of liver stiffness with 2D-SWE has high diagnostic performance in the determination of hepatic fibrosis and can be used to evaluate the response to treatment in patients receiving antiviral therapy.
本研究旨在评估慢性乙型肝炎（CHB）患者二维（2D）剪切波弹性成像（SWE）的肝纤维化程度，比较 2D-SWE 与组织病理学，并确定抗病毒治疗后肝硬度值的变化。
本前瞻性研究共纳入 253 例 CHB 患者。对 CHB 患者进行 2D-SWE 检测，采用传播图引导测量肝硬度，同时检测纤维化 4 指数（FIB-4）和天冬氨酸氨基转移酶与血小板比值指数（APRI）评分，并进行额外的肝活检。所有患者在 24 周和 48 周时再次测量肝硬度。采用 Spearman 秩相关检验分析变量之间的相关性，采用受试者工作特征曲线分析评估纤维化诊断性能。
2D-SWE 测量的肝硬度与纤维化分期和 FIB-4 评分呈显著正相关（r 值分别为 0.774 和 0.337，均 P<0.001）。kPa 预测显著纤维化的曲线下面积值为 0.956（95%可信区间）（0.920-0.991），最佳截断值为 8.2 kPa（敏感性：92.7%，特异性：78.9%）；预测严重纤维化的曲线下面积值为 0.978（95%可信区间，0.945-1.000）和 10.1 kPa（敏感性：92.9%，特异性：96.4%）。抗病毒治疗后，通过 2D-SWE 检测到肝硬度值降低（0 周和 48 周的平均 kPa 值分别为 9.24 和 7.36，P<0.001）。
总之，2D-SWE 测量肝硬度在确定肝纤维化方面具有较高的诊断性能，可用于评估抗病毒治疗患者的治疗反应。
