Shen Max, Lee Anna, Lefkowitch Jay H, Worman Howard J
Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Clin Transl Hepatol. 2022 Apr 28;10(2):197-206. doi: 10.14218/JCTH.2021.00188. Epub 2021 Aug 13.
Vibration-controlled transient elastography (VCTE) is a noninvasive tool that uses liver stiffness measurement (LSM) to assess fibrosis. Since real-life data during everyday clinical practice in the USA are lacking, we describe the patterns of use and diagnostic performance of VCTE in patients at an academic medical center in New York City.
Patients who received VCTE scans were included if liver biopsy was performed within 1 year. Diagnostic performance of VCTE in differentiating dichotomized fibrosis stages was assessed via area under the receiver operating characteristics (AUROC). Fibrosis stage determined from VCTE LSM was compared to liver biopsy.
Of 109 patients, 49 had nonalcoholic fatty liver disease, 16 chronic hepatitis C, 15 congestive hepatopathy, and 22 at least two etiologies. AUROC was 0.90 for differentiating cirrhosis (stage 4) with a positive predictive value (PPV) range of 0.28 to 0.45 and negative predictive value range of 0.96 to 0.98. For 31 (32%) patients, VCTE fibrosis stage was at least two stages higher than liver biopsy fibrosis stage. Thirteen of thirty-five patients considered to have cirrhosis by VCTE had stage 0 to 2 and 12 stage 3 fibrosis on liver biopsy.
VCTE has reasonable diagnostic accuracy and is reliable at ruling out cirrhosis. However, because of its low PPV, caution must be exercised when used to diagnose cirrhosis, as misdiagnosis can lead to unnecessary health care interventions. In routine practice, VTCE is also sometimes performed for disease etiologies for which it has not been robustly validated.
振动控制瞬时弹性成像（VCTE）是一种利用肝脏硬度测量（LSM）来评估肝纤维化的非侵入性工具。由于缺乏美国日常临床实践中的实际数据，我们描述了纽约市一家学术医疗中心患者使用VCTE的模式及其诊断性能。
纳入在1年内进行了肝活检且接受了VCTE扫描的患者。通过受试者操作特征曲线下面积（AUROC）评估VCTE在区分二分法肝纤维化阶段方面的诊断性能。将根据VCTE的LSM确定的纤维化阶段与肝活检结果进行比较。
109例患者中，49例患有非酒精性脂肪性肝病，16例患有慢性丙型肝炎，15例患有充血性肝病，22例至少有两种病因。区分肝硬化（4期）的AUROC为0.90，阳性预测值（PPV）范围为0.28至0.45，阴性预测值范围为0.96至0.98。对于31例（32%）患者，VCTE纤维化阶段比肝活检纤维化阶段至少高两个阶段。在VCTE诊断为肝硬化的35例患者中，13例肝活检显示纤维化0至2期，12例为3期。
VCTE具有合理的诊断准确性，在排除肝硬化方面可靠。然而，由于其PPV较低，用于诊断肝硬化时必须谨慎，因为误诊可能导致不必要的医疗干预。在常规实践中，有时也会对VCTE未得到充分验证的疾病病因进行VCTE检查。
