通过非侵入性评估确定门静脉高压症的严重程度：肝脏实质的声学结构定量分析。

The severity of portal hypertension by a non-invasive assessment: acoustic structure quantification analysis of liver parenchyma.

机构信息

Department of Ultrasound Diagnosis, Tangdu Hospital, The Fourth Military Medical University, Xin Si Road, Ba Qiao District, Xi'an, China.

Department of Ultrasound Diagnostics, General Hospital of Tibet Military Region, Lhasa, China.

出版信息

BMC Med Imaging. 2022 May 12;22(1):85. doi: 10.1186/s12880-022-00817-2.

DOI:10.1186/s12880-022-00817-2

PMID:35550032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9097305/

Abstract

BACKGROUND

Acoustic structure quantification (ASQ) has been applied to evaluate liver histologic changes by analyzing the speckle pattern seen on B-mode ultrasound. We aimed to assess the severity of portal hypertension (PHT) through hepatic ultrasonography.

METHODS

Sixty patients diagnosed with PHT and underwent surgical treatment with portosystemic shunts were enrolled. Portal pressure (PP) was measured intraoperatively. Patients were divided into subgroups according to the severity of gastroesophageal varices and Child-Pugh class. Three difference ratio (C) values on ASQ histogram mode were analyzed for their relationships with PP, degree of gastroesophageal varices and Child-Pugh liver function. Thirty healthy volunteers matched with the patients for gender and age were enrolled as controls. Comparisons among groups and correlation of the parameters with PP were analyzed. Area under the receive operating characteristic curve was used to evaluate the predicting value of ASQ parameters.

RESULTS

In the patients, the ASQ parameters peak C (C), mean C (C) and the highest occurred C value of the obtained red curve (RC) were all greatly increased (P < 0.0001, P < 0.0001, P = 0.027). Multiple comparisons indicated that, regardless of Child-Pugh class and degree of gastroesophageal varices, the patients had significantly increased C and C compared with the controls (all P < 0.0001). No differences among subgroups were observed. C was significantly statistically correlated with PP (r = 0.3505, P < 0.01), degree of varices (r = 0.4998, P < 0.0001). Youden's index for C with a cut-off value of 140.3 for predicting the presence of PHT, gastroesophageal varices and liver function equal to or worse than Child-Pugh class B were 0.8, 0.91 and 0.84, respectively.

CONCLUSIONS

ASQ analysis of ultrasonographic images may have a role in the evaluation of the severity of PHT by detecting liver histologic changes in the speckle pattern caused by cirrhosis.

摘要

背景

声结构定量（ASQ）已被应用于通过分析 B 型超声上看到的斑点模式来评估肝组织学变化。我们旨在通过肝超声评估门静脉高压（PHT）的严重程度。

方法

纳入 60 例经手术治疗并伴有门体分流的 PHT 患者。术中测量门静脉压力（PP）。根据食管胃静脉曲张程度和 Child-Pugh 分级将患者分为亚组。分析 ASQ 直方图模式下的 3 个差异比（C）值与 PP、食管胃静脉曲张程度和 Child-Pugh 肝功能的关系。选择 30 名性别和年龄与患者匹配的健康志愿者作为对照组。分析组间比较和参数与 PP 的相关性。使用接收者操作特征曲线下面积评估 ASQ 参数的预测价值。

结果

在患者中，ASQ 参数峰值 C（C）、平均 C（C）和获得的红色曲线（RC）的最高发生 C 值（RC）均显著增加（P < 0.0001，P < 0.0001，P = 0.027）。多重比较表明，无论 Child-Pugh 分级和食管胃静脉曲张程度如何，患者的 C 和 C 均显著高于对照组（均 P < 0.0001）。亚组之间无差异。C 与 PP 显著相关（r = 0.3505，P < 0.01），与静脉曲张程度显著相关（r = 0.4998，P < 0.0001）。C 截断值为 140.3 时，预测 PHT、食管胃静脉曲张和肝功能等于或差于 Child-Pugh 分级 B 的存在的 Youden 指数分别为 0.8、0.91 和 0.84。