Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Institute of Ultrasound Medicine and Engineering, Fudan University, Shanghai, China.
Clin Hemorheol Microcirc. 2023;85(2):93-104. doi: 10.3233/CH-221511.
This study aimed to evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) with a propagation map in evaluating the degree of hepatic fibrosis in patients with liver tumors before resection.
From January 2020 to April 2021, 128 patients with liver tumors were prospectively enrolled, including 20 benign liver tumors and 108 malignant liver tumors. 2D-SWE with a propagation map technology was used to measure the stiffness of liver parenchyma 2 cm away from the tumor. The median value of five measurements was used in this study. The stage of hepatic fibrosis was graded in accordance with Scheuer standard. Spearman correlation was used to analyze the correlation between liver fibrosis stage and the liver stiffness. Univariate and multivariate linear regression analyses were used to determine significant affecting factors for liver stiffness value. The diagnostic performance of 2D-SWE with a propagation map in predicting fibrosis stage was evaluated by receiver operating characteristic curve analysis.
The median liver stiffness value in patients with benign liver tumors was lower than that in patients with malignant liver tumors (6.0 kPa vs. 9.4 kPa, p < 0.05). The median liver stiffness values in patients with primary liver cancer were higher than that in patients with benign liver tumors and other types of malignant liver tumors (9.6 kPa vs. 6.0 kPa, p < 0.05). The liver stiffness measured by 2D-SWE was highly correlated with the fibrosis stage confirmed by postoperative pathology (r = 0.834, p < 0.05). For the liver stiffness value, PLT,TB,ALB and fibrosis stage are significantly associated with liver stiffness. The median liver stiffness values in stages S0-S4 of fibrosis were 6.0, 7.2, 8.0, 9.4, and 12.6 kPa, respectively. The areas under the ROC curve of S≥1, S≥2, S≥3, and S = 4 as predicted by SWE were 0.932, 0.945, 0.945, and 0.916, respectively. According to the Youden index, the optimal critical values for predicting fibrosis S≥1, S≥2, S≥3, and S = 4 were 6.8 (sensitivity of 89.69% and specificity of 93.55%), 7.5 (sensitivity of 87.50 % and specificity of 95.00 %), 8.3 (sensitivity of 87.14 % and specificity of 87.93 %) and 9.8 (sensitivity of 79.55 % and specificity of 86.90 %) kPa.
2D-SWE with a propagation map could noninvasively and accurately predict the staging of liver fibrosis in patients with liver tumors before resection.
本研究旨在评估二维剪切波弹性成像（2D-SWE）及其传播图技术在评估肝肿瘤切除术前肝纤维化程度中的诊断性能。
本研究前瞻性纳入了 2020 年 1 月至 2021 年 4 月的 128 例肝肿瘤患者，包括 20 例良性肝肿瘤和 108 例恶性肝肿瘤。使用 2D-SWE 及其传播图技术测量肿瘤 2cm 外肝实质的硬度。本研究采用五次测量的中位数。根据 Scheuer 标准对肝纤维化程度进行分级。采用 Spearman 相关分析评估肝纤维化分期与肝硬度的相关性。采用单因素和多因素线性回归分析确定肝硬度值的显著影响因素。采用受试者工作特征曲线分析评估 2D-SWE 及其传播图预测纤维化分期的诊断性能。
良性肝肿瘤患者的肝硬度中位数低于恶性肝肿瘤患者（6.0kPa 比 9.4kPa，p<0.05）。原发性肝癌患者的肝硬度中位数高于良性肝肿瘤患者和其他类型恶性肝肿瘤患者（9.6kPa 比 6.0kPa，p<0.05）。2D-SWE 测量的肝硬度与术后病理证实的纤维化分期高度相关（r=0.834，p<0.05）。对于肝硬度值，PLT、TB、ALB 和纤维化分期与肝硬度显著相关。纤维化分期 S0-S4 的肝硬度中位数分别为 6.0、7.2、8.0、9.4 和 12.6kPa。SWE 预测 S≥1、S≥2、S≥3 和 S=4 的 ROC 曲线下面积分别为 0.932、0.945、0.945 和 0.916。根据 Youden 指数，预测纤维化 S≥1、S≥2、S≥3 和 S=4 的最佳临界值分别为 6.8kPa（敏感性为 89.69%，特异性为 93.55%）、7.5kPa（敏感性为 87.50%，特异性为 95.00%）、8.3kPa（敏感性为 87.14%，特异性为 87.93%）和 9.8kPa（敏感性为 79.55%，特异性为 86.90%）。
2D-SWE 及其传播图可无创、准确地预测肝肿瘤切除术前肝纤维化的分期。
