Academic Department of Gastroenterology.
First Department of Internal Medicine, Medical School of National & Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece.
Eur J Gastroenterol Hepatol. 2022 Sep 1;34(9):961-966. doi: 10.1097/MEG.0000000000002412. Epub 2022 Jul 19.
The aim of this study is to evaluate the performance of 2D-shear wave elastography (2D-SWE) in patients with nonalcoholic fatty liver disease (NAFLD) and compare it to transient elastography.
Over 6 months, 552 patients with NAFLD underwent liver stiffness measurement (LSM) by both 2D-SWE and transient elastography with controlled attenuation parameter (CAP) at the same visit.
LSM was not feasible by transient elastography (M/XL probe) in 18 (3.3%) and by 2D-SWE in 26 (4.7%) patients. The median LSM of transient elastography was 5.5 (2.8-75) kPa and of 2D-SWE 6.2 (3.7-46.2) kPa. LSMs by transient elastography and 2D-SWE were correlated regardless of the obesity status (r, 0.774; P < 0.001; r, 0.774; P < 0.001; r, 0.75; P < 0.001 in BMI <25, 25-30 and ≥30 kg/m2 respectively), or the degree of liver steatosis (r = 0.63; P < 0.001 and r = 0.743; P < 0.001 in mild and moderate/severe steatosis, respectively). According to transient elastography, 88 (15.9%) patients were classified with at least severe fibrosis (≥F3) and 55 (10%) with cirrhosis. By using the 2D-SWE, 85 (15.4%) patients had at least severe fibrosis and 52 (9.4%) cirrhosis. The correlation between the two methods was strong in patients with at least severe fibrosis (r, 0.84; P < 0.001) or cirrhosis (r, 0.658; P < 0.001). When transient elastography was used as reference, 2D-SWE showed an excellent accuracy of 98.8 and 99.8% in diagnosing severe fibrosis and cirrhosis, respectively.
In NAFLD, 2D-SWE and transient elastography have comparable feasibility and clinical applicability providing LSMs with strong correlation, even in overweight/obese patients, independently of the severity of liver steatosis and fibrosis. Thus, either of the two methods can be effectively used for the assessment of fibrosis in this setting.
本研究旨在评估二维剪切波弹性成像（2D-SWE）在非酒精性脂肪性肝病（NAFLD）患者中的性能，并与瞬时弹性成像（TE）进行比较。
在 6 个月内，552 例 NAFLD 患者在同一次就诊时同时接受了 2D-SWE 和 TE 检测，包括受控衰减参数（CAP）。
TE（M/XL 探头）无法检测到 18 例（3.3%），2D-SWE 无法检测到 26 例（4.7%）患者的肝硬度值（LSM）。TE 的中位 LSM 为 5.5（2.8-75）kPa，2D-SWE 的中位 LSM 为 6.2（3.7-46.2）kPa。无论肥胖程度如何（BMI＜25、25-30 和≥30kg/m2 时 r 值分别为 0.774、P＜0.001；r 值分别为 0.774、P＜0.001；r 值分别为 0.75、P＜0.001），或肝脂肪变性程度如何（r=0.63、P＜0.001 和 r=0.743、P＜0.001 分别用于轻度和中重度脂肪变性），2D-SWE 和 TE 的 LSM 均呈相关性。根据 TE，88 例（15.9%）患者至少存在严重纤维化（≥F3），55 例（10%）患者存在肝硬化。应用 2D-SWE，85 例（15.4%）患者至少存在严重纤维化，52 例（9.4%）患者存在肝硬化。两种方法在至少存在严重纤维化（r=0.84、P＜0.001）或肝硬化（r=0.658、P＜0.001）患者中相关性较强。以 TE 为参考，2D-SWE 诊断严重纤维化和肝硬化的准确率分别为 98.8%和 99.8%。
在 NAFLD 中，2D-SWE 和 TE 具有相似的可行性和临床适用性，提供的 LSM 具有很强的相关性，即使在超重/肥胖患者中也是如此，与肝脂肪变性和纤维化的严重程度无关。因此，这两种方法均可有效地用于评估该人群的纤维化程度。
