二维剪切波弹性成像技术在腹水患者中的应用：一种比瞬时弹性成像更可靠的无创检测肝脏硬度的方法——一项针对170例患者的原创性研究
Two-dimensional shear wave elastography utilized in patients with ascites: a more reliable method than transient elastography for noninvasively detecting the liver stiffness-an original study with 170 patients.
作者信息
Guo Huan-Yi, Liao Mei, Zheng Jian, Huang Ze-Ping, Xie Si-Dong
机构信息
Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ultrasound Department of the Second Affiliated Hospital School of Medicine the Chinese University of Hong Kong Shenzhen and Longgang District People's Hospital of Shenzhen, Shenzhen, China.
出版信息
Ann Transl Med. 2023 Jan 31;11(2):80. doi: 10.21037/atm-22-6454.
BACKGROUND
Two dimensional shear wave elastography (2D-SWE) is an ultrasound elastography technique based on shear waves implemented on a diagnostic ultrasound system. Transient elastography (TE) uses an ultrasound displacement M-mode and A-mode image produced by the system. So, TE mechanically induced impulse at tissue surface and difficultly across water. This paper compared the reliability and reproducibility of 2D-SWE with that of TE in patients with chronic hepatic disease. Comparisons were made in terms of the success rate, reliability, reproducibility, operation time, and influence of operator experience.
METHODS
A total of 170 patients were included in this study. Participants underwent 2D-SWE and TE performed by 2 different operators (a novice and veteran) on the same day. Nonparametric statistical tests were used to compare the technical success rate and reliable measurement rate, and inter-operator reproducibility was evaluated using intra-class correlation coefficients (ICCs).
RESULTS
The 2D-SWE technique showed a higher technical success rate than TE. Either 2D-SWE or TE can be utilized in patients with ascites lamella of less than 10 mm or ascites lamella plus skin-capsular distance of less than 25 mm. However, although the reliability rate of liver stiffness measurement with 2D-SWE did not significantly differ between the novice and veteran operators, for TE, there was a significant difference when body mass index (BMI) ≤25 kg/m. When performed by the novice and veteran operators, 2D-SWE and TE both showed excellent inter-operator agreement, with ICCs of 0.968 and 0.973, respectively. Both 2D-SWE and TE displayed reliable measurement and excellent reproducibility in patients with chronic liver disease, were minimally influenced by operator experience.
CONCLUSIONS
2D-SWE may be a more reliable method for clinical application in noninvasive detecting the liver stiffness.
背景
二维剪切波弹性成像（2D-SWE）是一种基于剪切波的超声弹性成像技术，在诊断超声系统上实现。瞬时弹性成像（TE）使用系统产生的超声位移M型和A型图像。因此，TE在组织表面机械诱导脉冲，且难以穿透水。本文比较了2D-SWE与TE在慢性肝病患者中的可靠性和可重复性。在成功率、可靠性、可重复性、操作时间和操作者经验的影响方面进行了比较。
方法
本研究共纳入170例患者。参与者在同一天由2名不同的操作者（一名新手和一名老手）进行2D-SWE和TE检查。采用非参数统计检验比较技术成功率和可靠测量率，并使用组内相关系数（ICC）评估操作者间的可重复性。
结果
2D-SWE技术显示出比TE更高的技术成功率。对于腹水层小于10mm或腹水层加皮肤-包膜距离小于25mm的患者，2D-SWE或TE均可使用。然而，尽管新手和老手操作者使用2D-SWE测量肝脏硬度的可靠性率没有显著差异，但对于TE，当体重指数（BMI）≤25kg/m²时存在显著差异。当由新手和老手操作者进行操作时，2D-SWE和TE均显示出极好的操作者间一致性，ICC分别为0.968和0.973。2D-SWE和TE在慢性肝病患者中均显示出可靠的测量和极好的可重复性，受操作者经验的影响最小。
结论
2D-SWE可能是一种在无创检测肝脏硬度方面更可靠的临床应用方法。
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