超声定量评估肝纤维化程度研究进展

肝纤维化程度的判断对于监测肝脏疾病的进展和监控药物疗效具有重要意义。作为肝纤维化分期金标准的肝活检因为有创操作,临床上不能广泛开展。而超声作为一种无创性的影像学技术,越来越多地被用于评价肝纤维化程度。本文对瞬时弹性成像技术、实时组织弹性成像技术、声脉冲辐射力弹性成像技术、实时剪切波弹性成像、组织结构声学定量技术,用于无创定量评估肝纤维化程度的研究进展进行综述。     

实时剪切波弹性成像技术在肝脏中的应用现状

超声检查是肝脏最常用的影像学检查方法。但是传统的超声检查无法检测组织弹性的变化。许多肝脏疾病,尤其是肝纤维化和肝脏肿瘤均可导致肝脏组织硬度的变化。超声弹性成像技术使检测肝组织的弹性变化成为可能。虽然目前许多肝脏疾病的诊断仍依靠传统的诊断方法,但是超声弹性成像技术尤其是实时剪切波弹性成像技术因其无创、无痛、成像快速、客观定量检测等优点在肝脏的应用方面具有十分广泛的前景。本文主要就实时剪切波弹性成像技术的原理及其在肝脏中的应用作一综述。     

实时组织弹性成像定量诊断肝纤维化的初步探讨

目的 探讨实时组织弹性成像(RTE)在肝纤维化诊断中的应用价值.方法 120例正常人为对照组,120例肝纤维化患者,120例肝硬化患者,常规超声和RTE检查其肝脏,记录肝脏弹性图像的弹性参数:相对应变值的平均值(Mean)、相对应变值的标准差(SD)、解析区域蓝色面积百分比(%Area)、蓝色区域复杂度(Comp).将常规超声检查结果与弹性成像评分分别与病理结果进行对照,同时三组超声弹性参数进行比较.结果 弹性成像评分与常规超声诊断肝纤维化的灵敏度分别为90%、53.3%,准确率分别为86.7%、76.7%,弹性成像评分灵敏度、准确率均高于常规超声(P<0.05);弹性成像评分与肝组织病理结果的相关系数为0.893(P=0.000),对照组、肝纤维组、肝硬化组的Mean依次减小,SD、%Area、Comp依次增大,各组间差异均有统计学意义(P<0.01).结论 RTE是一项非侵入性检测肝纤维化的新技术,在肝纤维化诊断中有广阔的应用前景.     

实时弹性成像技术在脑死亡供肝及肝移植术后早期效果评估的临床价值初探北大核心CSCD

目的应用实时组织弹性成像（RTE）技术对脑死亡供肝及肝移植术后受体肝脏的硬度进行评价,探讨其在脑死亡供肝评估中的应用价值。方法脑死亡供肝24例术前分别行电镜和超声弹性成像检测,肝移植术后第1d、第7d行超声弹性成像检测。根据电镜结果分为肝纤维化组（12例）和非纤维化组（12例）,并对结果进行对比分析。（MEAN）小于非纤维化组,两组差异有统计学意义结果在脑死亡供肝中,纤维化组的应变均值（P〈0．05）;在肝移植术后第1d受体肝纤维化组的MEAN值小于非纤维化组,两组差异有统计学意义（P〈0．05）;在肝移植术后第7d受体肝纤维化组的MEAN值与非纤维化组差别不大,两组差异无统计学意义（P〉0．05）。结论弹性成像可以评价脑死亡供肝的肝脏硬度,并可以动态监测肝移植术后肝脏硬度的改变,有望成为供肝评估的新方法。     

超声实时组织弹性成像定量分析对肝脏纤维化程度的诊断和鉴别诊断价值

目的探讨超声实时组织弹性成像定量分析对肝脏纤维化程度的诊断和鉴别价值。方法回顾性分析60例慢性乙型肝炎患者的临床资料,均经肝穿刺活检确诊,作为研究组。选取同期到本院体检的60例健康对象,作为对照组。两组均行超声实时组织弹性成像定量分析。以肝穿刺活检病理结果为标准,判断超声实时组织弹性成像定量分析对肝脏纤维化的诊断效能。并测算两组实时组织弹性成像参数。结果以肝穿刺活检病理结果为标准,超声实时组织弹性成像定量分析诊断灵敏度为94.74%,特异度为95.45%,准确度为95.00%;研究组平均相对应变值低于对照组,蓝色面积百分比、对比度、偏度、复杂度高于对照组,差异有统计学意义(P 0.05)。结论超声实时组织弹性成像定量分析可为肝脏纤维化程度诊断及鉴别提供较准确依据。     

超声造影与SWE技术在乙肝肝纤维化评估中的应用

目的：探讨超声造影与剪切波弹性成像（SWE）技术在慢性乙型肝炎（CHB）肝纤维化评估中的应用价值。方法：选取2015年1月~2018年12月我院收治的CHB患者120例,均行超声造影及SWE检查,获得肝动静脉渡越时间（HAVTT）值及肝脏弹性测值。结果：随着肝纤维化分期提高,HAVTT1、HAVTT2逐渐缩短,肝脏弹性测值逐渐增大;HAVTT1、HAVTT2及肝脏弹性测值在无纤维化组、纤维化组及肝硬化组之间两两比较均有统计学差异（P <0.05）。ROC曲线分析显示,HAVTT1、HAVTT2诊断肝纤维化及肝硬化的曲线下面积分别为0.870、0.851和0.889、0.856,肝脏弹性测值诊断肝纤维化及肝硬化的曲线下面积为分别为0.953、0.898;肝脏弹性测值的诊断效能明显优于HAVTT1及HAVTT2（P<0.05）。结论：SWE技术获得肝脏弹性值对乙肝纤维化及肝硬化的诊断优于超声造影。     

肝纤维化的超声诊断学研究现状及进展

肝纤维化是各种慢性肝病发展为肝硬化的早期可逆的共同通路,是肝内细胞外基质成分降解与合成失平衡的过程。肝纤维化的临床治疗与预后均高度依赖其诊断与分期,临床亟待可靠的非侵入性评估肝纤维化进展的新技术。随着超声诊断学的飞速发展,各类超声诊断技术因其显著优势广泛用于肝纤维化诊断,包括常规超声、超声造影、实时组织弹性成像、瞬时弹性成像、单点剪切波速度测量弹性成像、剪切波速成像及声学结构定量技术等。尤其是超声弹性成像技术,在无创肝纤维化诊断及分期方面显示出极大的临床价值。本文回顾国内外诸多文献与报道,系统探讨并总结了肝纤维化超声诊断学的研究现状及进展。     

肝脏瞬时弹性成像技术评价慢性乙肝患者肝纤维化临床效果

目的:研究肝脏瞬时弹性成像技术评价慢性乙肝患者肝纤维化的临床效果.方法:选取2018年4月—2021年7月中山市小榄人民医院超声科诊断的80例慢性乙肝肝纤维化患者,根据是否存在肝硬化分为观察组(有肝硬化,30例)和对照组(无肝硬化,50例),两组均使用肝脏瞬时弹性成像技术对肝纤维化进行评价,对比两组肝脏瞬时弹性成像数据...     

超声造影与剪切波弹性成像评估慢性乙型肝炎肝纤维化的对比研究

目的探讨超声造影与剪切波弹性成像(SWE)在慢性乙型肝炎(CHB)肝纤维化评估中的应用价值。方法选取我院行肝穿刺活检的CHB患者120例,根据活检结果分为无纤维化组(S0期)18例、肝纤维化组(S1~S3期)73例、肝硬化组(S4期)29例。应用超声造影获取各组肝动静脉渡越时间(HAVTT1和HAVTT2)值,SWE检查获得肝脏弹性测值;应用受试者工作特征(ROC)曲线分析各检测指标预测肝纤维化及肝硬化的诊断效能。结果随着肝纤维化分期提高,HAVTT1、HAVTT2逐渐缩短,肝脏弹性测值逐渐增大;HAVTT1、HAVTT2及肝脏弹性测值在无纤维化组、肝纤维化组及肝硬化组之间两两比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,HAVTT1、HAVTT2诊断肝纤维化及肝硬化的曲线下面积分别为0.870、0.851和0.889、0.856,肝脏弹性测值诊断肝纤维化及肝硬化的曲线下面积为分别为0.953、0.898;肝脏弹性测值的诊断效能明显优于HAVTT1及HAVTT2,差异均有统计学意义(均P<0.05)。结论应用SWE技术获取的肝脏弹性值对CHB患者肝纤维化及肝硬化的诊断优于超声造影。     

超声弹性成像评价肝纤维化程度的初步探讨

目的 探讨超声弹性成像在评价肝纤维化程度中的应用价值.方法 慢性乙型肝炎患者50例,进行肝穿前作超声弹性成像评分,分为1～4分,将肝组织纤维化病理分期与超声弹性成像评分进行对比分析.结果 超声弹性成像评分与肝组织纤维化病理分期的相关系数为0.813(P=0.000),超声弹性成像评分随肝纤维化程度的上升而增高.肝纤维化S4期作为早期肝硬化诊断指标,通过ROC曲线分析超声弹性成像评分曲线下面积为0.883(P=0.000),敏感性88.9%、特异性95.1%.结论 超声弹性成像在评价肝纤维化程度中具有独特优势和广阔的应用前景.     

超声弹性成像在肝纤维化分期中的应用研究

目的 探讨超声弹性成像(RTE)在肝纤维化分期中的应用价值.方法 选择不同病理分期的肝纤维化患者224例,应用RTE评分标准将患者分级,对比其与病理检查分期的相关性,并界定肝纤维化与肝硬化的RTE评级的分界点.结果 肝脏RTE分级为F0、F1、F2级的患者,病理分期多为纤维化(S0、S1、S2、S3)(P<0.05);RTE分级为F4级的患者,病理分期多为肝硬化(S4)(P<0.05);RTE分级为F3时,病理分期分布差异无统计学意义(P>0.05).RTE评分方法与病理分期方法在评价肝纤维化程度时有较高的一致性(Kappa值=0.816).结论 RTE可作为较客观地评价肝纤维化分期的辅助检查方法;此外,乃级可认为是肝纤维化与肝硬化分界点.     

Non-invasive assessment of hepatic fibrosis: comparison of MR elastography to transient elastography and intravoxel incoherent motion diffusion-weighted MRI

Abdominal Radiology - To compare the ability of MR elastography (MRE) with transient elastography (TE) and intravoxel incoherent motion (IVIM) diffusion-weighted MRI in staging hepatic fibrosis...     

New diagnostic method for liver fibrosis and cirrhosis

Liver fibrosis, i.e. excessive accumulation of extracellular matrix proteins, occurs in most types of chronic liver diseases. The prognosis and management of chronic liver diseases depend on the degree of liver fibrosis. Therefore, the assessment of liver fibrosis provides useful information not only for diagnosis but also for treatment planning. Although liver biopsy is still the gold standard for assessing hepatic fibrosis, it has some technical limitations and risks. Furthermore, the dynamic process of liver fibrosis resulting from progression and regression cannot be quantified by liver biopsy. Therefore, alternative, simple, reliable and noninvasive tests are needed to assess the stage of fibrosis. Several noninvasive direct and indirect serum markers able to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy have been reported. However, since most of these markers require complicated calculations, clinical application is difficult. Transient elastography (FibroScan) is a new method for the evaluation of liver stiffness. The technique is based on changes in tissue elasticity induced by hepatic fibrosis. Liver stiffness measured by transient elastography is a noninvasive, reproducible and reliable method to assess hepatic fibrosis as well as to diagnose liver cirrhosis. Based on accumulating clinical data, clinical applications of elastography will increase in the near future.     

Prospective Comparison of the Diagnostic Performance of Magnetic Resonance Elastography with Acoustic Radiation Force Impulse Elastography for Pre-operative Staging of Hepatic Fibrosis in Patients with Hepatocellular Carcinoma

The purpose of this study was to compare the diagnostic accuracy of magnetic resonance (MR) elastography with that of acoustic radiation force impulse (ARFI) elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. We prospectively enrolled 77 patients who were scheduled to undergo hepatectomy for hepatocellular carcinoma. Pre-operative MRE and ARFI elastography examinations were performed on the same day, and liver stiffness/velocity values were determined. Fibrosis stage and necro-inflammatory activity of resected specimens were determined histopathologically using the METAVIR scoring system. Correlations between MRE and ARFI elastography findings and histologic findings were determined by receiver operating characteristic (ROC) analysis. Correlation of MRE was excellent and correlation of ARFI elastography was good with fibrosis stage. MRE had better diagnostic performance than ARFI elastography in estimating substantial fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4). The optimal cutoff value and the area under the ROC curve (AUROC) were determined using ROC curve analysis. The highest Youden index was used as a criterion for selecting the optimal cutoff value. ROC analysis revealed that MRE discriminated advanced stages of fibrosis (F?≥?2) well in patients with hepatocellular carcinoma at a cutoff value of 3.0?kPa with an AUROC value of 0.93, and ARFI elastography did so at a cutoff value of 1.77?m/s with an AUROC value of 0.81 for predicting advanced stages of fibrosis (F?≥?2). In conclusion, MRE is a more accurate imaging modality than ARFI elastography in estimating advanced stages of fibrosis and cirrhosis.     

超声弹性成像在胆道闭锁患儿中的应用进展

胆道闭锁是婴儿持续性黄疸常见病因,可快速发展为胆汁性肝硬化,甚至导致死亡。胆道闭锁肝纤维化程度与肝门空肠吻合术术前评估、术后追踪及选择肝移植时间点密切相关。超声弹性成像是无创评价肝纤维化程度较有前景的技术之一。本文就超声弹性成像技术在胆道闭锁中的应用进展进行综述。     

弹性成像定量分析与肝纤维化分期的相关性研究

目的 探讨基于弹性成像技术的组织弥散定量分析软件评价肝纤维化的可行性.方法 应用组织弥散定量分析软件对46例慢性肝病患者肝硬度进行分析,得到11个弹性图的量化数据,包括应变均值、标准差、蓝色区域面积(蓝色区域%)、复杂度、峰度、偏度、对比度、均等性、复杂度、一致性、相关性,将11个量化数据与肝穿刺活榆病理肝纤维化分期结果进行对照.结果 11个弹性图的量化数据中除了复杂度和相关性在多组间比较差异无统计学意义,且与病理分期无相关性外,其余量化数据多组比较均有统计学差异(P<0.05),其中以蓝色区域%相关系数最高,为0.72.5.以蓝色区域%判断肝纤维化分期绘制ROC曲线,曲线下面积分别为0.865、0.880、0.886.结论 基于弹性成像技术的组织弥散定量分析软件有助于肝纤维化分期的评估,以蓝色区域%与病理分期相关性最高,并具有较好的诊断价值.

Abstract：

Objective To explore the feasibility of evaluation of hepatic fibrosis using the tissue dispersion quantitative analysis software based on ultrasonic elastography. Methods Forty-six chronic liver disease patients were examined by tissue dispersion quantitative analysis software. There were 11 characteristic quantities of elastography imaging obtained by the tissue dispersion quantitative analysis software,including average relative strain value,standard deviation of relative strain value,area ratio of low-strain region ( AREA%) , complexity, kurtosis, skewness, contrast, entropy, inverse different moment,angular second moment,correlation. The 11 characteristic quantities were compared with pathological stages of hepatic fibrosis. Results The characteristic quantities had statistically significant differences except kurtosis and correlation in the analysis of variance and correlational study with pathological stages ( P < 0.05). The AREA% had the highest related coefficient ( r = 0.725). The ROC curve was made by AREA% ,the areas under the ROC curve were 0. 865 ,0. 880 and 0. 886. Conclusions The tissue dispersion quantitative analysis software is helpful in the evaluation of stages of hepatic fibrosis. The AREA% has the highest relationship with pathological stages of hepatic fibrosis and good diagnostic value.     

Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.     

Pediatric Liver Ultrasound Elastography

Ultrasound elastography is an easy, relatively affordable, noninvasive method that can be used to assess for hepatic fibrosis. The aim of this article is to present an introduction to ultrasound elastography and provide case examples to show when its use can be beneficial.     

Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis

The aim of this study was to determine the performance of shear wave elastography (SWE) with a propagation map in the diagnosis of hepatic fibrosis, and to assess its reliability with transient elastography (TE) as the reference standard. Our prospective study included 115 consecutive patients with suspected or alleged chronic hepatitis. Patients underwent SWE by two different operators and TE by sonographers on the same day. The correlation coefficient of the intra-class correlation test between an experienced radiologist and a third-year radiology resident was 0.878. There was a moderate correlation between SWE and TE (r = 0.511) in the diagnosis of hepatic fibrosis. The best cutoff values predicting significant hepatic fibrosis and liver cirrhosis by SWE were >1.78 m/s (area under the receiver operating characteristic curve [AUROC] = 0.777) and >2.24 m/s (AUROC = 0.935), respectively. SWE with a propagation map is a reliable method for predicting hepatic fibrosis regardless of operator experience.