实时超声弹性成像诊断肝纤维化的探讨

目的 探讨实时超声弹性成像(real-time ultrasound elastography,RTE)评价肝纤维化的价值.方法 对82例慢性病毒性肝炎的患者进行RTE扫查,将弹性图像进行0～4分的评分,将RTE评分与肝组织活检结果和实验室检测结果分别进行对照研究.结果 RTE评分结果与肝纤维化病理分期的相关性高于评分与天门冬氨酸氨基转移酶/血小板比例指数(aspartate aminotransferase to platelet ratio index,APRI)的相关性.以明显肝纤维化(S≥2期)作为诊断标准,RTE评分的受试者工作特征(receiver operating characteristic,ROC)曲线下面积优于APRI.其诊断肝纤维化的敏感度为94.29％,特异度为78.72％0.结论 RTE为无创诊断肝纤维化程度提供了新方法,必将在临床中有着良好的应用前景.     

实时超声弹性成像在婴儿肝炎综合征和胆道闭锁肝纤维化诊断中的应用价值

目的探讨实时超声弹性成像(RTE)在婴儿肝炎综合征(IHS)和胆道闭锁(BA)肝纤维化诊断中的应用价值。方法回顾性分析行肝组织病理检查的15例淤胆型IHS患儿(IHS组)和21例BA患儿(BA组)的RTE资料,比较其RTE评分情况及与肝纤维化病理分期的相关性。结果 1IHS组RTE评分为1.20±0.94,BA组RTE评分为3.05±0.92,差异有统计学意义(t=5.882,P=0.000);2无肝纤维化患儿RTE评分为0.27±0.55,肝纤维化患儿RTE评分为2.53±1.13,差异有统计学意义(t=-9.484,P=0.000);3RTE诊断肝纤维化的敏感性为97%,特异性为77%,准确性为88%,阳性预测值为86%,阴性预测值为94%;4IHS组和BA组的RTE评分与肝纤维化病理分期具有较高的相关性(r=0.968,P=0.000)。结论 RTE可反映IHS和BA患儿肝纤维化的程度,具有无创、简便及无痛的优点,具有重要临床价值。     

实时组织弹性成像弹性特征量与乙肝后肝纤维化的相关分析

目的 评价实时组织弹性成像(RTE)弹性特征量诊断肝纤维化程度的相关关系.方法 76例乙肝患者肝纤维化程度分为F0～F4期,同时进行RTE检查,获取弹性特征量:包括应变均值(MEAN)、标准偏差(SD)、蓝色领域％ (AREA)、复杂度(COMP)、峰度(KURT)、偏度(SKEW)、对比度(CONT)、均等性(ENT)及杂乱度(IDM).结果 F0/F1比较无显著性差异,F1/F2,F1/F3,F1/F4,F2/F3或F3/F4比较,部分弹性特征量有显著性差异.结论 RTE弹性特征量可能反映肝纤维化的程度,可望成为肝纤维化程度的无创性诊断方法之一.     

实时超声弹性成像评价肝纤维化程度的初步探讨

目的 探讨实时超声弹性成像(real-time tissue elastography,RTE)对慢性乙型肝炎病毒引起的肝纤维化程度的临床诊断价值.方法 选择慢性乙型病毒性肝炎、乙肝肝硬化患者共63例,按照肝功能Child-Pugh改良分级标准A、B、C3级,再将其分别为相对应的Ⅰ、Ⅱ、Ⅲ3组;设正常对照组22例.所有患者均经常规超声扫查后,再使用RTE技术扫查,图像根据弹性程度分为0～4分,将肝组织RTE评分与肝功能Child-Pugh改良分级进行对比分析.结果 RTE评分与肝功能Child Pugh改良分级呈正相关,相关度较高(rs=0.612,P=0.000),RTE评分随肝功能受损严重程度的增加而增加.结论 RTE技术为诊断肝纤维化提供了新的手段,有望成为客观评价肝纤维化程度的无创检查方法.     

实时超声弹性成像诊断慢性肝病肝纤维化

目的探讨实时超声弹性成像(RTE)评价肝纤维化的价值。方法对88例慢性病毒性肝炎患者进行RTE扫查,测量肝组织/肋间肌肉组织的应变比。全部患者均接受经皮肝穿刺术并采集血清生化学指标,将应变比与实验室检测结果与肝纤维化病理分期进行对照。结果应变比与肝纤维化病理分期呈负相关(r=-0.82,P<0.01)。以肝明显纤维化(≥S2期)作为诊断标准,应变比的ROC曲线下面积为0.92,优于天门冬氨酸氨基转移酶/血小板比例指数(0.90)和Forns指数(0.84);以应变比1.10作为诊断肝明显纤维化的最佳诊断界值,其敏感度为86.84%,特异度为82.00%,阳性预测值为78.57%,阴性预测值为89.13%。结论 RTE可作为无创判断肝纤维化程度的新方法。     

实时组织超声弹性成像与瞬时弹性成像评价慢性乙肝感染肝纤维化程度的对比研究

目的 对比分析实时组织弹性成像(RTE)与瞬时弹性成像(FibroScan)在评价肝纤维化程度中的应用价值.方法 对121例慢性乙肝感染患者进行经皮肝脏穿刺活检术病理组织学检查,分为S0～S4期,同时行RTE和FibroScan检查.将RTE检查中获取的9个弹性变量经多元逐步回归分析方程计算出肝纤维化指数(LF Ind...     

比较实时超声弹性成像与声触诊组织定性弹性成像诊断肝局灶性病变

目的比较实时超声弹性成像(RTE)与声触诊定性弹性成像(VTI)在肝局灶性病变诊断中的价值及二者诊断的一致性。方法对44例肝结节患者(共54个结节)分别进行RTE及VTI检查。对弹性图像分别进行评分,并评价结节硬度。对照临床诊断结果,分别计算RTE和VTI的敏感度、特异度、准确率、阳性预测值和阴性预测值,并绘制ROC曲线,计算曲线下面积。采用χ2检验比较两种检查方法的差异。结果 RTE诊断肝脏恶性结节的敏感度、特异度、准确率、阳性预测值、阴性预测值分别为81.82%(27/33)、71.43%(15/21)、77.78%(42/54)、81.82%(27/33)、71.43%(15/21),VTI分别为72.73%(24/33)、71.43%(15/21)、72.22%(39/54)、80.00%(24/30)、62.50%(15/24)。RTE和VTI的曲线下面积分别为0.766和0.722(Z=0.45,P=0.3264),两种弹性成像方法均具有一定诊断价值。RTE和VTI对同一病灶的诊断一致性较好(P>0.05)。结论RTE与VTI对肝内良恶性局灶性病变具有较好的诊断价值,且具有较高的一致性。     

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.     

实时组织弹性成像弹性特征量在肝纤维化诊断中的应用

实时组织弹性成像(real-time tissue elastography,RTE)是近年发展起来的一项超声新技术,本研究旨在探讨该技术诊断乙肝后肝纤维化程度的价值. 资料与方法一、研究对象2010年6-8月在我院接受RTE检查的76例乙肝患者,男性63例,女性13例,年龄9～70岁,平均(42±18)岁.病理获取途径为肝切除术(38例)及肝穿活检(38例).肝纤维化分级标准按Metavir分期方法分为F0～F4期:F0,无肝纤维化;F1,汇管区有纤维化但无分隔,为轻度肝纤维化;F2,汇管区有纤维化伴少量分隔,为中度肝纤维化;F3,有大量分隔但无肝硬化,为重度肝纤维化;F4,肝硬化[1].     

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.     

Real-time elastography as a noninvasive technique for quantification of fibrosis in patients with chronic viral liver disease: Preliminary findings

IntroductionReal-time elastography (RTE) is a novel technique for measuring tissue elasticity. The aims of this study were to prospectively measure liver stiffness with RTE in patients with chronic viral hepatitis and to evaluate the possible correlation between RTE data and the extent of fibrosis based on liver biopsy findings (Ishak score).Material and methodsBetween February and October 2011, 26 patients (18M, 8F, mean age 41 ± 13 [standard deviation], range 22–62) with chronic viral hepatitis were prospectively evaluated with ultrasonography (US) that included RTE. All patients then underwent US-guided percutaneous liver biopsy (right lobe) for evaluation of fibrosis. Examinations were performed with a iU22 scanner (Philips, Bothell, WA, USA); a convex transducer (C5-1) was used for the US examination, and a linear transducer (L12-5) for RTE. In the RTE images, relative tissue stiffness is expressed according to a color scale with soft areas represented in green/red and hard areas in blue. Patients were examined in the supine position in suspended normal respiration; three loops of 20 RTE frames were recorded for each case. For each patient, we calculated the mean strain ratio (MSR) for the 3 loops. The Spearman correlation coefficient was used to assess correlation between the ASR and fibrosis stage (F) reflected by the Ishak score.ResultsThe Spearman coefficient showed significant correlation between the MSR and F (Rho = 0.470, p = 0.015).ConclusionsRTE appears to be a useful tool for noninvasive evaluation of fibrosis in patients with chronic viral hepatitis although these findings need to be confirmed in larger case series.     

Real-time elastography (RTE): a valuable sonography-based non-invasive method for the assessment of liver fibrosis in chronic hepatitis B

Purpose

To investigate the diagnostic usefulness of real-time elastography (RTE) for liver fibrosis in chronic hepatitis B (CHB).

Methods

89 CHB patients were enrolled in the cross-sectional study. Ultrasound-guided percutaneous liver biopsies, RTE, and blood testing were performed in all patients. Areas under receiver operating characteristic curves (AUROC) were used to examine the diagnostic performance of liver fibrosis index (LFI) for the assessment of liver fibrosis.

Results

LFI differed significantly across histologic fibrosis stages (P < 0.05), except the comparison between S0 and S1 (P = 0.298). There was a strong positive correlation between LFI and histologic liver fibrosis stage (Spearman r = 0.831, P < 0.001). The cutoff LFI value of >2.74 indicated a sensitivity of 0.766 and a specificity of 0.872 for predicting significant liver fibrosis (S ≥ 2), and the cutoff LFI value of >3.61 indicated a sensitivity of 0.833 and a specificity of 0.878 for predicting early liver cirrhosis (S = 4). LFI showed higher AUROC for discriminating significant liver fibrosis (0.873 vs. 0.614) and early liver cirrhosis (0.923 vs. 0.769) than aspartate aminotransferase-to-platelet ratio index (APRI).

Conclusions

RTE is a valuable sonography-based non-invasive method for assessment of liver fibrosis and has better discrimination power for significant liver fibrosis and early liver cirrhosis than APRI in CHB.

     

Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis

Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.     

实时组织弹性成像在评估肝纤维化程度中的诊断价值

目的探讨实时组织弹性成像在评估肝纤维化程度中的诊断价值。方法选择我院住院收治的慢性肝炎患者156例,另选择同期健康体检者60例为对照组。行实时组织弹性成像检查和肝穿刺活体组织检查,分析实时组织弹性成像检测结果与肝组织纤维化程度及炎症程度的关系。结果肝纤维化弹性成像评分在肝炎各组及肝纤维化组不同病理分期的差异均有统计学意义（P〈0.05）。经Spearman等级相关分析显示,肝纤维实时组织弹性成像评分与病理学分期密切相关,呈正相关（r=0.846,P〈0.01）。实时弹性成像诊断肝纤维化的敏感度、特异度和准确度分别为94.5%、80.9%和90.4%。结论 RTE诊断肝纤维化具有较高的临床价值,是一项具有广阔应用前景的新的无创性诊断方法。     

肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值

目的:探讨肝硬化判别评分诊断慢性乙型病毒性肝炎肝纤维化的临床价值。方法:172例慢性乙型病毒性肝炎患者均接受肝组织病理检查,并同时检测肝功能、血常规和凝血功能,用ROC曲线评价肝硬化判别评分诊断无或轻度肝纤维化(S0/S1)、显著肝纤维化(S2/S3/S4)、严重肝纤维化(S3/S4)和肝硬化(S4)的能力。结果:S4的肝硬化判别评分明显高于S0、S1、S2和S3(P<0.01);肝纤维化分期和肝硬化判别评分的相关系数rs=0.375(P<0.01);肝硬化判别评分诊断显著肝纤维化的ROC曲线下的面积0.726,阳性预测值95.3%,肝硬化的AUC 0.814,阴性预测值96.5%,严重肝纤维化的AUC仅有0.626,敏感度38.8%。结论:肝硬化判别评分和肝纤维化分期有一定的相关性,肝硬化判别评分可以用于评估慢性乙型病毒性肝炎患者有无显著肝纤维化或肝硬化,但对S2和S3的区分能力有限。     

Serum gp73 is also a biomarker for diagnosing cirrhosis in population with chronic HBV infection

ObjectivesTo clarify the role of Golgi membrane glycoprotein 73 (gp73) in evaluating the progression of chronic hepatitis B virus (HBV) infection.Design and methodsParticipants included 958 controls, 421 chronic hepatitis B, 944 hepatic cirrhosis, and 127 hepatocellular carcinoma (HCC) patients. All the patients, with the exception of the controls, were diagnosed HBsAg positive. Serum biomarkers, including gp73, alpha-fetoprotein (AFP), alpha-l-fucosidase, and Lens culinaris agglutinin-reactive fraction of AFP, were determined.ResultsThe patients with Hepatic cirrhosis gp73 levels over 150 ng/mL had an odds ratio of 3.21 (95% CI: 2.07–5.00). In hepatic cirrhosis patients, serum gp73 correlated with the Child–Pugh score. gp73 is a marker for diagnosing cirrhosis in the hepatitis populations. When the cut-off was set at 75.5 ng/mL, the sensitivity, specificity, and AUC were 75.6% (95% CI: 71.30%–79.62%), 60.3% (95% CI: 56.95%–63.63%) and 0.72 (95% CI: 0.69–0.75), respectively.ConclusionThe variation trend of gp73 in chronic liver disease may indicate that monitoring of serum gp73 is helpful to diagnose cirrhosis in population with chronic HBV infection.     

Real-time tissue elastography (RTE) for noninvasive evaluation of fibrosis in liver diseases in children in comparison to liver biopsy

Purpose

To determine the value of real-time tissue elastography (RTE) in pediatric liver diseases in comparison to liver biopsy.

Methods

RTE was performed on 34 patients (♀, n = 17; ♂, n = 17; range 0–21 years) with various acute and chronic liver diseases: autoimmune hepatitis (n = 5), liver transplantation (n = 5), Wilson’s disease (n = 4), hepatopathy of unknown origin (n = 4), unclear cholestatic hepatitis (n = 2), thalassemia major (n = 2), glycogenosis (n = 2), hereditary fructose intolerance (n = 1), alpha-1-antitrypsin deficiency (n = 1), diabetes mellitus type 1 (n = 1), chronic intestinal pseudo-obstruction (n = 1), primary sclerosing cholangitis (n = 1), hepatitis B (n = 1), cirrhosis of unknown origin (n = 1), drug-induced hepatopathy (n = 1), unexplained transaminase elevation (n = 1), and nonalcoholic steatohepatitis (n = 1). Included children were biopsied. RTE was performed on a control group (n = 30; ♀, n = 15; ♂, n = 15). The mean value of strain (MEAN) in arbitrary units and the ratio of blue color-coded harder tissue (AREA) were calculated based on an elasticity histogram of the selected region of interest in liver parenchyma. They were compared with the histologically defined grade of liver fibrosis.

Results

In comparison to the scoring systems, a moderate correlation was observed for MEAN and AREA by excluding the F0 patients [MEAN r = ?0.575 to ?0.645, AREA r = 0.545–0.607 (p < 0.05)]. Differentiation of the control group and low-grade fibrosis (F1) from high-grade fibrosis (F2–4) was significantly possible (p values <0.001 at 5 % significance level).

Conclusion

RTE parameters enable a possible differentiation of high fibrosis; however, their correlation with fibrosis stage was moderate. RTE seems to be a promising method in liver fibrosis grading in children.     

剪切波点定量弹性成像技术对慢性乙型肝炎肝纤维化分期的诊断价值

目的 探讨剪切波点定量弹性成像（ElastPQ）技术测量肝组织硬度对诊断慢性乙型肝炎（CHB）肝纤维化分期的价值。方法 选取68例CHB患者为观察对象，24名健康体检者为对照，应用ElastPQ技术进行肝组织硬度检测，获得所有受试者的肝硬度值（ElastPQ值）。以肝穿刺活组织病理结果为金标准，绘制ElastPQ值诊断各肝纤维化分期的ROC曲线，分析其诊断效能。结果 不同分期肝纤维化ElastPQ值差异具有统计学意义（F=9.45，P<0.05），且ElastPQ值与肝纤维化程度呈正相关（r=0.672，P<0.001）。ElastPQ值诊断肝纤维化分期>S0期、>S1-2期、>S3期的界值分别为6.24 kPa、9.20 kPa、15.96 kPa，相应的AUC分别为0.904、0.855、0.772，敏感度分别为93.2%、78.0%、76.3%，特异度分别为100%、89.7%、76.9%。结论 ElastPQ技术可有效评估肝组织弹性硬度，对诊断肝纤维化分期具有重要的临床价值。