超声检查和血清肝纤维化相关标志与肝纤维化病理分级的相关性

目的：探讨慢性肝病患者超声检查指标和血清肝纤维化相关标志与肝纤维化病理分级的相关性。方法：经肝穿刺活检的181例慢性肝病患者按纤维化和蔼分为S0－S1组76例,S2－S4组105例。比较两组患者的4项超声检查指标和4项血清肝纤维化相关标志浓度。结果：超声检查指标中,两组患者的门静脉主干内径、脾长径和脾静脉内径有显著差异（P＜0．01）,而门静脉血流量参数无显著差异（P＞0．05）;血清肝纤维化相关标志中,透明质酸浓度的组间差异最为显著（P＜0．001）,7SⅣ胶原和基质金属蛋白酶抑制剂浓度也有差异（P＜0．02）,但Ⅲ型前胶原浓度无显著差异（P＞0．5）。脾长径和脾静脉内径与血清透明质酸浓度有较好的相关性（P＜0．001）。结论：门静脉主干内径、脾长径和脾静脉内径这3项常用超声检查指标结合血清肝纤维化相关标志与肝纤维化病理分级有一定相关性。     

彩色超声与慢性肝炎肝纤维化分期的相关性分析

目的探讨超声诊断慢性乙型肝炎(CHB)患者代偿期肝硬化的价值。方法 2010年1月至2015年1月行肝活组织检查的CHB患者226例,收集患者B型超声资料,利用Logistic回归分析与代偿期肝硬化程度相关的指标,采用受试者工作特征曲线下面积(AUROC)评价B型超声诊断代偿期肝硬化的价值。结果超声指标中SWV、门静脉主干内径、胆囊壁厚度、脾脏长径、脾脏厚度、脾脏面积、脾静脉内径、门静脉最大流速共8项指标与肝脏炎症分级和纤维化分期均相关。其中,SWV、门静脉主干内径、脾脏长径、门静脉最大流速、脾静脉内径与组织学代偿期肝硬化独立相关,AUC均0.7。结论超声的部分影像学指标对预测组织学代偿期肝硬化有潜在的价值。     

非创伤性诊断指标优势组合对肝纤维化诊断价值的初步研究

目的 探讨非创伤性诊断指标的优势组合及其对肝纤维化的诊断价值。方法 以肝活检组织学分级分期为标准,检测200例慢性肝病患者同期血清学指标、免疫学指标、肝纤维化血清标志物及B超、CT、MRI,运用 逐步回归方法判别分析获得肝纤维化非创伤性诊断指标的优势组合,并计算其敏感性、特异性及准确率。结果 以S0为无纤维化组,S1＋S2＋S3＋S4为纤维化组,获得指标组合：B超门静脉每分钟血流流量参数、年龄、B超肝右叶最大斜径、CT／MRI肝表面波浪状表现、γ－谷氨酰转肽酶（GGT）,其诊断敏感性为80．36％,特异性为86．67％,准确率为81．10％;以S1＋S2为轻度肝纤维化组,S3＋S4为重度肝纤维化组,获得指标组合：透明质酸（HA）、A／G比值、B超脾长径,其诊断敏感性为59．57％,特异性为91．26％,准确率为81．33％;以S1＋S2＋S3为纤维化组,S4为肝硬化组,获得指标组合：HA、CT／MRI肝内胆管附近小囊状改变情况、B超肝包膜厚度、年龄、症状积分,其诊断敏感性为77．78％,特异性为91．45％,准确率为89．63％。结论 非创伤性诊断指标的优势组合对诊断肝纤维化具有较高的敏感性和特异性,其诊断价值高于单一指标。     

超声波检查对肝脏纤维化分期的诊断价值

目的 了解超声波检查对早期肝硬化的诊断价值及其与肝纤维化程度的相关性。方法２６３例慢性乙型病毒性肝炎患者经皮肝脏穿刺活检术行病理组织学检查，同时行空腹肝脏Ｂ型超声波检查肝硬化声像、门静脉主干和脾静脉宽度及脾脏肿大，检查结果经 ｔ检验、ｘ２检验确定统计学意义。结果 ２６３例患者中 ６０例为早期肝硬化，超声波检查对早期肝硬化的诊断灵敏度 ５２．５％，特异度 ８８．３％，误诊率 １１．７０％，漏诊率 ４７．５％，约登指数 ０．５０８；肝纤维化Ｓ１、Ｓ２、Ｓ３、Ｓ４期的门静脉主干宽度分别为（１０．９３± １．２５）ｍｍ、（１１．３５±１．０６）ｍｍ、（１１．２９± １．５２）ｍｍ及（１１．４８±１．２５）ｍｍ，其中以与Ｓ１比较差异有显著意义（Ｐ＜０．０５）；脾静脉宽度分别（６．５１８±２．０３３）ｍｍ、（７．１９０±１．５６９）ｍｍ、（７．４４４±１．８０５）ｍｍ及（８．４０６±２．２２７）ｍｍ，其中 Ｓ４与 Ｓ２比较差异有显著意义（Ｐ＜０．０５）；脾脏肿大发生率随肝纤维化程度加重而增加。结论 超声波检查对早期肝硬化的诊断敏感度亟待提高，不足以作为早期肝硬化的常用诊断方法；门静脉主干、脾静脉宽度及脾脏肿大发生率与肝纤维化程度呈正     

慢性肝炎临床诊断与病理分级分期诊断的对比分析

１９１例慢性肝炎患者进行了肝活检，病理切片按Ｓｃｈｅｕｅｒ推荐标准进行了分级分期诊断，并与肝功能、肝脾Ｂ型超声检查对照，提示慢性肝炎随着炎症活动的严重和反复，肝内纤维化程度亦愈明显。慢性小叶性肝炎诊断必须依赖于病理诊断。肝硬化临床诊断与病理诊断符合率为３３％，故病理诊断分级分期是目前慢性肝炎，尤其是肝纤维化者的必要检查手段。     

肝纤维化的诊断方法及其评估(下)

(四)影像学诊断 1.B超:肝脏表面和边缘形态、肝包膜厚度、肝实质回声、肝右叶最大斜径、门静脉主干和左右支内径、脾长径和厚度、脾静脉内径和门静脉每分钟血流量、胆囊壁厚度等指标参数常用于评估肝纤维化程度,但需有量化分析标准才有诊断价值[1].陈煜等[2]报道,以肝实质回声、肝表面、肝脏边缘、肝静脉、脾面积5项指标每项以1～3积分划分,超声总积分＞10分诊断肝硬化的敏感性为86.1%,特异性为95.5%.Nishura等[3]报道,以低频(2～5 MHz)和高频(5～12 MHz)两种探头分别测定肝表面、肝脏边缘和肝实质特征3项指标予以评分,超声总积分(6.5分诊断肝硬化的敏感性可达100%.     

B型超声、胃镜和脾门静脉核素显像对门静脉高压症的量化诊断研究

目的 将B型超声、胃镜和脾门静脉核素显像三种检查方法的结果进行量化，建立判别式，以探讨其在肝硬化门静脉高压症诊断中的临床意义。方法 分别对40例肝硬化门静脉高压症、10例慢性肝病、12例非肝病患者进行B型超声、胃镜和脾门静脉核素显像检查。结果 经逐步回归分析，筛选出诊断肝硬化门静脉高压症的影像学指标是：门体分流指数（X1）、脾静脉宽度（X2）、肝脏回声分级（X3）、食管静脉曲张程度（X4），将其分别建立判别式为：Y1=-36．912＋15．650X1＋67．289X2-0．425X3-1．651X4，Y0=-23．193＋10．697X1＋61．425X2-3．251X3-2．758X4或Y1=-35．828＋15．857X1＋62．390X2＋0．228X3，Y0=-20．167＋11．042X1＋53．241X2-3．581X3，若Y1〉Y0，即为肝硬化门静脉高压症，其诊断肝硬化门静脉高压症的敏感度均为95％，特异度分别为96％、91％，明显优于B超或胃镜定性检查的78％、75％（P〈0．05）。结论 B型超声和脾门静脉核素显像联合定量检测并建立判别式，可以显著提高对肝硬化门静脉高压症的诊断敏感度。     

慢性乙肝患者肝脏CT检查与肝穿病理改变的对照研究

目的 了解肝脏CT检查对早期肝硬化的诊断价值及其与肝纤维化程度的相关性.方法 152例慢性乙型病毒性肝炎患者经皮肝脏穿刺活检术行病理组织学检查,同时行肝脏CT检查,测量肝脾CT值、门静脉及脾静脉宽度及脾脏大小.结果 152例患者中肝活检显示37例为早期肝硬化,CT检查33例为早期肝硬化,提示CT对早期肝硬化诊断的诊断灵敏度81.08%,特异度90.91%,误诊率9.09%,漏诊率18.91%.结论 肝脏CT检查对早期肝硬化的诊断灵敏度较高,可以作为慢性乙型肝炎患者的常规检查项目,从而有助于早期肝硬化的诊断,并指导积极抗病毒治疗.     

超声积分法对肝硬化的早期诊断

探讨早期肝硬化的影像学特征。102例慢性肝炎患者行B超、CT检查及肝穿刺活组织病理学检查，将超声、CT图象特征同病理组织学标准进行对照分析。随纤维化分期的加重，综合肝实质回声、肝表面、肝脏边缘、肝静脉、脾脏面积等5项参数的超声总积分值逐渐升高。以超声总积分大于l0分为界值，诊断肝硬化的敏感性为86．1％，特异性为95．5％。肝脏CT图象的形态学观察诊断肝硬化患者的特异性为100％，敏感性为48．5％。综合多项超声参数而成的超声总积分对诊断早期肝硬化有较高的敏感性和特异性。CT诊断早期肝硬化虽然特异性较高,但敏感性较低.     

超声二维图像和彩色多普勒血流评估肝纤维化的初步研究

目的 研究Ｂ超二给图像及彩色多普勒血流影像（ＣＤＦＩ）对监测肝纤维化的价值。方法 １８１例病理证实的慢性肝炎病人按病理纤维化分级分为５组,比较其二维超声和ＣＤＦＩ检查结果。结果 肝包膜厚度、肝右叶最大斜径、门静脉主干和左、右支内径、胆道壁厚度、脾长厚径、肝实质光点形态、脾静脉直径和门静脉每分钟血流量参数等指标反映肝纤维化均有较好的敏感性、特异性和准确性。结论 超声二维图象和ＣＤＦＩ在监测肝纤维化方面有一定应用价值。其敏感性、准确性和特异性有待通过引进新技术加以提高。     

FibroScan and ultrasonography in the prediction of hepatic fibrosis in patients with chronic viral hepatitis

Background  The aim of this study was to assess the diagnostic performances of liver stiffness measurement (LSM), ultrasonography (US) and their combined use in predicting the extent of hepatic fibrosis. Methods  Consecutive patients with chronic hepatitis B (HBV) or hepatitis C virus (HCV) infections, with indications for liver biopsy, were prospectively enrolled. LSM was performed on the same day as biopsy. US scores, including assessment of liver surface, liver parenchyma, intrahepatic vessels and spleen index, were used to assess the degree of hepatic fibrosis. The pathological findings were used as a reference standard and diagnostic accuracy was assessed and compared. Results  Three-hundred and twenty patients, including 199 men and 121 women, with a mean age of 50.8 years, were analyzed. There were 214 (66.9%) HCV patients, 88 (27.5%) HBV patients and 18 (5.6%) patients with both HCV and HBV. LSM correlated significantly with the hepatic fibrosis (F) scores, necro-inflammatory activity and US scores in multivariate analysis. The diagnostic accuracy of LSM is significantly superior to US, and equal to combined LSM with US, in the prediction of all HCV-related fibrosis scores. The cut-off value of LSM is 6 kPa for diagnosing F > =1, with a positive predictive value of 91%. Also, the cut-off value is 12 kPa for the prediction of cirrhosis, with a negative predictive value of 94%. Conclusions  LSM is useful for predicting hepatic fibrosis and excluding cirrhosis. A combination of LSM and US does not improve the accuracy in assessing hepatic fibrosis.     

Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

AIM： To assess the value of gray scale （GS） and colour Doppler ultrasonography （CDU） in differentiating the progression of chronic viral hepatitis （CVH） and compensated liver cirrhosis （CIR）. METHODS： Seventy-two patients and 32 normal individuals who were used as controls were studied. Forty-four patients suffered from CVH and 28 from CIR. All patients were underwent to liver biopsy. Multiple qualitative and quantitative variables were studied in liver, portal vein （PV）, hepatic artery （HA） and spleen with GS and CDU. On the basis of the obtained CDU data, several known indexes were calculated. In addition, alternative indices [PV diameter （D）/time average mean velocity （VTAM）, HA/PV VTAM ratio] were calculated and studied. RESULTS： ROC analysis showed that PV congestion index, PV D/VTAM and HA/PV VTAM indices had the best sensitivity and specificity in discriminating CVH from CIR. Stepwise discriminant analysis showed that 88.9% of the originally grouped cases could be correctly classified by the three qualitative and four quantitative variables selected as statistically significant predictors. Among the CVH patients who underwent to biopsy, statistically significant changes were found in those at fibrosis stage 5 compared to fibrosis stages 1-4. CONCLUSION： Simple GS and CDU parameters discriminate CVH from CIR. The alternative Doppler indexes can accurately differentiate chronic virus hepatitis from cirrhosis. These indexes can be used in monitoring chronic virus hepatitis and avoiding unnecessary biopsies.     

Assessment of hepatic fibrosis by analysis of the dynamic behaviour of microbubbles during contrast ultrasonography

Background/aims: Microbubble behaviour from the portal vein to the liver parenchyma may reflect haemodynamic changes because of hepatic fibrosis. The aim of this study was to determine the efficacy of contrast‐enhanced ultrasound (US) with Sonazoid^? for the assessment of the grade of hepatic fibrosis. Methods: This prospective study evaluated 117 patients with chronic liver disease (chronic hepatitis 85; cirrhosis 32) and 34 controls. All subjects received both contrast‐enhanced US with Sonazoid^? for 1 min after the agent injection and subsequent liver biopsy. Flow velocity and flow volume in the right portal vein, onset time of contrast enhancement in the right hepatic artery and right portal vein, maximum intensity ratio between the intra‐hepatic portal vein and liver parenchyma, and time interval between the onset time and the time of maximum intensity ratio were compared with the pathological findings. Results: Among the evaluated parameters, time interval between the onset time and the time of maximum intensity ratio showed the closest relationship with the grade of hepatic fibrosis: 4.21 ± 1.32 for controls (n=34), 5.58 ± 1.39 for F1 (n=31), 6.79 ± 1.77 for F2 (n=28), 8.85 ± 1.97 for F3 (n=26) and 14.3 ± 3.49 for cirrhosis (n=32); controls vs. F2, P=0.0004; F1 vs. F3, P<0.0001; F2 vs. F3, P=0.0177; F3 vs. cirrhosis, P<0.0001. The areas under the receiver operating characteristic curves of the time interval were 0.94, 0.96 and 0.98 for the diagnosis of marked fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis respectively. Conclusions: Contrast‐enhanced US with Sonazoid^? may be a promising method for the indirect evaluation of hepatic fibrosis.     

Application of a numerical scoring system for assessment of histological outcome in patients with chronic posttransfusion non-A, non-B hepatitis with or without antibodies to hepatitis C

A numerical scoring system was applied and compared to the conventional histological classification to assess the histological status of liver specimens from 37 patients with chronic posttransfusion non-A, non-B hepatitis followed for 7 to 105 months (mean 35 months). Four histological categories of alterations were assessed and scored: piecemeal necrosis (PMN), fibrosis and cirrhosis, lobular necrosis and portal inflammation. Sequential liver biopsies were obtained from 19 patients. PMN was generally mild but still predictive of progressing fibrosis. Thus, in none of the biopsies from four patients with initial PMN score 0 was there any increase in the fibrosis score in the follow-up biopsy, while in 10/15 (67%) patients with an initial PMN score of greater than or equal to 1 the fibrosis score increased with time (p = 0.033). Lobular necrosis and portal inflammation were not predictive of progressing fibrosis. Judging from the scoring method, 22% of all the 37 patients displayed cirrhosis and 27% bridging fibrosis in the latest liver biopsy performed. Patients with antibodies to hepatitis C did not differ in histological status or outcome from those without antibodies to hepatitis C. It is concluded that the scoring system can be used to monitor the histological long-term follow-up in patients with chronic posttransfusion non-A, non-B hepatitis, and offers a means of predicting the histological outcome.     

Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis.

OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.     

Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease

OBJECTIVES: To investigate the clinical utility and the intra-observer and inter-observer variability of Doppler ultrasound assessment of the hepatic and portal vessels along with measurement of spleen size in the diagnosis of chronic liver disease and cirrhosis. METHODS AND MATERIALS: Ultrasound measurements of portal vein diameter (PVD), portal vein velocity (PVV), hepatic arterial resistance index (HARI), hepatic vein profile (HVP), and spleen size were obtained in 49 controls and 45 patients with liver disease (23 with primary biliary cirrhosis, 22 with hepatitis C) by two experienced observers, who each performed three blinded measurements of each variable. Control values were derived from normal hospital workers. Percutaneous liver biopsies in 41 of the patients showed cirrhosis (14 patients), moderate/severe fibrosis (13 patients), and early disease (14 patients). RESULTS: Seventy-one percent of cirrhotic patients had splenomegaly (> 13.6 cm). The spleen size was significantly larger in cirrhotics (16.0 cm) than in non-cirrhotics (13.0 cm, P < 0.009) and healthy controls (10.7 cm, P < 0.00005), and was the only independent predictor of cirrhosis, with a threshold of 15 cm predicting cirrhosis with a specificity of 98%, positive predictive value of 93%, sensitivity of 57% and negative predictive value of 80%. HVP was abnormal in 76.9% of cirrhotics, 57.7% of non-cirrhotics and 2.1% of controls (P < 0.04). However, the mean PVV, PVD and HARI were no different between controls and patients or between cirrhotic and non-cirrhotic liver disease. There was significant inter-observer variability for PVV, but intra-observer and inter-observer variability was acceptable for the other measurements. CONCLUSIONS: Splenomegaly size and abnormal HVP are useful predictors of chronic liver disease and cirrhosis, and both can be measured reliably and reproducibly. However, Doppler measurements of PVV, PVD and HARI are not useful in distinguishing patients with chronic liver disease from normal controls.     

Model consisting of ultrasonographic and simple blood indexes accurately identify compensated hepatitis B cirrhosis

Background and Aim:  Several models for significant fibrosis or cirrhosis have been introduced for hepatitis C, but are seldom for hepatitis B. The present study retrospectively evaluates the relationship between ultrasonography, blood tests, and fibrosis stage, and constructs a model for predicting compensated cirrhosis.
Methods:  A total of 653 patients with chronic hepatitis B who underwent liver biopsies, ultrasonographic scanning, and routine blood tests were retrospectively analyzed. The patients were divided into the model set and validation set. Blood tests and ultrasonographic indexes were analyzed statistically. An ultrasonographic scoring system consisting of liver parenchyma, gallbladder, hepatic vessel, and splenomegaly was introduced.
Results:  There were significant differences between cirrhosis and other fibrosis stages in ultrasonographic indexes of liver parenchyma, gallbladder, hepatic vessel, and splenomegaly. Ultrasonographic scores were significantly different between F4 and other fibrosis, and significantly correlated with fibrosis stage. Apart from alanine aminotransferase and alkaline phosphatase, blood tests and patients' age were correlated with fibrosis, and were significantly different between patients with and without cirrhosis. The model for cirrhosis indexes consisting of ultrasonographic score, patient's age, and variables, including platelet, albumin, and bilirubin predicted cirrhosis with area under receiver–operator curve of 0.907 in the model set and 0.849 in the validation set. Using proper cut-off values, nearly 81% patients could be accurately assessed for the absence or presence of cirrhosis.
Conclusion:  The model consisting of ultrasonographic score, patients' age, blood variables of platelet, albumin, and bilirubin can identify hepatitis B cirrhosis with a high degree of accuracy. The application of this model would greatly reduce the number of biopsies.