瞬时弹性成像技术诊断肝纤维化专家意见

基于肝脏瞬时弹性成像技术(transient elastography,TE)的Fibroscan能够通过检测肝脏硬度值(liver stiffness measurement,LSM)来判断肝纤维化,TE诊断肝炎肝硬化的效能优于FibroTest、 FibroMeter、 HepaScore、APRI、API、FIB-4、Forns指数、Hui指数、代偿性肝硬化指数(CCD等血清生物学标志物[1-7],在我国已被批准用于临床.为促进这一技术在临床上的正确合理应用,中国肝炎防治基金会组织专家撰写了《瞬时弹性成像技术诊断肝纤维化专家意见》,并在郑州召开讨论会进一步修改、定稿.随着临床实践的进展及证据积累,专家委员会将对本意见作进一步完善.     

瞬时弹性扫描诊断肝纤维化准确性研究

目的验证瞬时弹性扫描（FibroScan）诊断肝纤维化的准确性。方法选取141例慢性肝病患者,每例均进行肝脏活体组织检查,并应用瞬时弹性扫描仪测量肝脏硬度,以病理检查结果为金标准,验证FibroScan诊断肝纤维化的准确性。结果肝脏硬度与肝纤维化程度密切相关,Kendall相关系数为0．74（P=0．001）。FibroScan诊断肝纤维化F1～F4、F2～F4、F3～F4、F4期的受试者工作特征曲线下面积分别为0．97、O．96、0．99、0．97。结论FibroScan诊断肝纤维化有较好的准确性。     

瞬时弹性成像在慢性乙型肝炎肝纤维化诊断中的应用

目的：探讨瞬时弹性成像（ FS）在慢性乙型肝炎（乙肝）肝纤维化诊断中的应用价值。方法选取慢性乙肝患者165例,其中轻度肝纤维化者77例,中度肝纤维化者47例,重度肝纤维化及肝硬化者41例;另选同期健康体检者50例。采用FS扫描仪检测所有受试者肝脏硬度值;采用常规及临床生化检查检测血小板、AST、谷氨酰转肽酶及胆固醇,计算APRI指数、Forns指数。采用受试者工作特征（ ROC）曲线分析FS、APRI、Forns单独及联合诊断慢性乙肝肝纤维化的准确性。结果在诊断中度肝纤维化时,FS、Forns、APRI的ROC曲线下面积（ AUC）值分别为0．807、0．786、0．767,诊断界值分别为8．5 kPa及8．1、11．7,敏感度分别为83．3％、60．0％、73．3％,特异度分别为81．6％、92．1％、76．3％;在诊断重度肝纤维化及肝硬化时,FS、Forns、APRI的AUC值分别为0．896、0．886、0．829,诊断界值分别为16．3 kPa及8．4、9．3,敏感度分别为73．3％、80．0％、73．3％,特异度分别为90．6％、83．0％、88．7％。在诊断中度肝纤维化时,FS＋APRI ＋Frons、FS＋Frons、FS＋APRI、FS 的AUC 值分别为0．851、0．832、0．826、0．807,敏感度分别为66．7％、76．7％、70．0％、83．3％,特异度分别为97．4％、81．6％、89．5％、81．6％;在诊断重度肝纤维化及肝硬化时,FS＋APRI＋Frons、FS＋Frons、FS＋APRI、FS的AUC值分别为0．922、0．904、0．907、0．896,敏感度分别为86．7％、86．7％、80．0％、73．3％,特异度分别为88．7％、83．0％、88．7％、90．6％。结论 FS对慢性乙肝肝纤维化诊断准确性高,联合血清学检测诊断效能增高,具有良好的临床应用价值。     

瞬时弹性成像在肝纤维化无创性诊断中的应用

肝组织活检是目前肝纤维化疾病诊断的金指标,但具有局限性。近年来,无创性诊断方法的确立已成为国内外学者关注的热点。目前临床常用多种血清纤维化指标进行肝纤维化的评价,但其敏感性和特异性尚无法令人满意。国外研制出瞬时弹性测定的方法用于肝纤维化评估,此文对FibroScan在肝纤维化无创性诊断的研究进展进行综述。     

瞬时弹性成像技术和血清无创预测模型对慢性药物性肝损伤患者肝纤维化的预测价值

目的 探讨瞬时弹性成像技术(TE)、APRI、FIB-4、Sheth指数、GUCI评分、GPR、King′s评分对慢性药物性肝损伤患者肝纤维化的诊断价值。方法 选取2020年9月至2023年7月于首都医科大学附属北京佑安医院收治并行肝穿刺活检的慢性药物性肝损伤患者。应用TE测量LSM值,按照公式计算APRI、FIB-4、Sheth指数、GUCI评分、GPR、King′s评分,绘制受试者工作特征曲线,计算曲线下面积(AUC)、敏感度、特异度、阳性预测值、阴性预测值。评估各模型的诊断价值。结果 63例患者中,S0-1 11例,S2 30例,S3-4 22例。3组患者除GPR为0.98(0.43,1.39)比1.18(0.63,3.06)比1.28(0.85,2.48),差异无统计学意义(P=0.478)外,LSM[5.4(5.0,7.4)比14.7(9.55,39.6)比21.3(13.7,33.8),P=0.016]、APRI[0.57(0.31,1.64)比1.70(0.67,3.20)比1.35(0.82,2.60),P=0.048]、FIB-4[1.19(0.90,3.00)比3....     

瞬时弹性超声成像在评价乙型肝炎肝纤维化严重程度中的价值

目的探讨瞬时弹性超声成像在评价乙肝肝纤维化严重程度中的价值。方法选取我院2015年1月至2016年6月期间收治的220例慢性乙肝患者在肝脏穿刺活检,根据肝脏穿刺纤维化的结果分为5组,分别为S0组(45例)、S1组(42例)、S2组(50例)、S3组(41例)、S4组(42例),同时在肝穿1周内运用瞬时弹性成像对肝硬度值(LSM)进行检测。比较5组患者肝硬度值的差异,分析肝硬度值(LSM)和肝纤维化严重程度的关系,并绘制受试者工作特性曲线(ROC),并计算瞬时弹性超声成像在诊断肝纤维化程度的特异度和灵敏度。结果①5组患者肝硬度值的比较:5组患者肝硬度值分别为[(4.97±1.45)、(7.14±1.36)、(9.05±1.51)、(11.43±1.32)、(13.17±1.65)kPa],S0期的肝硬度值最低,S4期肝硬度值最高,组间比较均具有统计学差异(均P0.05)。②肝硬度值(LSM)与肝纤维化分期的相关性:肝硬度值随着肝纤维化分期的升高而不断升高,肝硬度值与肝纤维化分期呈正相关(r=0.668,P=0.003)。③肝硬度值诊断肝纤维化程度的特异度和灵敏度:肝硬度值诊断S1、S2、S3、S4期纤维化的曲线下面积(AUC)分别为0.754、0.863、0.902、0.927;诊断的临界值分别为(6.24、7.61、9.06、10.46)kPa,特异度分别为81.2%、77.5%、94.3%、97.8%;灵敏度分别为71.2%、74.6%、86.2%、87.9%。结论瞬时弹性成像在评价慢性乙肝患者肝纤维化严重程度中有重要价值,特别是针对S3期以上的肝纤维化,具有较高的特异度和灵敏度。     

瞬时弹性超声成像在评价非酒精性脂肪性肝炎肝纤维化严重程度中的价值

目的 探讨瞬时弹性超声成像在评价非酒精性脂肪性肝炎肝纤维化严重程度中的价值.方法 研究对象选取成都大学附属医院2018年9月到2019年9月间收治的非酒精性脂肪性肝炎患者236例,依据肝脏穿刺纤维化程度,将全部患者分为5组,分别是A组(50例)、B组(47例)、C组(52例)、D组(44例)、E组(43例).肝脏穿刺1...     

瞬时弹性成像技术在慢性肝病肝纤维化诊断中的应用进展

肝脏纤维化程度及进展与慢性肝脏疾病的诊断与治疗密切相关。早期诊断肝纤维化程度有助于避免代偿期患者向肝硬化失代偿期发展,也有助于降低肝细胞癌的发生率。目前,临床上评估肝纤维化程度的“金标准”仍为肝脏穿刺活检,但是由于其操作的有创性,以及穿刺后可能出现的多种并发症等多种因素的影响,限制了它在临床研究中的使用。瞬时弹性成像技术无创、安全、有利于动态监测肝纤维化进展、客观评价肝脏纤维化程度,使其在国内外得到了广泛的认同,在临床上具有良好的应用前景。     

影响瞬时弹性成像术检测肝纤维化的相关因素分析

Fibroscan是检测肝脏组织弹性程度的一种方法,现已逐渐被广泛应用于临床检测肝纤维化,其与肝活检相比具有无创、可重复性好、简单快速、易于操作等优点。但是它检测肝纤维化测量值的准确性受到一系列相关因素的影响,如肥胖、肝脏炎症、胆汁淤积、进食等,本文就Fibroscan在检测肝纤维化中的影响因素作一概述。     

纤维化扫描仪用于肝纤维化无创诊断研究进展

肝纤维化是各种慢性肝病共同的病理表现,肝穿刺活检是目前诊断肝纤维化的金标准,其有创性限制了在临床上的广泛应用,因此无创性诊断方法成为研究热点.目前临床常用的各种无创诊断方法的特异性和敏感性不能令人满意.法国学者研究出瞬时弹性测定方法用于肝纤维化的诊断,具有无创、无痛、客观、定量等优点.此文就纤维化扫描仪的原理、临床应用...     

瞬时弹性检测技术在肝脏疾病诊断中的应用

目前,瞬时弹性检测肝脏疾病得到了广泛应用。越来越多的学者发现合理应用该技术能够帮助无创诊断肝纤维化、监测治疗效果及预估病情。本文主要介绍了该技术的原理、应用、影响因素及前景等方面的研究进展。     

肝脏瞬时弹性成像和门静脉血流动力学指标检测对慢性乙型肝炎患者肝纤维化的诊断意义

目的 探讨瞬时弹性成像（TE,Fibroscan®）技术测量肝脏硬度值（LSM） 和超声检测门静脉血流动力学参数对慢性乙型肝炎（CHB）患者肝脏纤维化分级的效能。方法 91例CHB患者和41例正常人经Fibroscan-502仪测定LSM;使用彩色多普勒超声诊断仪检测门静脉主干内径（PVD）、最大流速（PVVmax）和平均流速（PVVmean）;CHB患者在超声引导下行肝脏穿刺,对穿刺组织进行病理学检查。结果 CHB患者LSM、PVD、PVVmax和PVVmean分别为（9.40±0.95）kPa、（11.63±0.12）mm、（35.40±0.94）cm/s和（29.82±0.84）cm/s,均显著高于正常人[分别为（4.45±0.20）kPa、（10.85±0.12）mm、（26.10±1.07）cm/s和（21.94±0.73）cm/s,P<0.01];CHB患者肝组织纤维化病理分期为S0者LSM、PVD、PVVmax和PVVmean分别为（5.46±0.33）kPa、（11.36±0.24）mm、（40.99±1.46）cm/s和（34.42±1.29）cm/s,S1期者为（6.06±0.31）kPa、（11.33±0.16）mm、（34.09±1.43）cm/s和（28.90±1.31）cm/s,S2期者为（9.87±1.15）kPa、（12.14±0.31）mm、（33.51±1.59）cm/s和（27.78±1.73）cm/s,S3期者为（15.48±2.16）kPa、（12.42±0.26）mm、（33.01±2.11）cm/s和（28.48±2.05）cm/s,和S4期者为（31.85±8.38）kPa、（12.50±0.34）mm、（28.42±2.78）cm/s和（24.58±2.91）cm/s],差异有统计学意义（F=29.13、F=4.52、F=5.98和F=4.36,P均<0.01）;CHB患者LSM与PVD、PVVmax和PVVmean存在相关性（r=0.362、r=-0.364、r=-0.345,P<0.01）。结论 综合应用LSM及门静脉血流动力学指标对临床无创评估CHB患者肝纤维化有一定的诊断意义。     

两种超声弹性成像技术诊断慢性乙型肝炎患者肝纤维化价值比较*

目的 探讨瞬时弹性成像和二维剪切波弹性成像用于CHB患者肝纤维化诊断的临床价值。方法 2016年3月～2018年12月我院收治的CHB患者164例,均行瞬时弹性成像和二维剪切波弹性成像检查及肝穿刺活检,采用受试者工作特性(ROC)曲线下面积比较两种超声弹性成像检查诊断不同肝纤维化分期的效能。结果 经肝穿刺活检,在164例CHB患者中,诊断肝组织S₁期50例,S₂期42例,S₃期39例,S₄期33例;瞬时弹性成像检查S₁～S₄期肝纤维化分期的弹性值分别为(6.5±1.1)kPa、(8.6±1.4)kPa、(11.7±1.8)kPa和(16.3±1.8)kPa,二维剪切波弹性成像检查弹性值分别为(5.9±0.8) kPa、(8.1±1.2)kPa、(10.9±1.5)kPa和(16.7±1.9) kPa,两种超声弹性成像检查不同肝纤维化分期弹性值差异无统计学意义(P >0.05);二维剪切波弹性成像检查诊断肝纤维化S₂、S₃和S₄期的ROC曲线下面积(AUC)分别为0.971、0.979和0.973,显著高于瞬时弹性成像检查的0.902、0.906和0.904(P <0.05),其诊断的敏感性分别为90.3%、90.6%和100.0%,特异性分别为95.8%、90.6%和84.5%,而瞬时弹性成像检查诊断则分别为78. 5%、81.3%和73.1%,和93.3%、87.9%和91.0%。结论 二维剪切波弹性成像和瞬时弹性成像检查均可用于慢性乙型肝炎患者的肝纤维化诊断,其临床价值均需要进一步探讨。     

瞬时弹性成像技术在肝病诊断中的应用进展

正肝脏瞬时弹性成像技术(Transient elastography,TE)的原理是通过超声波测量剪切波在肝组织中的传播速度来推算其硬度。剪切波在组织中的传播速度为1~10 m/s,不同硬度组织中的传播速度不同,硬度越高,传播速度越快,传播速度可衡量组织的硬度。超声波在组织中的传播速度为1500 m/s以上,超声波可以用以捕捉剪切波的传播过程,计算剪切波的传播速度,剪波速度可转化计算成肝脏硬度,单     

Noninvasive methods,including transient elastography,for the detection of liver disease in adults with cystic fibrosis

BACKGROUND:

Liver disease is the third leading cause of mortality in patients with cystic fibrosis (CF). However, detection of CF-associated liver disease (CFLD) is challenging.

OBJECTIVE:

To evaluate the diagnostic performance of noninvasive methods for the detection of CFLD with a focus on transient elastography (TE).

METHODS:

Patients at the Adult CF Clinic of Calgary and Southern Alberta (n=127) underwent liver stiffness measurement (LSM) by TE using the FibroScan (FS, Ecosens, France) M probe; aspartate amino-transferase to platelet ratio index (APRI) and FibroTest (FT) scores were also calculated. The diagnostic performance of these tools for the detection of CFLD (defined as two or more the following criteria: abnormal liver biochemistry, hepatomegaly or sonographic abnormalities other than steatosis) were compared using the area under ROC curves.

RESULTS:

Forty-seven percent of the cohort was male. The median age was 27 years (interquartile range [IQR] 22 to 37 years) and body mass index 21 kg/m² (IQR 19 kg/m² to 23 kg/m²); 25% of patients were on ursodeoxycholic acid and 12% had undergone lung transplantation. The prevalence of CFLD was 14% (n=18). FS was successful in all patients; one (0.8%) patient had poorly reliable results (IQR/M >30% and LSM ≥7.1kPa). Compared with patients without CFLD (n=109), individuals with CFLD had higher median LSM according to FS (3.9 kPa [IQR 3.4 to 4.9 kPa] versus 6.4 kPa [IQR 4.4 to 8.0 kPa]), APRI (0.24 [IQR 0.17 to 0.31] versus 0.50 [IQR 0.22 to 1.18]) and FT scores (0.08 [IQR 0.05 to 1.5] versus 0.18 [IQR 0.11 to 0.35]; all P<0.05). Area under ROC curve for FS, APRI and FT for the detection of CFLD were 0.78 (95% CI 0.65 to 0.92), 0.72 (95% CI 0.56 to 0.87) and 0.76 (95% CI 0.62 to 0.90) (P not significant). At a threshold of >5.2 kPa, the sensitivity, specificity, positive and negative predictive values of LSM according to FS for detecting CFLD were 67%, 83%, 40% and 94%, respectively.

CONCLUSIONS:

FS, APRI and FT were useful noninvasive methods for detecting CFLD in adults.     

Assessment of disease progression in patients with transfusion-associated chronic hepatitis C using transient elastography

AIM: To evaluate the relationship between liver stiffness and duration of infection in blood transfusion-associated hepatitis C virus (HCV) patients with or without hepatocellular carcinoma (HCC).METHODS: Between December 2006 and June 2008, a total of 524 transfusion-associated HCV-RNA positive patients with or without HCC were enrolled. Liver stiffness was obtained noninvasively by using Fibroscan (Echosens, Paris, France). The date of blood transfusion was obtained by interview. Duration of infection was derived from the interval between the date of blood transfusion and the date of liver stiffness measurement (LSM). Patients were stratified into four groups based on the duration of infection (17-29 years; 30-39 years; 40-49 years; and 50-70 years). The difference in liver stiffness between patients with and without HCC was assessed in each group. Multiple linear regression analysis was used to determine the factors associated with liver stiffness.RESULTS: A total of 524 patients underwent LSM. Eight patients were excluded because of unsuccessful measurements. Thus 516 patients were included in the current analysis (225 with HCC and 291 without). The patients were 244 men and 272 women, with a mean age of 67.8 ± 9.5 years. The median liver stiffness was 14.3 kPa (25.8 in HCC group and 7.6 in non-HCC group). The patients who developed HCC in short duration of infection were male dominant, having lower platelet count, with a history of heavier alcohol consumption, showing higher liver stiffness, and receiving blood transfusion at an old age. Liver stiffness was positively correlated with duration of infection in patients without HCC (r = 0.132, P = 0.024) but not in patients with HCC (r = -0.103, P = 0.123). Liver stiffness was significantly higher in patients with HCC than in those without in each duration group (P < 0.0001). The factors significantly associated with high liver stiffness in multiple regression were age at blood transfusion (P < 0.0001), duration of infection (P = 0.0015), and heavy alcohol consumption (P = 0.043)CONCLUSION: Although liver stiffness gradually increases over time, HCC develops in patients with high stiffness value regardless of the duration of infection.     

Invasive and non-invasive methods for the assessment of fibrosis and disease progression in chronic liver disease

Chronic liver diseases represent a major public health problem, accounting for significant morbidity and mortality worldwide. Their prognosis and management greatly depend on the amount and progression of liver fibrosis with the risk of developing cirrhosis. Liver biopsy, traditionally considered as the reference standard for staging of fibrosis, has been challenged over the past decade by the development of novel non invasive methodologies. These methods rely on two distinct but complementary approaches: i) a 'biological' approach based on the dosage of serum biomarkers of fibrosis; ii) a 'physical' approach based on the measurement of liver stiffness using transient elastography (TE). Non invasive methods have been initially studied and validated in chronic hepatitis C but are now increasingly used in other chronic liver diseases, resulting in a significant decrease in the need for liver biopsy. However, they will likely not completely abolish the need for liver biopsy and they should rather be employed as an integrated system with liver biopsy. This review is aimed at discussing the advantages and inconveniences of non invasive methods in comparison with liver biopsy for the management of patients with chronic liver diseases.     

A health technology assessment of transient elastography in adult liver disease

BACKGROUND:

An estimated one in 10 Canadians have some form of liver disease. The reference standard for staging and monitoring liver fibrosis is percutaneous liver biopsy – an invasive procedure associated with risks and complications. Transient elastography (TE) represents a noninvasive, ultrasound-based alternative.

OBJECTIVE:

To assess the efficacy of TE compared with liver biopsy for fibrosis staging in adults with five common types of liver disease: hepatitis B, hepatitis C, nonalcoholic fatty liver disease, cholestatic liver disease and complications post-liver transplantation.

METHODS:

A systematic review of published and grey literature from 2001 to June 2011 was conducted. Included were observational studies evaluating the accuracy of TE using liver biopsy as the comparator. An economic model was developed to estimate the cost per correct diagnosis gained with liver biopsy compared with TE. Identification of moderate fibrosis (stages 2 to 4) and cirrhosis (stage 4) were considered.

RESULTS:

Fifty-seven studies were included in the review. The diagnostic accuracy of TE for the five clinical subgroups had sensitivities ranging from 0.67 to 0.92 and specificities ranging from 0.72 to 0.95. Liver biopsy was associated with an additional $1,427 to $7,030 per correct diagnosis gained compared with TE. The model was sensitive to the sensitivity and specificity of TE and the prevalence of fibrosis.

CONCLUSIONS:

TE is an accurate diagnostic method in patients with moderate fibrosis or cirrhosis. TE is less effective but less expensive than liver biopsy. Systemic implementation of TE should be considered for the noninvasive assessment of liver fibrosis.