声辐射力脉冲成像技术定量预测肝硬化食管静脉曲张程度的临床价值

目的探讨声辐射力脉冲成像(ARFI)技术定量分析预测肝硬化门静脉高压食管静脉曲张程度的临床价值。方法选取2014年10月-2016年2月解放军第三〇二医院收治的肝硬化患者116例,应用ARFI技术分别对肝脏、脾脏的实时超声弹性进行测量,以胃镜为食管静脉曲张程度的诊断金标准,将患者分为无曲张组(EV0,n=16)、轻度曲张组(EV1,n=39)、中度曲张组(EV2,n=26)和重度曲张组(EV3,n=35)。采用受试者工作特征曲线分析肝脏、脾脏ARFI技术预测食管静脉曲张程度的临床诊断价值。计量资料多组间比较采用方差分析或Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验;计数资料多组间比较采用χ~2检验。ARFI弹性测值与食管静脉曲张程度的相关性采用Spearman相关分析。结果肝硬化患者食管静脉曲张程度从EV0至EV3级的脾脏ARFI测值分别为(2.54±0.34)、(3.05±0.34)、(3.48±0.50)、(3.69±0.33)m/s,组间比较差异有统计学意义(χ~2=60.121,P0.001)。脾脏ARFI测值与食管静脉曲张分级呈正相关(r=0.713,P0.001)。脾脏ARFI测值诊断不同食管静脉曲张程度≥EV1、≥EV2、EV3的受试者工作特征曲线下面积分别为0.93、0.88、0.83。肝脏ARFI测值在不同食管静脉曲张程度组间差异无统计学意义(P=0.085),其与肝硬化食管静脉曲张程度亦无相关性(P=0.245)。结论脾脏ARFI弹性测值可较准确地无创定量预测肝硬化门静脉高压食管静脉曲张程度,具有潜在的临床应用前景。     

声脉冲辐射力成像技术在非酒精性单纯性脂肪肝患者中的诊断价值

目的探讨应用声辐射力脉;中成像（ARFI）技术评价非酒精性单纯性脂肪肝（NAFL）的价值。方法选取2011年6月-2011年12月本院收治的84例NAFL患者作为脂肪肝组,用二维超声分为轻、中、重度3组,并进行VTQ检测。同时选取36例健康人作为对照组,进行VTQ检测。比较对照组和脂肪肝组以及不同程度脂肪肝组内的差异。两组间比较采用t检验,多组间比较采用多因素方差分析,脂肪肝程度与VTQ值相关性采用Spearman秩相关检验。结果脂肪肝组与对照组间VTQ测值差异具有统计学意义[（1．74±0．49）m／sVS（1．18±0．22）m／s;t=3．436,P〈0．01）,不同程度脂肪肝组间VTQ测值差异具有统计学意义（F=21．266,P〈0．01）,且随着患者脂肪肝程度的加重,肝脏的VTQ值逐渐增高,两者存在正相关（Spearman相关系数为0．542,P〈0．001）。结论ARFI技术能够反映NAFL的程度,可以用于门诊及体检中心对NAFL的筛查工作,可较准确的对NAFL进行定量评价。     

声辐射力脉冲弹性成像技术预测肝硬化食管静脉曲张破裂出血的临床价值

目的探讨声辐射力脉冲弹性成像(ARFI)技术在预测肝硬化食管静脉曲张破裂出血中的临床价值。方法回顾分析2014年10月-2017年5月于解放军总医院第五医学中心就诊的271例肝硬化患者资料,所有患者均应用ARFI技术对肝脏和脾脏的超声弹性进行检测,并根据有无食管静脉曲张破裂出血将患者分为出血组(n=56)和无出血组(n=215),比较两组间相关指标的差异并结合受试者工作特征曲线(ROC曲线)评估分析ARFI弹性测值对肝硬化食管静脉曲张破裂出血的诊断价值。正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验。结果肝硬化食管静脉曲张出血组及无出血组脾脏ARFI弹性测值分别为3.89(3.49~4.11)m/s和3.46(2.93~3.80)m/s,出血组显著高于无出血组(Z=-4.941,P<0.001);出血组及无出血组肝脏ARFI弹性值分别为2.08(1.57~2.74)m/s和1.98(1.49~2.70)m/s,两组间差异无统计学意义(Z=-1.025,P=0.305)。脾脏和肝脏ARFI弹性测值预测肝硬化食管静脉曲张破裂出血的ROC曲线下面积分别为0.714和0.544(P=0.0025),以3.71 m/s作为脾脏ARFI弹性测值预测食管静脉曲张出血发生的诊断界值,其敏感度为0.68,特异度0.69。结论脾脏ARFI弹性测值较肝脏弹性测值可更有效预测肝硬化食管静脉曲张破裂出血的风险,具有良好的临床应用前景。     

声辐射力脉冲成像技术定量评价慢性丙型肝炎肝纤维化的临床研究

目的 探讨声脉冲辐射力成像技术(ARFI)在评价慢性丙型肝炎肝纤维化程度上的临床价值. 方法 对108例慢性丙型肝炎患者应用ARFI技术对肝脏的实时超声弹性进行测量,患者均进行肝活组织检查,以病理检查结果与肝脏的实时超声弹性测值进行比较,计算ARFI技术诊断肝纤维化的灵敏度,特异度,取敏感度和特异度之和最大时为最佳界限值.应用SPSS10.0统计学软件进行统计学处理,多组间比较根据数据是否正态分布及方差齐性来选择采用参数或非参数检验分析,相关性分析采用spearman相关分析. 结果 慢性丙型肝炎患者肝纤维化分期S1 ～ S4期的ARFI平均值分别为(1.26±0.27) m/s(n=36)、(1.45±0.51) m/s(n=31)、(2.01±0.54)m/s(n=27)和(2.28±0.82) m/s(n=14),组间比较,秩和检验KW=42.307,P＜0.01.肝脏ARFI测值与肝纤维化分期相关,相关系数为0.61,P＜0.01.ARFI技术诊断慢性丙型肝炎肝纤维化S≥2,S≥3和S=4的受试者工作特征曲线下面积分别为0.779,0.863和0.880.结论 ARFI可较准确的定量评价慢性丙型肝炎肝纤维化程度,具有良好的临床应用前景.     

声脉冲辐射力弹性成像技术评估周围型肺部肿瘤的可行性研究

目的探讨声脉冲辐射力弹性成像技术(acoustic radiation force impulse,ARFI)用于评价周围型肺部肿瘤的可行性。方法使用ARFI技术,测量肺部肿块剪切波速度值(SWV),统计分析不同病理类型肿瘤之间SWV的差异,同时采用roc曲线评价SWV对周围型肺癌良恶性的鉴别诊断价值。结果良恶性病灶SWV比较,差异具有统计学意义,恶性组中肺腺癌和肺鳞癌SWV比较,差异没有统计学意义。以SWV=1.2 m/s作为鉴别良恶性病变截断点。结论声脉冲辐射力弹性成像技术对于评估周围型肺部肿块的良恶性具有可行性,展现了良好的应用前景。     

脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值

目的应用声辐射力脉冲成像(ARFI)技术和APRI(AST/PLT)及AAR(AST/ALT)指数对慢性肝炎肝硬化患者进行脾脏弹性检测和分析,探讨和对比上述三项无创技术对预测肝硬化食管静脉曲张(EV)的应用价值。方法选择2016年6月-2017年3月就诊于解放军第三○二医院的247例慢性肝炎肝硬化患者,应用ARFI技术检测脾脏实时超声弹性,并计算APRI及AAR指数,所有患者均于检测前后1周内行胃镜检查明确EV程度,以胃镜结果为金标准,应用受试者工作特征(ROC)曲线比较脾脏ARFI弹性、APRI和AAR诊断肝硬化EV的临床价值。2组间计量资料比较采用t检验。结果胃镜结果显示肝硬化伴EV患者169例(EV组),无EV患者78例(无EV组)。EV组脾脏ARFI弹性、APRI和AAR分别为(3.64±0.53)m/s、0.8±0.91和1.54±0.67,无EV组分别为(2.97±0.65)m/s、0.52±0.80和1.29±0.55,2组间比较差异均有统计学意义(t值分别为-7.93、-2.90、-2.93,P值分别为<0.001、0.004、0.004)。脾脏ARFI弹性、APRI和AAR预测肝硬化EV的ROC曲线下面积分别为0.80、0.72和0.63,脾脏ARFI弹性与AAR相比差异有统计学意义(P=0.005),脾脏ARFI弹性与APRI相比差异无统计学意义(P=0.10)。结论 ARFI技术作为实时超声弹性成像技术,脾脏ARFI弹性较APRI和AAR能更准确地无创预测慢性肝炎肝硬化EV的存在,具有良好的临床应用前景。     

声脉冲辐射力成像技术评估肝纤维化的临床应用

目的探讨声脉冲辐射力成像技术(ARFI)评估不同程度肝纤维化的临床应用价值。方法对健康志愿者250例、肝病患者361例行ARFI检测,测量其声触诊组织量化值(VTQ),统计归纳出肝纤维化程度的增加与VTQ相关性及相应界限值。结果受检361例患者中348例行超声引导下肝脏穿刺活检并行S0～S4分期,不同时期肝纤维化VTQ平均值(m/s):S0(1.21±0.14)、S1(1.26±0.13)、S2(1.36±0.13)、S3(1.77±0.32)、S4(2.23±0.20),正常组(1.11±0.17);各组间除S0和S1期的病例组(P=0.048)并不能说明实际临床上VTQ值差异是否具有临床意义外,其余组间VTQ值差异均有统计学意义(P均<0.001);慢性肝病程度的加重,弹性参数值也随之增加,两者具有一定相关性。结论 ARFI能对肝纤维化程度进行量化分析,从而避免肝脏穿刺活检,为临床提供一种无创、操作简单、可重复性强的肝纤维化程度及疗效的评估手段。     

声脉冲辐射力弹性成像在甲状腺实性结节性质鉴别诊断中的价值

目的观察声脉冲辐射力弹性成像（ARFI）技术评估甲状腺实性结节弹性的效果,探讨其诊断价值。方法回顾性分析经手术病理证实的76例患者81个甲状腺结节的ARFI特征,根据声触诊组织定性成像（Ⅷ）模式将甲状腺结节的弹性分为6级,与病理结果对照分析甲状腺恶性结节诊断界点的临床价值;根据声触诊组织定量成像（VTQ）模式检测结节及其周边正常甲状腺组织的剪切波速度值（swV）,并绘制ROC曲线、找出最佳诊断界点。结果以VTl分级Ⅳ级作为甲状腺恶性结节的诊断界点,准确性、敏感性、特异性、阳性预测值、阴性预测值均〉80％;良恶性结节的swV有显著差异,ROE曲线下面积为0．9、最佳诊断临界点为2．85m／s,准确性、敏感性、特异性、阳性预测值、阴性预测值均〉86％。结论ARFI技术可定性、定量评估甲状腺结节弹性,与常规超声检查结合可提高甲状腺良恶性结节的鉴别能力。     

血清脂联素的表达及肝功能、肝脾CT值等联合检测对非酒精性脂肪肝诊断的临床意义

目的探讨血清脂联素的表达及肝功能、肝脾CT值等联合检测对非酒精性脂肪性肝病（NAFLD）诊断的临床意义。方法选取NAFLD患者71例,分为轻、中、重三组;对照组41例。检测ALT、AST、GGT、TG、TC、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及脂联素,分析脂联素与各临床指标的相关性,NAFLD组与对照组、NAFLD不同组间上述指标的变化。结果（1）与对照组比较,NAFLD组的脂联素水平、肝脏CT值、CT肝脾比值、HDL-C明显降低（P〈0.01）,BMI、ALT、AST、TG、TC、GGT、LDL-C明显增高（P〈0.01）;（2）脂联素与BMI、ALT、AST、GGT、LDL-C呈负相关,与肝脏CT值、HDL-C呈正相关;（3）ALT在轻度与中度、轻度与重度组间表达有统计学意义（P〈0.05）,而中度与重度组间差异表达无统计学意义（P〉0.05）。结论联合检测脂联素、ALT对于NAFLD的诊断和鉴别诊断有临床意义。     

超声定量评估非酒精性脂肪性肝病患者肝脏ARFI值对显著NASH的诊断价值分析

目的 探讨采用声辐射力脉冲成像技术（ARFI）定量评估非酒精性脂肪性肝病（NAFLD）患者肝脏炎症的应用价值。方法 在经肝活检病理学检查诊断的非酒精性单纯性脂肪肝（NAFL）患者31例、明显非酒精性脂肪性肝炎（NASH）患者31例和显著NASH患者31例及健康人31例,使用超声检测左肝和右肝4 cm、6 cm和8 cm位点ARFI值变化。结果 健康人、NAFL、明显NASH和显著NASH患者左肝4 cm、6 cm和8 cm位点ARFI平均值分别为（1.32±0.15） m/s 、（1.25±0.12） m/s 、（1.18±0.11） m/s 和（1.05±0.10） m/s,右肝ARFI平均值分别为（1.08±0.09） m/s、（0.94±0.08） m/s、（0.89±0.09） m/s 和（0.84±0.07） m/s,左右肝ARFI平均值分别为（1.19±0.10） m/s、（1.10±0.09） m/s、（1.02±0.08） m/s和（0.93±0.08） m/s,显示显著性NASH患者ARFI值显著降低（P<0.05）;四组左肝在8 cm位点ARFI值分别为（1.18±0.14）m/s、（1.02±0.13） m/s、（0.87±0.15） m/s 和（0.71±0.11） m/s,右肝在6 cm位点 ARFI值分别 为（1.06±0.10） m/s、（0.95±0.09） m/s、（0.90±0.08） m/s和（0.85±0.07） m/s,右肝在8 cm位点ARFI值分别为（1.02±0.07） m/s、（0.91±0.06） m/s、（0.81±0.08） m/s和（0.72±0.05） m/s,显示显著NASH患者ARFI值显著降低（P<0.05）。结论 ARFI技术定量评估NAFLD患者肝脏损害程度有助于对显著NASH患者的诊断,可能具有一定的临床意义。     

New method for assessing liver fibrosis based on acoustic radiation force impulse: a special reference to the difference between right and left liver

Background  

Virtual touch tissue quantification (VTTQ) based on acoustic radiation force impulse (ARFI) imaging has been developed as a noninvasive bedside method for the assessment of liver stiffness. In this study, we examined the diagnostic performance of ARFI imaging in 103 patients, focusing on the difference in VTTQ values between the right and left liver lobes.     

Is it better to use two elastographic methods for liver fibrosis assessment？

AIM:To find out if by combining 2 ultrasound based elastographic methods:acoustic radiation force impulse(ARFI)elastography and transient elastography(TE),we can improve the prediction of fibrosis in patients with chronic hepatitis C.METHODS:Our study included 197 patients with chronic hepatitis C.In each patient,we performed,in the same session,liver stiffness(LS)measurements by means of TE and ARFI,respectively,and liver biopsy(LB),assessed according to the Metavir score.10 LS measurements were performed ...     

Acoustic radiation force imaging sonoelastography for noninvasive staging of liver fibrosis

AIM: To investigate the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging as a noninvasive method for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients.METHODS: We performed a prospective blind comparison of ARFI elastography, APRI index and FibroMax in a consecutive series of patients who underwent liver biopsy for CHC in University Hospital Bucharest. Histopathological staging of liver fibrosis according to the METAVIR scoring system served as the reference. A total of 74 patients underwent ARFI elastography, APRI index, FibroMax and successful liver biopsy.RESULTS: The noninvasive tests had a good correlation with the liver biopsy results. The most powerful test in predicting fibrosis was ARFI elastography. The diagnostic accuracy of ARFI elastography, expressed as area under receiver operating characteristic curve (AUROC) had a validity of 90.2% (95% CI AUROC =0.831-0.972, P < 0.001) for the diagnosis of significant fibrosis (F ≥ 2). ARFI sonoelastography predicted even better F3 or F4 fibrosis (AUROC = 0.993, 95% CI =0.979-1).CONCLUSION: ARFI elastography had very good accuracy for the assessment of liver fibrosis and was superior to other noninvasive methods (APRI Index,FibroMax) for staging liver fibrosis.     

Ultrasound-based elastography for the diagnosis of portal hypertension in cirrhotics

Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.     

Elevated plasma homocysteine concentrations as a predictor of steatohepatitis in patients with non-alcoholic fatty liver disease

BACKGROUND: Although steatosis is common in patients with severe hyperhomocysteinemia due to deficiency of cystathionine beta-synthase, there are no satisfactory data on homocysteine concentrations in patients with non-alcoholic fatty liver disease. The main aim of the present study was to evaluate the clinical significance of plasma homocysteine concentrations in patients with non-alcoholic fatty liver disease. METHODS: Seventy-one non-alcoholic fatty liver disease patients, 36 patients with chronic viral hepatitis and 30 healthy persons were enrolled in the study. Homocysteine levels were measured by high-performance liquid chromatography. Insulin, folate, vitamin B(12) and lipoprotein levels were also determined in all groups. RESULTS: Homocysteine in the non-alcoholic fatty liver disease group was found to be significantly higher than other groups. Homocysteine was found to be significantly higher in the non-alcoholic steatohepatitis group when compared with simple steatosis group. A positive correlation was found between homocysteine and triglyceride, very-low-density-lipoprotein (VLDL) cholesterol, insulin, and index of insulin resistance in the non-alcoholic fatty liver disease group, and a negative correlation was found between homocysteine and folate, or vitamin B(12) in all groups. The homocysteine threshold for the prediction of steatohepatitis was 11.935 ng/mL. Furthermore; plasma homocysteine was a statistically significant predictor for severity of necroinflammatory activity in non-alcoholic steatohepatitis. CONCLUSIONS: The plasma homocysteine concentrations were significantly higher in patients with non-alcoholic fatty liver disease, while the concentrations were not affected by chronic viral hepatitis. Plasma homocysteine is a parameter for discriminating steatohepatitis from simple steatosis. Determining the plasma homocysteine concentrations may facilitate selection of steatosis patients in whom a liver biopsy should be performed.     

Measurement of liver stiffness as a non‐invasive method for diagnosis of non‐alcoholic fatty liver disease

Non‐alcoholic fatty liver disease (NAFLD) is one of the major causes of liver disease worldwide. To detect early stages of NAFLD and start treatment or to monitor the changes in trials of new drugs, non‐invasive diagnostic methods are needed, such as biochemical markers or liver stiffness measurement (LSM). LSM with transient elastography (TE) and acoustic radiation force impulse (ARFI) has been shown to be useful in NAFLD, although the cut‐off values have varied among reports. Magnetic resonance elastography and real‐time tissue elastography also can be useful for the diagnosis of NAFLD, although the number of studies is limited. Fibrosis is absent in 8–40% of patients with non‐alcoholic steatohepatitis (NASH), making it difficult to diagnose NASH by LSM because LSM is usually associated with fibrotic stage. The presence of inflammation or hepatocyte ballooning may affect LSM and aid the diagnosis of NASH without fibrosis. However, obesity significantly increases the failure of LSM and its interference is more conspicuous in TE than in ARFI. The newly implemented XL probe of TE has overcome the difficulty to some degree. Nonetheless, the effects of obesity, hepatocyte ballooning, steatosis and inflammation on LSM values have not yet been adequately investigated, although they are likely to affect LSM values. Further studies are needed to establish the clinical utility of LSM in NAFLD.     

Acoustic radiation force impulse (ARFI) elastography in acute liver failure: necrosis mimics cirrhosis

Acoustic radiation force Impulse (ARFI) technology correlates shear-wave velocity with fibrosis. It can differentiate between advanced fibrosis and normal tissue in chronic liver disease. However, specificity is impaired by cholestasis, inflammation or oedema in acute hepatitis. In patients with acute liver failure (ALF) necessitating liver transplantation ARFI has not been evaluated yet. We investigated 3 patients with ALF and compared their ARFI results to those of healthy controls (n = 33) and cases with liver cirrhosis (n = 21). In the 3 ALF patients shear-wave velocities were 3.0, 2.5, and 2.7 m/s, respectively. These results were significantly increased compared to those of healthy controls (median: 1.13 m/s; p < 0.001) and similar to those of cirrhotic individuals (median: 2.93 m/s). Two individuals underwent liver transplantation. Explants showed massive necrosis, but no signs of chronic liver disease. Patient 3 recovered spontaneously and showed decreasing ARFI results during follow-up. In conclusion, hepatic necrosis can mimic liver cirrhosis at ARFI evaluation in ALF patients and this impairs the specificity of ARFI.