Liver elasticity in NASH patients evaluated with real-time elastography (RTE)

Liver elasticity as assessed by real-time elastography (RTE) has been shown to be correlated to liver fibrosis in various chronic liver diseases. The aim of our study was to assess the RTE performance in the evaluation of liver fibrosis in nonalcoholic steatohepatitis (NASH), as well as the histopathologic variables determining the eventual discordance between the RTE-predicted and the biopsy-proven fibrosis. Fifty-two consecutive biopsy proven NASH patients and 20 controls were studied. Liver tissue elasticity measurements were performed using the Hitachi EUB-8500 sonographer and the EUP-L52 Linear (3–7 MHz) probe. RTE liver tissue mean elasticity (TME) values were calculated and correlated to the histologic fibrosis, activity and steatosis scores. A decrease in TME was observed with increasing fibrosis (r = −0.75). Similarly, TME varied together consistently with steatosis (r = −0.3). In contrast, TME did not show any correlation with the severity of inflammation. Multiple regression analysis showed that fibrosis was the only variable able to significantly (p < 0.0001) modify TME values. The diagnostic accuracy of TME measurement for F > 0 evaluated by AUC-ROC analysis was 0.86. The diagnostic accuracy of TME measurement for F ≥ 2 was 0.92. We suggest that RTE could be used as a complementary imaging method to evaluate liver fibrosis in NASH patients. Future studies of larger patient cohorts are necessary for the validation of the technique.     

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.     

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。     

实时组织弹性成像弹性特征量分析乙型肝炎后肝纤维化程度的初步探讨

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价值。方法 76例乙型肝炎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)、蓝色领域百分比(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 Spearman秩相关分析显示各弹性特征量与肝纤维化程度相关,其中MEAN、AREA、COMP及SKEW的相关系数较大,分别为-0.742、0.815、0.640及0.652。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。     

实时剪切波弹性成像技术定量评价正常宫颈组织

目的 应用实时剪切波弹性成像(SWE)技术对正常宫颈的弹性进行定量研究,探讨其可行性及影响因素.方法 利用SWE超声诊断仪对300名志愿者进行经阴道超声检查,获得不同时期正常宫颈前后壁肌层在不同扫查切面的弹性模量值.结果 增生期、分泌期及绝经期三组志愿者宫颈纵切前壁肌层的弹性平均值分别为(21.52±3.89)kPa、(21.10±4.34)kPa和(21.58士3.71)kPa;宫颈纵切后壁肌层的弹性平均值分别为(21.72±3.31)kPa、(21.32±4.14) kPa和(21.82±3.45)kPa;宫颈横切前壁肌层的弹性平均值分别为(21.44±3.39) kPa、(21.32士3.67)kPa和(21.91±3.37)kPa.各组及每组各切面之间的宫颈弹性平均值差异均无统计学意义(P均＞0.05).结论 不同年龄及月经周期或绝经期、宫颈前后壁肌层的不同扫查切面均不是正常宫颈弹性模量值的显著影响因素.     

实时组织弹性成像在评价肝肿瘤中的应用价值

目的 探讨实时组织弹性成像对肝肿瘤的诊断价值.方法 对67例85个肝实性病灶进行常规超声及实时组织弹性成像检查,采用5级评分标准(a～e级)将所得弹性图像进行评分,并与手术或超声引导下穿刺病理结果对照,分析肝良、恶性肿瘤的超声弹性成像特点.结果 肝良性病变以a～b级多见,而恶性病变以c～e级多见;弹性成像区分肝良、恶性肿瘤的敏感性、特异性及准确性分别为93.5%,87.0%及91.8%,而常规超声分别为74.2%,73.4%及74.1%;两名医师对深度≤10cm组的病灶弹性成像独立评分结果Kappa值明显高于深度＞10cm组.结论 实时组织弹性成像为肝肿瘤的诊断提供了方便、无创的新方法,有助于肝良、恶性肿瘤的鉴别.     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

实时组织弹性成像在评价肝肿瘤中的应用价值

Objective To explore the imaging features of liver tumors with real-time tissue elastography.Methods Eighty-five liver lesions in 67 cases were scanned with conventional ultrasonography and elastography using HI-Vision900 system and then assessed with grade scores.Results on ultrasound were compared with those on pathology.Results Majority of lesions with grade a-b on elastography were identified as benign on pathology, while most of masses with grade c-e on elastography were confirmed as malignant on pathology.The sensitivity, specificity and accuracy were 93.5%, 87.0% and 91.8% for elastography to detect malignant lesions,74.2% ,73.4% and 74.1% for conventional ultrasound.The Kappa value of two doctors on elastography in group Ⅰ (the depth of the lesion ≤10cm) was significantly higher than group Ⅱ (the depth of the lesion ＞10cm).Conclusions Real-time tissue elastography of liver tumors provides a new convenient,non-invasive diagnostic methods,contribute to identify the benign and malignant live tumors.     

Metachronous bilateral segmental testicular infarction: multi-parametric ultrasound imaging with grey-scale ultrasound,Doppler ultrasound,contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE)

Segmental testicular infarction is a rare cause of acute scrotal pain. The appearances on grey-scale sonography are often indistinguishable from that of a testicular tumour, resulting in unnecessary orchiectomy. We report a case of acute bilateral testicular infarction, of unknown etiology, which was conservatively managed to resolution following a confident diagnosis achieved with the aid of contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE) along with conventional grey-scale and Doppler sonography. The evolving appearances on each of the sonographic modalities are described. We discuss the importance of complementing conventional sonography with CEUS and RTE in order to make a confident diagnosis and avoid unnecessary surgical intervention.     

Normal values of combinational elastography in adult liver: the influence of age

Journal of Medical Ultrasonics - We aimed to clarify the normal values obtained by simultaneous use of shear wave imaging and strain imaging (combinational elastography) in liver and reveal how...     

实时组织弹性超声成像定量评价猪离体心室心肌弹性

目的 应用实时组织弹性超声成像(RTE)技术定量评价猪离体心室心肌弹性,探讨心肌弹性与心肌间质胶原纤维含量及其三维分布的关系。 方法 离体猪心10个,分别切取左、右心室前壁和室间隔基底部的心肌组织立方体块。应用RTE获取2%无胶原纤维琼脂与心肌组织块的弹性应变比值(SR)。在组织病理切片上测量Masson染色心肌组织块的胶原纤维面积(CA)及胶原纤维面积百分比(CA%)。比较3个部位心肌组织块的SR、CA、CA%,并分析心肌组织块SR与CA、CA%的相关性。 结果 3个部位心肌SR在心室长轴方向上的差异均有统计学意义(P均<0.01);室间隔基底部心肌SR在心室长轴和短轴方向上差异有统计学意义(P<0.01)。心室长轴方向各部位心肌CA比较和CA%比较差异均有统计学意义(P均<0.05);室间隔基底部心肌在心室长轴和短轴方向上的CA比较和CA%比较差异均有统计学意义(P均<0.05)。心室长轴方向上各部位心肌组织块的SR与CA、CA%呈正相关(P<0.05);心室短轴方向上左心室前壁和室间隔基底部的SR与CA、CA%呈正相关(P<0.05)。 结论 猪离体心肌左、右心室和室间隔基底部心肌组织块SR存在明显差异,心肌弹性与心肌间质胶原纤维含量及其分布特征有关。     

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相关参数诊断肝纤维化的价值

目的观察乙肝患者由实时组织弹性成像(RTE)获得的弹性相关参数水平的改变,并初步探讨弹性相关参数水平与肝纤维化程度的关系。方法 58例乙肝患者依据病理分成5组(S0,n=7、S1,n=11、S2,n=9、S3,n=14、S4,n=17),另20名健康志愿者为对照。通过RTE获得每一受试者相关弹性参数水平,作统计学分析。结果相关弹性参数中解析区域蓝色面积百分比(%AREA)、应变值的平均值(MEAN)与肝纤维化程度密切相关(r=0.857和-0.825,P﹤0.001),肝纤维化组%AREA、MEAN水平与无纤维化组比较差异有统计学意义(P﹤0.001),%AREA在S1组开始随着肝纤维化程度的增加而逐渐升高,在S3和S4组显著升高(P﹤0.001),MEAN在S1组开始随着肝纤维化程度的增加而逐渐降低,在S3和S4组显著降低(P﹤0.01)。结论弹性相关参数%AREA、MEAN可作为早期诊断肝纤维化和判断肝纤维化严重程度的指标。     

实时组织弹性成像技术在肝脏肿瘤穿刺活检与介入治疗中的应用

实时组织弹性成像作为一门新的诊断技术,具有很好的发展前景,本文就该技术在肝脏肿瘤的穿刺活检和介入治疗中的应用做一综述。     

实时组织弹性成像在兔肝创伤中的应用价值

目的 探讨实时组织弹性成像在兔肝创伤中的应用价值.方法 16只健康新西兰兔分别选择不同肝叶制作钝性肝创伤模型30处.应用实时组织弹性成像技术测量正常肝组织和创伤灶创伤后5 min、30 min及60 min的弹性值,分析其变化趋势,并与病理结果作对照分析.结果 成功建立肝创伤灶30处.创伤后5 min、30 min及6...     

实时剪切波弹性成像对正常儿童肝脏硬度的研究

目的 探讨实时剪切波弹性成像（SWE）技术在检测健康儿童肝组织硬度中的应用价值。方法 对243名正常健康儿童行SWE检查,测量肝脏硬度值（LSM）,比较不同性别及肝段间LSM差异。根据年龄将243名儿童分为学龄前期组、学龄期组、青春期组,比较3组间LSM差异。对不同操作者测量值行一致性分析。结果 正常儿童LSM均值为（4.21±0.70）kPa,95%可信区间为（4.11,4.31）kPa;肝S5段的取样成功率高于S4段[（100%（243/243） vs 79.83%（194/243）],S5段LSM平均值[（4.07±0.71）kPa]低于肝S4段[（4.49±0.95）kPa],差异有统计学意义（P<0.01）;LSM随年龄增长有增高趋势,男童LSM较女童稍高,差异均无统计学意义（P均>0.05）。不同操作者测值一致性非常好,组内相关系数为0.92。结论 SWE可客观、定量评估儿童肝脏硬度。     

三维超声检测儿童肾脏体积正常参考值及其临床意义

目的研究三维超声测量儿童肾脏体积的正常参考值及其临床意义。方法采用三维超声容积成像及虚拟器官计算机辅助定量分析方法,检测325例1个月～14岁健康儿童的肾脏体积,分析肾脏体积变化与年龄、身高、体质量、体表面积及肾脏长径增长的相关性。结果肾脏体积随年龄、体表面积的增长呈逐渐增加的趋势,与年龄、身高、体质量、体表面积及肾脏长径均呈强相关（r〉0．6）。肾脏的体积指数相对恒定,仅在1-6个月组与1-2岁组之间比较差异有统计学意义（P=-0．047）。结论正常儿童肾脏体积的生长变化具有一定的规律性,肾脏体积指数相对恒定,其正常参考值可用于协助临床评价肾脏功能和诊断儿童肾脏疾病。     

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。     

实时组织弹性成像弥散定量分析技术诊断甲状腺弥漫性病变

目的 探讨实时组织弹性成像弥散定量分析技术在甲状腺弥漫性病变中的应用价值。方法 纳入甲状腺弥漫性病变患者165例,包括甲状腺功能亢进56例(甲亢组)、桥本甲状腺炎81例(桥本组)和亚急性甲状腺炎28例(亚甲炎组),另收集健康志愿者81名作为正常对照组,对所有研究对象行超声弹性成像,采用实时组织弹性成像技术获得弹性声像图,计算应变均值与蓝色区域所占百分比(蓝色区域%)。结果 正常对照组甲状腺弹性声像图均为Ⅰ级(81/81,100%),甲亢组Ⅱ级多见(39/56,69.64%),桥本组病Ⅲ级多见(54/81,66.67%),亚甲炎组Ⅳ级多见(21/28,75.00%)。正常对照组、甲亢组、桥本组、亚甲炎组应变均值依次下降,分别为121.06±14.58、101.31±17.16、89.73±17.57和56.00±23.29,蓝色区域%依次升高,分别为(19.14±11.23)%、(32.42±11.70)%、(39.03±12.66)%和(67.00±18.18)%,两两比较差异均有统计学意义(P均<0.01)。结论 不同甲状腺弥漫性病变硬度不同,实时组织弹性成像弥散定量分析技术能定量其硬度,有助于鉴别诊断。