脉冲多普勒超声测定肝硬化患者肝静脉频谱与Fibroscan测值关系研究

目的探讨脉冲多普勒超声和瞬时弹性成像(Fibroscan)观察肝硬化患者肝静脉(HV)血流频谱改变的意义。方法选择乙型肝炎肝硬化患者(130例)和同期健康体检者(80例),使用脉冲多普勒超声测定肝硬化患者肝静脉血流频谱,并将频谱波形分为0型、1型、2型,同时进行Fibroscan检测。结果肝硬化代偿期与失代偿期患者HV1(%)、HV2(%)、HV1+HV2(%)(26.74、18.60、45.35、43.18、38.64、81.82)明显高于正常对照组(8.75、0、8.75,P0.001),Fibroscan测值(11.80±4.30,17.60±5.73)明显高于正常对照组(4.90±1.36,P0.001),而HV0(%)(54.65,18.18)明显低于正常对照组(91.25,P0.001)。结论运用Fibroscan测值以及脉冲多普勒超声测定肝硬化患者肝静脉频谱波形变化,对判断肝硬化程度,选择治疗方案及预后判断具有重要意义,有望成为当前无痛、无创条件下评估肝硬化程度的另一新途径。     

肝静脉彩色多普勒血流频谱在肝纤维化分期中的临床价值

目的 探讨肝左静脉、肝中静脉、肝右静脉彩色多普勒血流频谱在诊断肝纤维化分期中的应用价值。方法 应用彩色多普勒超声检测344例慢性肝炎患者的肝左静脉、肝中静脉及肝右静脉频谱波形，全部病例均行肝组织穿刺活检病理诊断，将获得肝静脉频谱波形与肝纤维化分期进行对照分析。结果 344例患者肝静脉频谱波形分为：双向波型(O型)、单向波型(Ⅰ型)、连续平坦型(Ⅱ型);按肝纤维化程度分为轻度(S0～S1)、中度(S2～S3)和重度(S4)三组。肝左静脉、肝中静脉、肝右静脉O、Ⅰ、Ⅱ波型与轻、中、重度三组间构成比差异有统计学意义(χ²=30.090、29.447、15.572,P<0.001)。肝左静脉O型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.268、0.194,P<0.001)。肝中静脉O型波、Ⅰ型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.268、0.108、0.154,P<0.001、<0.05、<0.05)。肝右静脉O型波、Ⅱ型波与肝纤维化分期比较差异有统计学意义(r=-0.198、0.147,P<0.001、...     

肝纤维化及早期肝硬化的超声研究进展

随着超声医学检测技术的不断提高,他已成为肝纤维化及早期肝硬化的重要诊断和评价手段.二维超声用于显示肝脏形态及回声,是超声诊断的基础手段.彩色多普勒和频谱多普勒可以显示门静脉系统血流情况,不仅可以作为评价肝实质病变程度的指标,也是判断门脉高压及相关并发症的有效指标.超声造影提供了良好的血池示踪剂,能够反映肝脏的血流灌注,从而能够评估肝脏疾病的严重程度.近年来出现的弹性成像通过测量肝组织弹性模量的差异评估肝脏病变程度.Fibroscan在分期诊断慢性丙型肝炎肝纤维化、监测肝硬化门静脉高压发展中表现出了优异的诊断价值,为无创性诊断肝硬化提供了新的发展方向.以上技术综合应用于临床,大大提高了肝脏疾病的诊断成功率.本文就超声医学在肝纤维化及早期肝硬化诊断中的作用,从以上几个方面作一综述.     

FibroTouch与肝脏血流动力学变化对慢性乙型肝炎肝纤维化分期价值分析

目的 探讨Fibro Touch与肝脏血流动力学软件(PMD)对慢性乙型肝炎患者肝纤维化程度的诊断价值。方法 将82例慢性乙型肝炎患者及32例正常人作为研究对象,应用FibroTouch检测肝脏硬度值(LSM);同时使用彩色多普勒超声检测门静脉、肝左静脉、肝中静脉、肝右静脉血流频谱波形,应用M型超声测量心率,所得血流频谱图像及心率上传至PMD系统内,计算出肝脏血流流动频率值(LBFF)。将FibroTouch检测LSM及PMD所测LBFF与肝穿刺活组织病理诊断对照。结果 82例慢性乙型肝炎患者肝纤维化分期1期33例,2期22例,3期10例,4期17例。114例研究对象的LSM 3.7～55.1 kPa,与肝纤维化分期呈显著正相关(r=0.811,P<0.01);肝脏LBFF 0～26 Hz,与肝纤维化分期呈显著正相关(r=0.831,P<0.01)。Fibro Touch检测结果显示,≥S1、≥S2、≥S3、=S4 LSM截断值分别为6.05、7.95、11.2、10.35 kPa, AUC分别为0.959、0.883、0.916、0.90;敏感度分别为89%、 93.9%...     

慢性肝病肝纤维化程度的非侵入性诊断

探讨慢性肝病患者肝纤维化的非侵入性诊断、灵敏度等。对80例慢性肝病患者进行彩色多普勒超声 检查,检测肝动脉收缩期最大流速／门静脉流速比值(A／P)、肝动脉阻力指数(RI),并同时测定血透明质酸(HA)、凝 血酶原指数。肝硬化患者A／P、RI、HA水平显著高于慢性肝病和正常对照组,P<0．05;凝血酶原指数显著低于慢 性肝病和正常对照组,P<0．05。A／P、RI、HA、凝血酶原指数对慢性肝病肝纤维化程度的非侵入性诊断有一定的指 导意义。     

彩色多普勒超声检查对慢性肝炎肝纤维化的判断

目的 探讨彩色多普勒超声检查对慢性乙型肝炎肝维化诊断及程度判断的应用价值。方法 通过对193例不同程度慢性乙型肝炎患者的彩色多普勒超声检测，选取与肝纤维化相关的血流动力学指标，即门静脉内径(Dpv)、门静脉血流速度(Vpv)、脾静脉内径(Dsv)、脾静脉血流速度(Vsv)及肝静脉频普变化，利用SPSS10．0统计软件进行统计学处理。结果 Dpv、Vpv、Dsv、vsv、肝静脉频普变化与肝纤维化发展的阶段性一致，均与慢性乙型肝炎时的肝损伤程度呈正相关。Vpv、肝静脉频普变化在慢性乙型肝炎的各阶段差异均有显著性；Dpv、Dsv在慢性乙型肝炎的中、重度阶段及肝硬化阶段差异才有显著性；Vsv只有慢性乙型肝炎单个阶段差异有显著性，而且重叠较大。结论 慢性乙型肝炎时Dpv、Vpv、Dsv、Vsv及肝静脉频普变化与肝纤维化发展的阶段性一致，可作为反映肝纤维化程度的指标。     

肝固有动脉、门静脉最大血流速度比(A/P)对肝纤维化的诊断作用

肝组织穿刺活检是肝纤维化诊断的金标准 ,但操作复杂 ,患者痛苦大 ,且可能发生严重并发症。很多学者应用彩色多普勒超声研究肝炎、肝硬化的血流动力学变化 ,以期无创性检测肝维化 ,并取得了进展 ,如门静脉流速[1] 、肝静脉频谱改变[2 ] 均与肝纤维化程度有一定关系。我们根据肝硬化患者肝动脉流速升高、门静脉流速降低的血流动力学变化 ,设想两者比值可能与肝纤维化分期有一定关系。资料与方法一、临床资料本组共 98例 ,男 80例 ,女 18例 ,年龄 2 1～ 48岁 ,平均( 3 0 .1± 5 .68)岁 ,经血清学检测证实 88例为慢性乙型病毒性肝炎 ,10例为慢…     

肝脏血流动力学变化对肝纤维化分期诊断价值

目的 探讨肝脏血流动力学软件在肝纤维化分期中的应用价值。方法 选取2017年1月—2021年10月于石家庄市第五医院就诊行彩色多普勒检查肝脏检查并行肝组织穿刺活检的慢性乙型肝炎患者148例。应用彩色多普勒超声检测门静脉、肝左静脉、肝中静脉及肝右静脉频谱波形,M型超声测量心率。将频谱图像及心率上传至杭州精康科技有限责任公司生产的肝脏血流动力检测软件系统内,计算出肝纤维化值,与肝组织穿刺活检病理诊断对照。结果 148例患者肝组织活检病理诊断0期32例,1期39例,2期24例,3期12例,4期41例。根据肝血流动力学软件诊断值,将148例患者分为4组,其ROC曲线下面积分别为AUC=0.91(95%可信区间0.867～0.959)、0.962(95%可信区间0.938～0.987)、0.975(95%可信区间0.956～0.994)、0.966(95%可信区间0.940～0.993)。根据约登指数最大原则,肝血流动力学软件诊断≥S1、S2、S3、S4期的截断值分别为1.27、3.78、3.98、5.85。肝脏血流动力学软件在评估有无严重纤维化、肝硬化时评估准确性较高,各期AUC均大于0.9,...     

肝右静脉多普勒波形及门静脉右支血流速度诊断脂肪肝的临床价值

探讨彩色多普勒血流显像(CDFI)门静脉右支血流速度及肝右静脉多普勒波形诊断脂肪肝的临床价值。通过CDFI对2 80例脂肪肝的门静脉右支血流速度测定,观察其肝右静脉多普勒波形,并与4 5例正常肝组进行对比分析。结果发现,脂肪肝组的门静脉右支血流速度比正常明显降低,两组间比较有显著性差异(P <0 .0 5 )。脂肪肝患者的肝右静脉多普勒波形出现三种不同类型,其异常波形共占76 % ;而4 5例健康者肝右静脉多普勒形均为三相波形。脂肪肝组与正常组比较,肝右静脉多普勒频谱异常有显著性差异(P <0 .0 5 )。肝门静脉血流速度变化及肝右静脉多普勒频谱图异常有助于脂肪肝的早期诊断及预后判断。     

肝纤维化的超声诊断

一、慢性肝病肝纤维化超声诊断指标 有直接诊断指标、间接诊断指标. 1.直接诊断指标:通过超声直接观察肝脏的实质回声形态、肝包膜、肝边缘角、肝静脉壁的改变,直接判断肝纤维化的程度[1].     

Contrast-enhanced ultrasound to evaluate the severity of chronic hepatitis C

BACKGROUND: Non-invasive techniques are being developed to assess the severity of liver disease. Haemodynamic changes in the hepatic circulation during the development of liver disease can be evaluated with contrast-enhanced ultrasound. AIM: To evaluate the possible correlation between ultrasound contrast-agent transit times and different stages of chronic hepatitis C. PATIENTS: Sixteen patients with clinically evident hepatitis C virus-related cirrhosis, 22 non-cirrhotic patients with chronic hepatitis C and 14 controls with no clinical evidence of liver disease were studied. METHODS: Contrast-enhanced hepatic ultrasonography was performed with a sulphur hexafluoride-filled microbubble contrast agent, and time curves of hepatic vein signal intensity were analysed to determine the time of enhancement onset (hepatic vein arrival time) and peak enhancement (hepatic vein peak enhancement). RESULTS: Hepatic vein arrival time in cirrhotic patients was significantly shorter (p<0.001) than in non-cirrhotic patients and controls. Within the group with chronic hepatitis C, METAVIR scores of fibrosis and necro-inflammatory changes had no significant effect on hepatic vein arrival times. CONCLUSION: Analysis of the time of onset of ultrasound contrast enhancement of the hepatic vein appears to be a simple, non-invasive method for reliably excluding cirrhosis with signs of portal hypertension, but not for assessing the severity of either chronic hepatitis C or cirrhosis.     

肝静脉波形分型联合肝脏超声半定量评分对慢性乙型肝炎患者肝纤维化程度评估价值研究

目的 旨在探讨应用肝静脉波形分型联合超声肝脏半定量评分对慢性乙型肝炎(CHB)患者肝纤维化分期的评估价值.方法 2018年2月～2020年12月我院收治的126例CHB患者,均行肝活检和超声检查,行超声半定量评分和肝静脉波形分型,应用MedCal 15.2软件绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价...     

超声造影对慢性乙型肝炎患者肝组织纤维化分级的诊断价值

目的探讨应用超声造影评价肝纤维化的价值。方法选择慢性乙型肝炎患者80例及健康对照人群10例,经肘静脉团注超声造影剂SonoVue,记录造影剂到达肝动脉时间(HAAT)、到达门静脉时间(PVAT)及到达肝静脉时间(HVAT),计算造影剂到达肝动脉与到达肝静脉间隔时间(HAVTT)。结果 S3和S4期肝纤维化组HVAT和HAVTT均较对照组、S1期组缩短(P<0.05);以肝纤维化达到S4期为阳性判断标准,HVAT和HAVTT的ROC曲线下面积分别为0.87和0.89(P<0.01);以HVAT≤21s为诊断S4期肝纤维化的截断点,其敏感性为88%,特异性为95%;以HAVTT≤10s为诊断S4期的截断点,其敏感性和特异性分别为90%和97%;联合两项指标评估S4期的敏感性和特异性分别为98%和100%。结论超声造影对S3和S4期肝纤维化具有一定的定量诊断价值,但对诊断≤S2期的肝纤维化在准确性方面仍存在不足。     

Comparison of portal vein doppler indices and hepatic vein doppler waveform in patients with nonalcoholic fatty liver disease with healthy control

Background

The purpose of the present study is to investigate the association of nonalcoholic fatty liver disease (NAFLD) with the doppler waveform pattern of hepatic veins and portal vein doppler indices.

Objectives

This assay may be useful in evaluating the natural course of NAFLD and monitor treatment efficacy on follow-up.

Patients and Methods

This case control study was performed in 31 patients with NAFLD and 31 normal healthy adults who served as the control group. The patients presented with elevated liver enzymes levels (ALT/AST) and hyperechogenic livers in the B-mode ultrasonography examination. Eleven patients had a liver biopsy. After an 8-hour fast,B-mode and duplex doppler ultrasonography were performed, and the waveform patterns of the right hepatic vein, portal vein diameter, grade of fatty liver, portal vein pulsatility index (VPI), and mean flow velocity (MFV) were measured.

Results

VPI and MFV values were 0.42 ± 0.92 and 17.27 ± 5.34 cm/second, respectively, in the control group and 0.25 ± 0.50 and 12.82 ± 4.32 cm/second in patients with NAFLD (P< 0.01). The frequency of abnormal hepatic vein doppler waveform patterns (biphasic or monophasic) was significantly higher in patients with NAFLD (55.2%) versus control subjects (3.2%) (P < 0.001). There was no correlation between the degree of fat infiltration and VPI (P = 0.714), MFV (P = 0.911), or hepatic vein waveform pattern (P = 0.197). We found no correlation between liver enzyme levels and MFV or VPI. However, the rate of abnormal hepatic vein was higher in patients with enzyme levels that exceeded twice the normal value (P = 0.05).

Conclusions

Patients with NAFLD have a high rate of abnormal hepatic vein doppler waveform patterns, and decreased VPI and MFV are suggestive of reduced vascular compliance in the liver. Elevated liver enzymes levels do not influence VPI or MFV, but patients with abnormal enzymes have higher rates of abnormal hepatic vein doppler waveform patterns.     

彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断价值

目的 研究彩色多普勒超声半定量评分诊断早期乙型肝炎肝硬化的临床价值。方法 选择2014年8月~2015年12月在我院诊治的肝硬化患者136例和慢性乙型肝炎患者364例,使用GE Logiq E8彩色多普勒超声诊断仪检测肝脏超声并进行半定量评分,常规进行肝活检。结果 肝硬化组门静脉流量、流速和内径分别为（86.3±7.5） ml/min、（3.8±0.1） cm/s、（11.5±1.4） mm,均明显高于慢性乙型肝炎组[分别为（62.3±6.4） ml/min、（3.1±0.1） cm/s、（8.7±1.6） mm,P<0.05];慢性乙型肝炎组肝静脉清晰度、肝表面被膜、胆囊壁、肝脏边缘形态、肝脏实质回声、肝内韧带、脾脏面积评分和总分分别为（1.1±0.3）分、（1.2±0.3）分、（1.1±0.2）分、（1.0±0.4）分、（1.1±0.5）分、（1.0±0.2）分、（1.4±0.4）分、（8.12±0.39）分,均明显低于肝硬化组[分别为（2.6±0.3）分、（4.1±1.2）分、（1.9±0.3）分、（1.9±1.0）分、（2.7±0.4）分、（1.4±0.5）分、（4.1±1.6）分、（15.1±1.1）分,P<0.05];彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断灵敏度为96.3%,特异度为92.31%,阳性预测值为82.4%,阴性预测值为98.5%。结论 彩色多普勒超声半定量评分对早期乙型肝炎肝硬化的诊断具有较高的灵敏度和特异度,可作为临床筛检早期乙型肝炎肝硬化的有效方法。     

Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease in the United States.While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation,no imaging modality is recommended as standard of care for screening or diagnosis.Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings.Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes,increased hepatorenal echogenicity,vascular blurring of portal or hepatic vein and subcutaneous tissue thickness.These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD.While sonographic findings such as attenuation of image,diffuse echogenicity,uniform heterogeneous liver,thick subcutaneous depth,and enlarged liver filling of the entire field could be identifiedby clinicians from bedside ultrasound.The accessibility,ease of use,and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis.When used with appropriate clinical risk factors and steatosis involves greater than 33%of the liver,ultrasound can reliably diagnose NAFLD.Despite the ability of ultrasound in detecting moderate hepatic steatosis,it cannot replace liver biopsy in staging the degree of fibrosis.The purpose of this review is to examine the diagnostic accuracy,utility,and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.     

New Doppler ultrasound signs improve the non-invasive diagnosis of cirrhosis or severe liver fibrosis

OBJECTIVES: To determine whether ultrasound and, particularly, new Doppler signs increased the diagnostic accuracy of the most accurate, currently available markers for the diagnosis of cirrhosis or severe fibrosis. METHODS: Thirty-two clinical (n = 4), biochemical (n = 11) and Doppler ultrasound (n = 17) variables were recorded in 106 patients with compensated chronic liver disease. Diagnostic accuracy was evaluated by discriminant analysis; first, globally, using all variables then by stepwise analysis. RESULTS: (A) Diagnosis of cirrhosis. Using Doppler ultrasound, diagnostic accuracy was 92% (95% confidence interval 81-98) globally, and 89% (76-95) with three variables (spleen length, hepatic vein spectrum and maximum portal vein velocity). Based upon clinical signs, diagnostic accuracy was 86% (77-92) globally, and 85% (76-91) with one variable (firm liver). Based upon biochemical parameters, diagnostic accuracy was 80% (70-88) globally, and 81% (72-88) with two variables (hyaluronate and platelet count). Based upon all parameters, diagnostic accuracy was 91% (79-96.5) globally, and 91% (79-96.5) with four variables (firm liver, hyaluronate, platelet and hepatic vein spectrum). On an intention to diagnose basis, Doppler ultrasound provided a lower independent contribution due to missing data. (B) In the diagnosis of severe fibrosis, diagnostic accuracy was 83% (69-92) globally, and 77% (62-87) with one variable. CONCLUSIONS: Cirrhosis can be correctly diagnosed in approximately 90% of patients with compensated chronic liver disease using a few Doppler ultrasound signs including a new sign, the hepatic vein spectrum. Doppler ultrasound could be used for the first line diagnosis and biochemical markers, such as hyaluronate, in patients with missing Doppler ultrasound data.     

超声造影在评估肝纤维化程度分级中的临床价值

目的:探讨超声造影在评估肝纤维化程度分级中的临床价值.方法:选择70例慢性乙肝患者及健康对照组20例,肝纤维化病理诊断标准采用Scheuer方案,按肝纤维化程度不同分4组:轻度肝纤维化组(n=15)、中度肝纤维化组(n=29)、肝硬化组(n=26)、对照组(n=20).在反相脉冲谐波模式下,经肘静脉团注法注射超声造影剂SonoVue2.4mL,并采集90s的超声造影动态影像供脱机分析,记录造影剂到达肝动脉时间、到达门静脉时间、到达肝静脉时间及肝实质增强峰值时间,计算肝动脉-肝静脉渡越时间(HA-HVTT)、门静脉一肝静脉渡越时间(PV-HVTT)及肝实质-肝静脉渡越时间(PA-HVTT),比较各参数与肝纤维化程度的相关性.结果:轻度肝纤维化组,造影剂到达肝静脉显影时间与对照组相近或稍有延长,差异无统计学意义(P>0.05),时间分别为28.63s±3.14s、26.27s±1.74s;中度及肝硬化组造影剂到达肝静脉时间为23.11s±1.34s及20.56s±3.37s,较轻度肝纤维化组、对照组缩短,差异有统计学意义(P<0.05);中度肝纤维化组、肝硬化组的肝实质增强峰值时间较对照组延长,差异有统计学意义(...     

Why, who and how should perform liver biopsy in chronic liver diseases

Chronic viral hepatitis is a common disease in the general population.During chronic hepatitis,the prognosis and clinical management are highly dependent on the extent of liver fibrosis.The fibrosis evaluation can be performed by FibroTest（using serological markers）,by Elastography or FibroScan（a noninvasive percutaneous technique using the elastic properties of the hepatic tissue） and by liver biopsy（LB）,considered to be the ＂gold standard＂.Currently,there are three techniques for performing LB：percutaneous,transjugular and laparoscopic.The percutaneous LB can be performed blind,ultrasound（US） guided or US assisted.There are two main categories of specialists who perform LB：gastroenterologists（hepatologists） and radiologists,and the specialty of the individual who performs the LB determines if the LB is performed under ultrasound guidance or not.There are two types of biopsy needles used for LB：cutting needles（Tru-Cut,Vim-Silverman） and suction needles（Menghini,Klatzkin,Jamshidi）.The rate of major complications after percutaneous LB ranges from 0.09% to 2.3%,but the echoguided percutaneous liver biopsy is a safe method for the diagnosis of chronic diffuse hepatitis（cost-effective as compared to blind biopsy） and the rate of complications seems to be related to the experience of the physician and the type of the needle used（Menghini type needle seems to be safer）.Maybe,in a few years we will use non-invasive markers of fibrosis,but at this time,most authorities in the field consider that the LB is useful and necessary for the evaluation of chronic hepatopathies,despite the fact that it is not a perfect test.