CT、磁共振定量诊断肝纤维化的研究进展

肝纤维化是肝脏对各种病因所致的肝损伤的修复愈合反应,也是各种慢性肝病向肝硬化发展的中间阶段。肝纤维化发展过程是潜隐渐进而可逆的。肝纤维化能否得到及时和正确的诊断,对临床治疗效果及患者预后有着重要的意义。随着影像技术的发展完善,肝纤维化的无创性影像定量诊断备受临床关注。总结了目前用于肝纤维化诊断的各种CT、磁共振（MR）扫描技术,就各种技术的优缺点进行了比较。结果表明CT、MR可对肝纤维化进行定量评估,尤其MR无辐射、高分辨率、可重复性好在将来完全有可能取代有创的病理检查。     

超声技术在肝纤维化诊断中的应用进展

肝纤维化是临床上各类慢性肝病进行性发展的重要病理过程之一,可进一步发展为肝硬化甚至肝癌.肝纤维化的早期诊断对预防各类肝病发展为肝硬化及肝癌具有重要意义.肝穿刺活检是诊断肝纤维化的"金标准",但其具有创伤性,易引起多种并发症,目前无法作为常规筛查手段.近年来,超声检查技术作为一种无创性肝纤维化诊断方法在临床上得到越来越多...     

FibroScan技术在肝纤维化中的临床应用

肝纤维化是各种慢性肝病共同的病理表现。肝纤维化在早期乃至晚期都可以发生逆转。故预测及早期诊断肝脏纤维化对整个疾病的进程和治疗特别重要。肝活检仍是诊断肝纤维化的金标准,因有创性限制了其在临床上的广泛应用。目前,Fi-broScan作为一种无创性诊断方法成为研究热点,广泛应用于肝纤维化的诊断,此文就FibroScan临床应用进展作一综述。     

Fibroscan对肝纤维化诊断价值的研究进展

近年来,国内外学者关注于肝纤维化的无创性诊断.其中,多种血清纤维化指标检验及影像学检查是目前临床较为常用的无创性评估肝纤维化的方法,但敏感性和特异性不高.Fibroscan是一种对肝纤维化进行定量诊断的新技术,以瞬时弹性成像为原理,通过对肝脏硬度指标的测量进行肝纤维化程度评估.本文就其工作原理、临界值确定、诊断价值及应用现状进行综述.     

肝纤维化无创性诊断技术的临床应用

肝纤维化是各种病因引起的慢性肝病的共同转归。目前,肝活组织检查是肝纤维化诊断的"金标准",但其有一定的创伤性及局限性,因此无创评估肝纤维化技术得到了推行和发展。主要从临床表现、血清学及影像学等方面介绍了无创性诊断肝纤维化技术及其应用,指出了这些无创性诊断技术的临床价值,并针对目前无创诊断肝纤维化在临床研究的进展及其局限性进行了探讨。     

丙型肝炎肝纤维化诊治进展

丙型肝炎肝纤维化是丙型肝炎进展至肝硬化的关键病理过程,其诊断方法除常规肝脏活体组织检查及肝纤维化标志物检测外,无创性诊断方法包括影像学检查新技术及无创性诊断模型的研究取得重要进展,使丙型肝炎肝纤维化的诊断准确率及对治疗反应的预测效果显著提高.在抗病毒治疗基础上的中西医结合治疗可能成为未来防治丙型肝炎肝纤维化的发展方向.     

血清学指标综合模型预测慢性乙型肝炎进展性肝纤维化

慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化的严重程度是决定CHB及其他肝病疾病发展、预后和治疗策略的重要因素,评估肝纤维化的严重程度对临床治疗具有重要意义.目前,肝活组织病理学检查仍然是诊断肝纤维化及肝硬化的金标准,但由于肝穿刺活检是创伤性操作,且存在采样误差及标本穿刺偏移、病理科医师间的评估结果差异以及患者依从性差等原因,一直不能成为临床常规检查.因此,寻求无创性诊断肝纤维化及肝硬化的方法以替代肝穿刺活检已成为当今研究热点.     

超声技术无创评估肝纤维化的临床应用进展

肝纤维化可发展为肝硬化,其中部分可进展为肝癌、肝衰竭。因此肝纤维化程度的评估对临床治疗、预后评价非常重要,而超声弹性成像是一种新的无创性评估肝纤维化程度的方法,为肝纤维化的早期诊断提供了新思路。本文就其在肝纤维化诊断中的应用进行综述。     

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。     

早期肝纤维化MRI分子影像学研究进展

肝纤维化早期诊断,对其治疗及改善预后具有重要意义.目前肝纤维化诊断和分期的"金标准"仍是肝穿刺活检,但因其具有取样误差大、有创等局限性,学术界致力于寻找更准确的无创性诊断方法.目前,还没有一种无创技术能够完全做到对肝纤维化进行早期诊断及准确分期.随着磁共振成像技术的迅速发展,其在肝纤维化严重程度及其发病机制探索等方面展现出良好的应用前景.磁共振分子影像学进行肝纤维化靶向显像,可有助于早期检测肝纤维化,并进行肝纤维化分期.本文主要对肝纤维化早期诊断及分期的分子影像学研究进展作简要综述.     

肝纤维化血清学诊断研究进展

肝纤维化是由各种慢性肝病引起细胞外基质在肝脏过度沉积所致,可进展为肝硬化并导致肝功能衰竭和门静脉高压等。肝纤维化具有可逆性已成为共识。因此,准确诊断和评估肝纤维化程度对肝纤维化的防治及其预后评估具有非常重要的意义。肝纤维化诊断的金标准是肝脏活检,但由于其具有创伤性、费用昂贵而难以被患者接受。血清学检查是诊断肝纤维化较为理想的检测方法,可对肝纤维化进行早期诊断,并可进行动态观察。由多个血清学指标组成的非创伤性诊断模型,提高了肝纤维化的诊断准确性。本文就肝纤维化的血清学诊断研究进展进行综述。     

肝纤维化血清学诊断的研究

肝纤维化是多种慢性肝病的共同病理过程,可导致肝硬化及相关并发症的发生,而肝纤维化具有可逆性。因此,肝纤维化诊断对慢性肝病的防治及预后评估具有重要意义。肝活检一直是诊断肝纤维化的金标准,但有其局限性,近来研究发现血清学指标与肝纤维化之间有良好的相关性,且简便易行,有望替代肝活检,本文就血清学检查在肝纤维化诊断中的研究作一概述。     

2009 APASL肝纤维化共识解读

肝纤维化在慢性肝病的进展中起重要作用。正确诊断、分期并有效治疗肝纤维化对肝病严重程度的评估和预后十分关键。为规范和统一认识,亚太肝脏研究学会(APASL)根据现阶段肝纤维化研究的证据,于2009年发布了肝纤维化共识意见,本文对此共识作一介绍。     

Noninvasive assessment of liver fibrosis in patients with chronic hepatitis B

Infection with hepatitis B virus is an important healthproblem worldwide:it affects more than 350 millionpeople and is a leading cause of liver-related morbidity,accounting for 1 million deaths annually.Hepatic fibrosis is a consequence of the accumulation of extracellular matrix components in the liver.An accurate diagnosis of liver fibrosis is essential for the management of chronic liver disease.Liver biopsy has been considered the gold standard for diagnosing disease,grading necroinflammatory activity,and staging fibrosis.However,liver biopsy is unsuitable for repeated evaluations because it is invasive and can cause major complications,including death.Several noninvasive evaluations have been introduced for the assessment of liver fibrosis:serum biomarkers,combined indices or scores,and imaging techniques including transient elastography,acoustic radiation force impulse,real-time tissue elastography,and magnetic resonance elastography.Here,we review the recent progress of noninvasive assessment of liver fibrosis in patients with chronic hepatitis B.Most noninvasive evaluations for liver fibrosis have been validated first in patients with chronic hepatitis C,and later in those with chronic hepatitis B.The establishment of a noninvasive assessment of liver fibrosis is urgently needed to aid in the management of this leading cause of chronic liver disease.     

Liver fibrosis in paediatric liver diseases

Numerous paediatric liver diseases from different origins may be complicated by development of liver fibrosis and progression to cirrhosis. Although fibrogenesis, which represents a major driving force for the development of liver fibrosis, has common tracts whatever the aetiology, liver fibrosis has different histopathological patterns in paediatric liver disease. In these diseases management choices may depend upon the stage of liver fibrosis. Thus, the accurate estimation of histological pattern of liver fibrosis is important for the prevention of the subsequent complications. Liver biopsy has long been considered as a gold standard diagnostic method for assessing liver fibrosis. However, due to its several disadvantages, in the last decades alternative and accurate non-invasive means to estimate fibrosis are developed. In this review, we characterised the most frequent histological patterns of liver fibrosis in paediatric liver diseases. Furthermore, we describe use of liver biopsy in diagnosis and staging of liver fibrosis, list the alternative non-invasive techniques that have an emerging role in the assessment of liver fibrosis, and propose a management algorithm.     

Real time elastography for noninvasive diagnosis of liver fibrosis

Background/purpose

The accurate preoperative evaluation of liver fibrosis stage is important in determining surgical procedures. Although percutaneous liver biopsy is the gold standard, it may cause undesirable complications, such as bleeding. This study aimed to evaluate the usefulness of real-time tissue elastography for the preoperative assessment of liver fibrosis stage.

Methods

We focused on a new mode of sonogram, real-time elastography, which can show tissue elasticity on images, and express the elasticity numerically. The elastic ratio of the liver for the intercostal muscle for each patient was calculated preoperatively, using the sonography device. The liver fibrosis stages were finally determined in the operative specimens from 41 patients. We examined the correlation between the elastic ratio and the histological fibrosis stage.

Results

The lower the elastic ratio, the more advanced was the liver fibrosis stage. There was a significant correlation between the elastic ratio and the histological fibrosis stage. The area under the receiver-operating characteristics curve for the diagnosis of significant liver fibrosis using this device was superior to those conventionally determined by blood parameters.

Conclusions

Real-time elastography is a promising sonography-based noninvasive method for the preoperative assessment of liver fibrosis.     

Assessment of fibrosis in chronic liver diseases

The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decisions. Although liver biopsy is the current gold standard for fibrosis assessment, it has some risks and limitations, including intra‐observer and inter‐observer variation, sampling error and variability. In recent years, many studies and great interest have been dedicated to the development of non‐invasive tests to substitute a liver biopsy for fibrosis assessment and follow up. Advances in serological and radiological tests such as serum marker panels, transient elastography and their combinations can assess fibrosis accurately and reduce the need for a liver biopsy. But at present, all have failed to completely replace a liver biopsy because of their respective limitations and an imperfect gold standard used in current researches. The searching for an ideal surrogate is still in progress.     

Transient elastography (FibroScan) for the non-invasive assessment of liver fibrosis: current status and perspectives

A precise staging of the degree of liver fibrosis is important for the estimation of prognosis, surveillance and treatment decision in patients with chronic liver diseases. At present, liver biopsy is still the reference standard for the assessment of liver fibrosis. However, it is an invasive method associated with patient discomfort and in rare cases with serious complications. In addition, the accuracy of liver biopsy is limited due to intra- and interobserver variability and sampling errors. Non-invasive markers and methods for the assessment of liver fibrosis have been intensively evaluated in many studies. The FibroScan (Echosens, France) uses the transient elastography principle for the measurement of liver stiffness. At present (January 2007), studies evaluating the FibroScan in a wide range of liver diseases have been published in 20 full papers and 76 abstracts. The present review gives an overview of the current literature. The best results are reported for the differentiation between cirrhosis and no cirrhosis. With the combination of FibroScan and non-invasive serum fibrosis markers, the accuracy for the diagnosis of significant fibrosis (Metavir F > or = 2) can be further improved. According to recent data the FibroScan can also be useful for the evaluation of treatment response in patients receiving antiviral treatment for chronic hepatitis C. In addition, several studies have shown, that the FibroScan can be applied to estimate the risk of complications associated with liver cirrhosis.