超声声衰减成像用于肝脏检查的方法学分析

目的：对超声声衰减成像（attenuation imaging, ATI）检查肝脏的方法学进行研究。方法：纳入200例受检者行肝脏常规超声检查及ATI检查，分析ATI技术检测肝左、右叶的成功率、重复测量次数、操作者内及操作者间的可重复性。 结果：健康体检者肝左、右叶的检测成功率分别为64%、100%，肝右叶的操作者内ICC为0.948；脂肪肝患者肝左、右叶的检测成功率分别为80%、100%，肝右叶的操作者内ICC为0.996；对健康体检者肝右叶重复测量5次的ICC为0.904，与10次测量结果比较差异无统计学意义（P＞0.05），重复测量7次的ICC为0.957，与10次测量结果比较差异无统计学意义（P＞0.05）。脂肪肝患者重复测量2次的ICC为0.975，与10次结果比较差异无统计学意义（P＞0.05），重复测量5次的ICC为0.994，与10次结果差异无统计学意义（P＞0.05）。操作者1和操作者2的测量结果在健康体检者和脂肪肝患者的差异均无统计学意义（P＞0.05）。结论：肝右叶为ATI检测肝脏的最佳检测部位，对健康体检者宜选择5次为最少测量次数，7次为最优测量次数，对脂肪肝患者宜选择2次为最少测量次数，5次为最优测量次数，ATI技术的操作者内及操作者间的可重复性较好，适用于临床推广。

Methodology analysis of attenuation imaging of ultrasound in liver examination

Objective To evaluate the methodology of attenuation imaging (ATI) in liver examination. Methods A total of 200 subjects were included and underwent the conventional ultrasound examination and ATI examination. The success rates of measuring position, the number of measurements, the inter- and intra-observer consistency were analyzed. Intraclass correlation coefficient (ICC) was used to analyze the intra-observer reproducibility and the consistency between the results of different measurements and the mean values of 10 measurements. Results The success rates of the left and right lobes of the liver in healthy subjects were 64% and 100%, respectively, ICC of the intra-observer reproducibility in the right lobe of the liver was 0.948; the success rates of the left and right lobes of the liver in fatty liver subjects were 80% and 100%, respectively, ICC of the intra-observer reproducibility in the right lobe of the liver was 0.996. For the right lobe of the liver in healthy subjects, the ICC of 5 and 7 repeated measurements was 0.904 and 0.957, respectively, both showed no statistically significant differences as compared with 10 repeated measurements. For the right lobe of the liver in fatty liver subjects, the ICC of 2 and 5 repeated measurements was 0.975 and 0.994, respectively, both showed no statistically significant differences as compared with 10 repeated measurements. There was no statistically significant difference in measurement results between the 2 observers. Conclusion The success rate of ATI for liver measurement is high and has good repeatability, and the best measuring position is the right lobe of the liver. For the detection of ATI in healthy subjects, 5 times should be the minimum number of measurements and 7 times should be the optimal number of measurements; and for the detection of ATI in patients with fatty liver, 2 times should be the minimum number of measurements and 5 times should be the optimal number of measurements.