声辐射力脉冲成像定量评价非酒精性脂肪性肝病与病理对照研究

目的 本研究应用声脉冲辐射力成像技术(ARFI)对非酒精性脂肪性肝病(NAFLD)患者进行检测和分析,探讨该技术在无创定量评价NAFLD的临床应用价值.方法 对67例NAFLD患者应用ARFI技术对肝脏的实时超声弹性进行测量,所有患者均进行超声引导下肝脏穿刺活检,以病理结果为金标准,对肝脏的ARFI测值与肝脏脂肪变性、小叶内炎症及肝纤维化程度关系进行统计分析.结果 NAFLD患者不同脂肪变性和小叶内炎症程度间ARFI测值差异无统计学意义(P>0.05),肝纤维化分期为S0~S4期的ARFI测值分别为(1.18±0.28)m/s,(1.25±0.31)m/s,(1.44±0.52)m/s,(1.54±0.50)m/s和(1.86±0.73)m/s,组间比较差异具有统计学意义(P<0.05).肝脏ARFI测值与肝纤维化分期存在相关性,相关系数为0.42(P<0.001).ARFI技术诊断NAFLD肝纤维化S≥1,S≥2,S≥3和S=4的受试者工作特征曲线下面积分别为0.631、0.714、0.765和0.853.结论 声脉冲辐射力成像技术作为一种实时超声弹性成像技术,可较准确的无创定量评价NAFLD肝纤维化程度,具有良好的临床应用前景.

Value of acoustic radiation force impulse imaging on nonalcoholic fatty liver disease in comparison withpathological study

Objective To investigate the diagnostic value of the acoustic radiation force impulse （ARFI） technology for the nonalcoholic fatty liver disease （NAFLD）. Methods The study subjects were composed with 67 patients with NAFLD. The measurements of real-time ultrasonic elastography by ARFI technology using a ultrasonic instrument named ACUSON S2000. With liver biopsy as the gold standard, the relationship between liver real-time sonoelastography and major pathological parameters （hepatic fatty degeneration, lobular inflammation, and fibrosis）in NAFLD were analyzed. Results The results showed that the ARFI values were not significantly different （P 〉 0.05） among the different stage of hepatic steatosis and lobular inflammation. The liver stiffness at ARFI sonoealstography were （ 1.18 ± 0. 28 ） m/s for the patients with SO, （ 1.25 ± 0. 31 ） m/s for those with S1, （ 1.44 ± 0. 52） m/s for those with S2, （ 1.54 ±0. 50） m/s for those with S3, and （ 1.86 ± 0. 73 ） m/s for those with S4, respectively. This results showed that the ARFI values were significantly different （ P 〈 0. 05 ） among the different stage of liver fibrosis. Liver stiffness at ARFI sonoealstography was significantly correlated with liver fibrosis stage in NAFLD and spearman coefficient of correlation was 0. 42 （ P 〈 0. 001 ）. Using the ARFI technology for the assessment of liver fibrosis in NAFLD patients, the areas under the receiver operating characteristic curve for the patients with S ≥1, S ≥ 2, S ≥3, and S = 4 were 0.631,0. 714,0. 765, and 0. 853, respectively. Conclusions As real-time ltrasonic elastography, ARFI technology can directly reflect the elasticity modulus of liver, and the values were positive correlate with liver fibrosis grade of NAFLD. The operation is easy, non-invasive and quantitative evaluating the degree of liver fibrosis in NAFLD. ARFI technology has potential value for quantitative evaluation of the liver fibrosis for NAFLD.