实时剪切波弹性成像检测肝脏弹性模量与肝纤维化分期的相关性研究

摘要

目的 探讨应用实时剪切波弹性成像(SWE)检测肝脏弹性模量对肝纤维化分期进行评估的可行性.方法 将SWE应用于176例行肝穿刺活检的慢性肝病患者肝脏弹性模量的检测,测量右肝直径为3 cm大小的肝实质弹性模量,将弹性模量与肝穿刺活检病理结果的纤维化分期进行对照分析.结果 慢性肝病肝纤维化分期S0期、S1期、S2期、S3期、S4期的弹性模量值分别为5.441±0.827、6.756±1.764、10.105±4.885、15.727±8.449、26.436±10.519.各病理分期的弹性模量差异具有统计学意义(F=61.816,P=0.000).肝弹性模量与肝纤维化病理分期具有相关性(r=0.723,P=0.000).以肝弹性模量判断肝纤维化分期绘制受试者操作特性曲线(ROC曲线),曲线下面积分别为0.912、0.923、0.941、0.941,区分S0与S1、S2、S3、S4的阈值为6.278,对应敏感度、特异度为83.4%和88.0%,区分S0、S1与S2、S3、S4的阈值为7.321,对应敏感度、特异度为89.4%和84.7%,区分S0、S1、S2与S3、S4的阈值为9.363,对应敏感度、特异度为96.4%和82.6%,区分S0、S1、S2、S3与S4的阈值为13.214,对应敏感度、特异度为93.1%和86.4%.结论 SWE检测肝脏弹性模量对评估纤维化分期具有较好的诊断价值.%Objective To explore the feasibility of noninvasive evaluation of hepatic fibrosis using shear wave elastrography ( SWE). Methods SWE was applied to 176 patients with chronic liver diseases for the measurement of hepatic elastic modulus. All patients had liver biopsy. The measurement was taken on a 3 cm parenchyma of right liver lobe. The elastic modulus was compared with pathological stages of hepatic fibrosis. Results The elastic modulus of each pathological stage of hepatic fibrosis was S0 ( 5. 441 ± 0.827), S1(6.756 ±1.764), S2(10. 105 ±4. 885) , S3(15. 727 ±8.449) and S4(26. 436 ± 10.519) , respectively. The elastic modulus of each pathological stages had statistically significant difference (F = 61. 816, P =0.000). The elastic modulus were correlated with pathological stages with a correlation coefficient of 0. 723 (P = 0. 000). The ROC curve was set up by evaluating the pathological stages through elastic modulus. The areas under the ROC curve were 0. 912, 0. 923, 0. 941, 0. 941. The optimal cut-off for detection between S0 and S1, S2, S3, S4 was 6. 278, with sensitivity of 83.4% and specificity of 88.0%. The optimal cut-off for detection between S0, S1 and S2, S3, S4 was 7.321, with sensitivity of 89.4% and specificity of 84.7%. The optimal cut-off for detection between S0, S1, S2, and S3, S4 was 9. 363, with a sensitivity of 96.4% and specificity of 82. 6%. The optimal cut-off for detection between S0, S1, S2, S3 and S4 was 13. 214, with sensitivity of 93.1 % and specificity of 86.4%. Conclusion The elastic modulus measured by SWE is valuable in the evaluation of hepatic fibrosis .