声脉冲辐射力成像技术与超声积分法诊断乙肝病毒相关慢性肝病价值的对比研究

Comparison analysis between acoustic radiation force impulse and ultrasound-based scores in the diagnosis of HBV infection induced chronic liver disease

目的对比分析声脉冲辐射力(ARFI)成像技术与超声积分法对乙肝病毒相关慢性肝病早期诊断的价值。方法应用ARFI成像技术获得病例组(慢性肝损害组、肝硬化代偿组及肝硬化失代偿组)和对照组目标肝组织的声触诊组织量化(VTQ)值,应用超声积分法对肝脏超声图像进行评分,通过ROC曲线下面积(AUROC)对比分析两种方法对乙肝病毒相关慢性肝病早期诊断的效能。结果所有受检者均成功获得肝脏VTQ值。单因素方差分析示各组间VTQ值比较差异有统计学意义(P﹤0.05);SNK-q检验示任意两组间VTQ值比较差异均有统计学意义(P﹤0.05)。ROC曲线示慢性肝损害组、肝硬化代偿组、肝硬化失代偿组的VTQ阈值及其对应的诊断敏感性、特异性分别为1.203 m/s、94.0%、90.0%,1.578 m/s、94.6%、93.0%及2.370 m/s、92.6%、90.7%。慢性肝损害组VTQ值和超声积分的AUROC分别为0.962和0.873(Z=2.398,P﹤0.05),肝硬化代偿组VTQ值和超声积分的AUROC分别为0.987和0.952(Z=1.812),肝硬化失代偿组VTQ值和超声积分的AUROC分别为0.958和0.946(Z=0.457)。结论 ARFI成像技术是乙肝病毒相关慢性肝病早期诊断的可靠方法,其价值优于超声积分法;两种方法对乙肝病毒相关慢性肝病中晚期的诊断价值相当。

Objective To comparatively analysis the value of acoustic radiation force impulse （ARFI） and ultrasound- based scores in the diagnosis of HBV infection induced chronic liver disease. Methods ARFI and B-mode liver ultrasound were performed in all patients and healthy volunteers. The virtual touch tissues quantification （VTQ） values and ultrasound-based scores were calculated. Comparison analysis between VTQ values and ultrasound-based scores in HBV infection induced chronic liver disease was performed using the areas under receiver operating characteristics curves （AUROC）.Results The VTQ values were obtained in all the subjects and the differences were significant among all the groups as determined by one- way analysis of variance （P 〈 0.05 ）. The difference in VTQ values was significant between any two groups as determined by SNK-q method. As shown by ROC curve, the VTQ cut-off value and the according sensitivity and specificity of chronic liver damage group were 1.203 m/s, 94.0%, 90.0%, and 1.578 m/s, 94.6%, 93.0% and 2.370 m/s, 92.6%, 90.7% in compensated and deeompensated cirrhosis group,respectively. The AUROC of VTQ value and ultrasound-based scores in chronic liver damage group were 0.962 and 0.873 （Z=2.398, P 〈 0.05 ） . In compensated and decompensated cirrhosis group, they were 0.987,0.952 （Z=l.812 ） and 0.958,0.946 （Z=0.457）, respectively. Conclusion ARFI showed better diagnostic performance than ultrasound-based scores for the early diagnosis of HBV infection induced chronic liver disease.However,the two methods show the similar diagnostic performance in the intermediate and advanced stages.