实时剪切波弹性成像技术与常规超声检查诊断肝硬化效能的比较

Comparison of real-time shear wave elastography and ultrasonography in diagnosis of liver cirrhosis

目的比较实时剪切波弹性成像(SWE)技术和常规超声检查诊断代偿期肝硬化和失代偿期肝硬化的效能。方法对2012年1月至2013年4月中山大学附属第三医院134例慢性肝病患者行常规超声检查对肝包膜、肝实质和脾脏大小进行半定量评分,同时采用实时SWE技术检测肝脏弹性模量。以病理结果及临床诊断作为肝硬化诊断金标准,应用受试者操作特性(ROC)曲线分别评价实时SWE技术和常规超声积分诊断代偿期肝硬化、失代偿期肝硬化敏感度、特异度,并应用Z检验比较实时SWE技术和常规超声积分诊断代偿期肝硬化、失代偿期肝硬化的ROC曲线下面积。结果 96例患者经皮肝穿刺活组织病理学检查结果显示,S0期10例、S1期31例、S2期8例、S3期13例、S4期34例;经临床诊断为失代偿期肝硬化38例。ROC曲线显示,实时SWE技术、常规超声积分诊断代偿期肝硬化的曲线下面积分别为0.957、0.745,实时SWE技术诊断效能优于常规超声检查,且差异有统计学意义(Z=3.789,P<0.001),敏感度和特异度分别为97.06%和93.55%、52.94%和87.10%;实时SWE技术、常规超声积分诊断失代偿期肝硬化的曲线下面积分别为0.973、0.954,差异无统计学意义(Z=0.276,P=0.511),敏感度和特异度分别为100%和93.55%、94.74%和87.10%。结论实时SWE技术诊断早期代偿期肝硬化效能明显优于常规超声检查,但两者对失代偿期肝硬化诊断效能相当。

Objective To compare real-time shear wave elastography （SWE） with conventional ultrasonography in diagnosis of compensated and decompensated liver cirrhosis in patients with chronic liver disease. Methods From January 2012 to April 2013, 134 patients with chronic liver disease in Third Hospital of Sun Yat-Sen University were included. Real-time SWE and conventional ultrasonography were performed on the same day of liver biopsy. Conventional ultrasonography scores including liver surface, parenchyma and splenic size were used to assess liver cirrhosis. The pathological findings were used as the reference standard. And the diagnostic accuracy was assessed with receiver operating characteristic （ROC） curve. The area under ROC curves were compared with Z test. Results For liver fibrosis degree, patients were 10 at stage SO, 31 at S1,8 at S2, 13 at S3, 34 at S4 and 38 for decompensated liver cirrhosis. The area under ROC curves of SWE and conventional ultrasonography for compensated liver cirrhosis were 0.957 and 0.745 respectively, which indicated that real-time SWE was better than conventional ultrasonography scores （Z=3.789, P 〈 0.001）. The sensitivity and specificity of SWE and conventional ultrasonography were 97.06% and 93.55%, 52.94% and 87.10% respectively. While the area under ROC curves for decompensated liver cirrhosis of SWE and conventional ultrasonography were 0.973 and 0.954 respectively, which indicated no difference between real-time SWE and conventional ultrasonography＇ scores （Z=0.276, P=0.511）. The sensitivity and specificity of SWE and conventional ultrasonography were 100% and 93.55%, 94.74% and 87.10% respectively. Conelusions SWE has higher accuracy in assessment of compensated liver cirrhosis than conventional ultrasonography. But there was no significant difference between SWE and conventional ultrasonography in evaluation of decompensated liver cirrhosis.