组织弥散定量分析技术评价脑死亡所致供肝损伤的研究

Evaluation of liver damage caused by brain death with tissue dispersion quantitative analysis technique

目的探讨实时组织弹性成像(RTE)技术的组织弥散定量分析方法在脑死亡所致肝损伤评估中的应用价值。方法连续性收集脑死亡供肝50例,行超声弹性成像检查,应用组织弥散定量分析软件对感兴趣区进行分析,获得11个参数,包括应变均值(MEAN)、标准偏差(SD)、蓝色区域百分比(%AREA)、复杂度(COMP)、峰度(KURT)、偏度(SKEW)、对比度(CONT)、均等度(ENT)、杂乱度(IDM)、一致性(ASM)和相关性(CORR)。术中取肝组织行电镜检测,根据电镜结果分为无损伤组和损伤组,比较两组间组织弥散定量分析参数的差异,并分析超声定量参数与肝组织电镜超微结构检测结果的相关性。利用ROC曲线分析超声弹性成像评价脑死亡所致肝损伤的各参数曲线下面积及临界值。结果①无损伤组MEAN、IDM大于损伤组(均P<0.05),SKEW、ENT小于损伤组(均P<0.05),其余参数差异无统计学意义(均P>0.05);②MEAN、SKEW、COMP、ENT、IDM与电镜检测结果具有相关性(r=-0.633,P=0.000;r=0.388,P=0.005;r=0.315,P=0.026;r=0.324,P=0.022;r=-0.314,P=0.026);③根据ROC曲线分析显示MEAN值评价脑死亡所致肝损伤的诊断效能最高,曲线下面积为0.907,临界值为125.84。结论RTE的组织弥散定量分析技术可以初步评价脑死亡所致的供肝损伤,其中MEAN值的诊断效能最高。

Objective To investigate the application value of the tissue diffusion quantitative analysis technique of real-time elastic(RTE) imaging in evaluation of liver damage caused by brain death. Methods Fifty cases of brain dead donor liver were examined by ultrasound elastography,at the same time,11 parameters were obtained by the tissue dispersion quantitative analysis software,included MEAN (mean relative strain value within the ROI),SD(standard deviation of the relative strain value within the ROI),%AREA (area of low strain within the ROI),COMP(complexity of low strain area within the ROI),KURT(kurtosis),SKEW(skewness),CONT (contrast),ENT(entropy),IDM(inverse difference moment),ASM (angular second moment),CORR(correlation),and the pathologic specimens in the process of operating were obtained.According to pathological findings,50 patients were divided into damaged group and non-damaged group,and the results were compared and analyzed.The correlation analysis of electronic speculum results and RTE were carried out.According to the ROC curve,the RTE parameters′cut-off value and AUC were obtained. Results Among 11 parameters of tissue diffusion analysis,MEAN and IDM in damaged group were higher than those in non-damaged group(all P<0.05);and SKEW and ENT were lower in damaged group than those in non-damaged group (all P<0.05);there was no significant difference in the other parameters between the two groups(all P>0.05).The MEAN,SKEW,COMP,ENT and IDM had correlativity with electronic speculum(r=-0.633,P=0.000;r=0.388,P=0.005;r=0.315,P=0.026;r=0.324,P=0.022;r=-0.314,P=0.026,respectively).The diagnostic efficiency and sensitivity of MEAN were the highest,the critical value of MEAN was 125.84,AUC was 0.907. Conclusions The tissue dispersion quantitative analysis technique is a noninvasive method to preliminary evaluation of liver damage caused by brain death.MEAN had the highest effectiveness in eleven parameters.