实时二维剪切波弹性成像评估健康人及慢性肝病患者肝脏硬度的重复性研究

The reproducibility study on liver stiffness measurements by two-dimensional real time shear wave elastography

目的探讨实时二维剪切波弹性成像技术（2D-SWE）评估健康人和慢性肝病患者肝脏硬度的重复性和一致性。方法 2位不同经验的操作者使用Super Sonic Imagine Aixplorer型实时二维剪切波弹性成像超声诊断仪,分别对30例健康志愿者（健康对照组）、30例慢性乙型肝炎患者（慢性乙型肝炎组）、30例肝硬化患者（肝硬化组）进行肝脏硬度的杨氏模量值检测。用组内和组间相关系数（ICC）评价测值的重复性。结果操作者1（经验丰富者）检测健康对照组、慢性乙型肝炎组和肝硬化组受检者肝脏的杨氏模量值分别为（4.61±0.73）、（9.09±3.37）、（16.08±13.27）kPa;操作者2（经验较少者）检测3组的肝脏杨氏模量值分别为（4.50±0.56）、（8.79±3.47）、（16.52±16.79）kPa。2位操作者所测肝脏杨氏模量值在健康对照组、慢性乙型肝炎组和肝硬化组中比较,差异均无统计学意义（t=1.49、0.23、0.15,P均〉0.05）。2D-SWE检测各组的组间及组内重复性均非常好,健康对照组、慢性乙型肝炎组和肝硬化组的组间ICC分别为0.84、0.88和0.90。2位操作者的组内重复性为0.87-0.94,经验丰富者3次测量的组内ICC稍高于经验较少者,但差异均无统计学意义（Z=0.94、0.97、0.55,P均〉0.05）。结论 2D-SWE技术检测健康人和慢性肝病患者的肝脏效能稳定、重复性好、不受操作者经验影响,值得临床推广应用。

Objective To investigate the reproducibility of two-dimensional real-time shear wave elastography（2D-SWE） in assessing liver stiffness in chronic liver disease（CHB） patients and healthy volunteers.Methods Thirty healthy volunteers,thirty chronic hepatitis patients,and thirty cirrhosis patients were studied by two operators using the 2D-SWE.The reproducibility of the elastograms was assessed,and intraclass correlation coefficient（ICC） were calculated,respectively.Results The mean liver stiffness values of the healthy volunteers,the CHB patients and the patients with liver cirrhosis determined by experienced operator（operator 1） and a novice（operator 2） were（4.61±0.73） k Pa and（4.50±0.56） kPa,（9.09±3.37） k Pa and（8.79±3.47） k Pa,（16.08±13.27） kPa and（16.52±16.79） kPa,respectively.The differences of liver stiffness values detected by two operators in the same group were not significantly different（t=1.49,0.23,0.15,all P〉0.05）.Interobserver ICC values were 0.84,0.88 and 0.90,respectively.Intraobserver ICC values were ranged from 0.87 to 0.94,but there was no difference between the ICCs of two operactors（Z=0.94,0.97,0.55,all P〉0.05）.Conclusions 2D-SWE is a feasible and reliable method for assessing liver stiffness.The reproducibility of liver stiffness measurements is excellent in chronic liver disease patients and cirrhosis patients as well as in normal subjects.