组织结构声学定量技术与剪切波弹性成像评价肝纤维化的比较

Comparison of acoustic structure quantification and shear wave elastography in the assessment of diagnostic accuracy of liver fibrosis

目的 比较超声组织结构声学定量（acoustic structure quantification,ASQ）技术与实时剪切波弹性成像（shear wave elastography,SWE）评价肝纤维化的诊断效能.方法 收集我院2013年3月至2014年1月慢性肝病患者135例,所有病例同时行肝ASQ、SWE及肝穿刺活组织检查.比较ASQ定量参数中的Total Mode（总众数）、BR ratio（蓝红直方图曲线下面积比值）及SWE肝弹性模量值与肝纤维化病理分期的相关性.分别以之判断肝纤维化分期构建ROC曲线,比较两种方法定量诊断肝纤维化分期的效能.结果 ASQ定量参数中Total Mode、BR ratio及SWE弹性模量值与肝纤维化病理分期具有较好的相关性（r=0.46,P=0.000;r=0.49,P=0.000;r=0.68,P=0.000）.Total Mode,BR ratio及SWE肝弹性模量值在病理各纤维化分期的差异具有统计学意义（分别F=6.05,P=0.000;F=5.17,P=0.000;F=48.82,P=0.000）.SWE肝弹性模量值判断肝纤维化病理分期S≥1,S≥2,S≥3及S=4的ROC曲线下面积,均大于ASQ定量参数Total Mode和BR ratio判断肝纤维化各分期的曲线下面积（P均＜0.05） ;Total Mode和BR ratio诊断肝纤维化各分期的曲线下面积比较差异无统计学意义（P均＞0.05）.结论 SWE评价肝纤维化的诊断效能优于ASQ定量参数Total Mode和BR ratio,ASQ定量参数中Total Mode和BR ratio与肝纤维化病理分期具有较好相关性.

Objective To compare the value of acoustic structure quantification（ASQ） and shear wave elastography（SWE） in the evaluation of diagnostic accuracy of liver fibrosis.Methods One hundred and thirty-five patients with chronic hepatic diseases enrolled in our study were underwent ASQ,SWE and liver biopsy.Correlation between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis were analyzed by Spearman＇s rank test.ROC curves were set up by evaluating the degree of hepatic fibrosis through Total Mode,BR ratio,the elastic modulus.Results The significant positive correlation were observed between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis（r =0.46,P =0.000; r =0.49,P =0.000; r =0.68,P =0.000,respectively）.Total Mode,BR ratio,and the elastic modulus,of each pathological stages,had statistically significant differences （F =6.05,P =0.000 ; F =5.17,P =0.000; F =48.82,P =0.000,respectively）.The areas under the ROC curve （AUC） set up by evaluating the pathological stages of fibrosis （S≥ 1,S≥2,S≥3 and S =4） through the elastic modulus were larger than that of Total Mode and BR ratio（all P 〈0.05）.But the AUC for the diagnosis of fibrosis of Total Mode and BR ratio showed no statistically significant differences（all P 〉0.05）.Conclusions SWE was more accurate than ASQ parameters （Total Mode,BR ratio） in grading hepatic fibrosis.ASQ parameters （Total Mode,BR ratio） were observed well-correlated with the pathological staging of hepatic fibrosis.