应用ARFI技术评估肝脏纤维化和肝占位患者术前肝储备功能

The assessment of hepatic fibrosis and pre-operative functional reserve in patients with space-occupying lesions using acoustic radiation force impulse imaging

目的:探讨声脉冲辐射力弹性成像(ARFI)技术评估肝脏纤维化和肝占位患者肝脏储备功能的临床应用价值。方法:选取肝占位患者112例(肝占位组),健康志愿者34例(对照组),采用ARFI技术测量患者肝实质硬度(LS)值;采用吲哚氰绿(ICG)排泄实验记录ICG 15分钟滞留率(ICG-15R)和ICG血浆清除速率(ICG-K);采用Metavir分期对肝纤维化进行病理分期。LS值与肝纤维化分期、ICG-15R、ICG-K的相关性采用Pearson相关分析;比较肝脏占位组与对照组、手术治疗与非手术治疗患者及肝纤维化各病理分期之间的LS值并进行统计学分析;以肝纤维化病理分期为标准,采用受试者工作特性(ROC)曲线计算LS值对肝占位患者肝纤维化分期的诊断效能。结果:LS值与肝脏病理分期呈显著正相关(r=0.823,P<0.001),并且LS值在评估不同分期纤维化时均有较高的特异度和敏感度;LS值与ICG-15R呈显著正相关(r=0.716,P<0.001),与ICG-K呈显著负相关(r=-0.717,P<0.001)。肝占位组LS值为(1.78±0.48)m/s,对照组LS值为(1.19±0.11)m/s,差异有统计学意义(P<0.001)。非手术患者LS值为(2.49±0.27)m/s,手术患者LS值为(1.49±0.37)m/s,差异有统计学意义(P<0.001)。纤维化各病理分期之间的LS值差异有统计学意义(H=83.226,P<0.001)。结论:ARFI技术通过测量LS值能对肝纤维化进行量化分析,同时可有效评估肝占位患者的肝脏储备功能,为临床提供一种简单、无创的肝纤维化程度和术前肝储备功能的评估手段。

Objective：The purpose of this study was to investigate the clinical application values of acoustic radiation force impulse imaging （ARFI） in the assessment of liver fibrosis and hepatic functional reserve in patients with space-occup- ying lesions in the liver. Methods：The liver stiffness （LS） in 34 healthy volunteers and 112 patients with space-occupying lesions in the liver was measured with ARFI. Indoeyanine green （ICG） clearance tests were also performed to achieve ICG clearance rate constant （ICG-K） and ICG retention rate at 15 minutes （ICG-15R）. Fibrosis progression was evaluated with Metavir score system. Correlation between LS and liver fibrosis stage,ICG-K, ICG-15R and Child-Pugh score were studied using Pearson correlation. Difference between LS values of patients and healthy volunteers, patients with and with no surgery,and different Child-Pugh classifications were compared using t-test. With fibrosis stage as the gold standard, receiver operating characteristic （ROC） curve were analyzed to investigate the value of ARFI in the evaluation of liver fibrosis progression for patients with hepatic lesions. Results：There was a strong correlation between LS and fibrosis stage （r= 0. 710, P〈0. 001）. The ROC curve analysis demonstrated high sensitivity and specificity for ARFI in the evaluation of the fibrosis stage. We also found a significant correlation between LS and ICG-15R,Child-Pugh score （r=0. 455, P〈0. 001;r= 0. 688, P〈0. 001）, and an inverse correlation between LS and ICG-K （r=- 0. 722,P〈0. 000）. The LS value significantly differed among patients with Child-Pugh class A,B,and C （P〈0.01）. The average LS value in patients with operation was significantly lower than that in patients without operation （P〈0.01）. Conclusion： ARFI can be used to quantitatively analyze liver fibrosis before biopsy and also effectively evaluate the liver functional reserve in patients with hepatic focal lesions by measuring LS value. This technique is a simple and noninvasive evaluation method for liver fibrosis and liver functional reserve before surgery.