基于实时二维剪切波弹性成像的正常肝脏弹性模量值探讨

Determination of normal hepatic stiffness by using real-time two-dimensional shear wave elastography

目的基于对实时二维剪切波弹性成像(two-dimensional shear wave elastography,2D-SWE)技术可重复性的研究,以病理学作为金标准,建立正常肝组织的2D-SWE弹性模量值范围。方法选取42例健康体检者,由高低年资两位医师分别对其行2D-SWE肝组织弹性硬度检测,通过分析组内及组间差异探讨2D-SWE技术的方法学效能。设定严格入组条件,选取手术病理证实为无纤维化的128例患者,探讨基于2D-SWE技术的正常肝脏弹性模量值范围。结果 2D-SWE具有良好的可重复性,高低年资医师组内相关系数分别为0.984及0.978,且不同操作者对同一组受检者的弹性模量测值差异无统计学意义(P=0.121)。基于2D-SWE的正常肝脏弹性模量值参考范围为4.33~7.40 k Pa。男性弹性模量测值稍高于女性(P=0.013),不同年龄组及轻度炎症差异均无统计学意义(P=0.775,P=0.138)。结论 2D-SWE技术检测肝组织弹性硬度稳定性佳,推荐正常肝脏弹性模量值范围为4.33~7.40 k Pa,是肝纤维化诊断体系的可靠基础。

Objective To establish the normal reference value of elastic modulus in healthy liver by twodimensional shear wave elastography（ 2D-SWE） technology,using pathology as the gold standard,based on the repeatability study. Methods Liver stiffness measurements were firstly performed in 42 healthy volunteers with 2D-SWE by a senior and a junior physician,respectively. The intra- and inter- difference of liver stiffness measured with 2 D-SWE were investigated to discuss the methodology efficacy. By setting strict criterion,1 2 8 histologically proven non-fibrosis subjects successfully underwent 2 D-SWE preoperatively were enrolled in the research to determine the normal reference values of hepatic elasticity. Results 2 D-SWE technique showed a good repeatability with the intra-class correlation coefficients of 0. 9 8 4 and 0. 9 7 8 for the senior and the junior physician,respectively. There was no significant difference in the measurement of hepatic stiffness between different oper ators（ P = 0. 121）. The hepatic stiffness of histologically proven normal livers measured with 2D-SWE ranged from4. 33 k Pa to 7. 40 k Pa. The liver stiffness measurement was slightly higher in males than that in females（ P =0. 013）,and there was no statistically difference between different age groups and mild inflammation groups（ P = 0. 775,P = 0. 138）. Conclusions 2D-SWE technology possesses high stability. Hepatic stiffness of4. 33- 7. 40 k Pa is recommended to be the normal reference values,and it is a highly reliable basis of the diagnosis system for liver fibrosis.