声辐射脉冲成像及实时剪切波弹性成像对慢性乙型肝炎肝纤维化诊断的对比分析

Comparison of acoustic radiation force impulse and supersonic shear imaging in diagnosis of liver fibrosis in patients with chronic hepatitis B

目的分析比较声辐射脉冲成像（ARFI）及实时剪切波弹性成像（SWE）对慢性乙型肝炎肝纤维化程度的诊断价值。方法收集2015年1月至2016年12月慢性乙型肝炎患者80例，以肝脏穿刺活检的病理学检查结果为金标准，应用SWE技术检测肝脏的弹性模量（EI）值，应用ARFI检测肝脏剪切波速度（VTQ）。两种检测值之间的相关性采用Spearman相关分析法，利用受试者工作特征（ROC）曲线分析两种检查方法对慢性乙型肝炎患者肝纤维化程度的诊断价值，并对两种诊断方法进行比较。结果EI、VTQ值均随肝纤维化分期升高逐渐上升，差异有统计学意义（P〈0.01）。EI值与VTQ值之间的相关系数为0.651，P〈0.01，两者与肝活检组织病理学分期的相关系数分别为0.784和0.683（P〈0.01），SWE对纤维化分期≥ S2、≥ S3、=S4期的ROC曲线下面积分别为0.912、0.934、0.955，ARFI对纤维化分期≥ S2、≥ S3、=S4期的ROC曲线下面积分别为0.870、0.892、0.884，ARFI诊断不同纤维化分期的灵敏度与SWE接近，但是特异度低于SWE，SWE对纤维化分期≥ S2、≥ S3、=S4的诊断效能优于ARFI（Z=8.756，P〈0.01；Z=10.802，P〈0.01；Z=15.871，P〈0.01）。结论SWE和ARFI都能够评估慢性乙型肝炎患者肝纤维化程度，但是相比之下SWE对慢性乙型肝炎肝纤维化程度的诊断效能优于ARFI。

ObjectiveTo compare acoustic radiation force impulse （ARFI） and supersonic shear imaging （SWE） in diagnosis of liver fibrosis in patients with chronic hepatitis B.MethodsEighty patients with chronic hepatitis B having underwent ARFI and SWE examination were enrolled in this study. The elastic modulus E value（EI） was measured by SWE. The liver shear wave velocity （VTQ） was measured by ARFI. All patients underwent liver biopsy. The diagnostic values of SWE and ARFI for liver fibrosis were analyzed with Sperman correlation and the ROC curve.ResultsThe values of EI and VTQ were increased with the pathological stage determined by liver biopsy and there were significantly differences （P 〈 0.01）. The correlation coefficient of SWE and ARFI was 0.651, P 〈 0.01. The correlation coefficient of SWE, ARFI and pathological stage determined by liver biopsy were 0.784 and 0.683 and there were significant differences （P 〈 0.01）. The areas under ROC for diagnosing liver fibrosis ≥ S2, ≥ S3 and =S4 by using SWE were 0.912, 0.934 and 0.955 respectively and those by using ARFI were 0.870, 0.892 and 0.884. The sensitivity of ARFI in diagnosing liver fibrosis was similar with SWE, but SWE showed higher specificity （Z=8.756, P 〈 0.01; Z=10.802, P 〈 0.01; Z=15.871, P 〈 0.01）.ConclusionsBoth SWE and ARFI can be effectively used in the evaluation of liver fibrosis in patients with chronic hepatitis B. The SWE technology has more advantages.