剪切波弹性成像与瞬时弹性成像技术诊断肝硬化食管胃底静脉曲张程度的对比研究

Shear wave elastography and transient elastography in predicting the degree of esophageal and gastric varices in liver cirrhosis:a comparative study

目的探讨实时剪切波弹性成像(SWE)与瞬时弹性成像(TE)技术诊断肝硬化食管胃底静脉曲张(EGV)程度的价值。方法156例肝硬化患者根据静脉曲张程度分为无曲张组(47例)、轻度曲张组(27例)、中度曲张组(40例)、重度曲张组(42例),比较各组脾脏SWE指标(脾Emean)与TE指标(脾硬度)。绘制受试者工作特征(ROC)曲线分析脾Emean和脾硬度诊断肝硬化EGV程度的价值,计算曲线下面积(AUC)。结果各组脾Emean和脾硬度比较差异均有统计学意义(均P<0.05),且两两比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,Emean、脾硬度诊断轻度静脉曲张的AUC分别为0.764、0.648,差异无统计学意义;当Emean截断值为26.60 kPa时,其诊断肝硬化EGV程度的敏感性51.9%,特异性100%;当脾硬度截断值为41.94 kPa时,其诊断肝硬化EGV程度的敏感性40.7%,特异性91.5%。Emean、脾硬度诊断中度静脉曲张的AUC分别为0.985、0.872,差异有统计学意义(Z=3.304,P=0.001);当Emean截断值为37.25 kPa时,其诊断肝硬化EGV程度的敏感性90.0%,特异性98.6%;当脾硬度截断值为43.73 kPa时,其诊断肝硬化EGV程度的敏感性62.5%,特异性97.3%。Emean、脾硬度诊断重度静脉曲张的AUC分别为0.994、0.926,差异有统计学意义(Z=3.041,P=0.002);当Emean截断值为53.60 kPa时,其诊断肝硬化EGV程度的敏感性100%,特异性93.9%;当脾硬度截断值为48.12 kPa时,其诊断肝硬化EGV程度的敏感性95.2%,特异性83.3%。结论SWE和TE均对肝硬化EGV程度有一定诊断价值,但SWE诊断中、重度EGV的价值较TE更高。

Objective To explore the value of real-time shear wave elastography(SWE)and transient elastography(TE)in predicting the degree of esophageal and gastric varices(EGV)in liver cirrhosis.Methods Totally 156 patients with liver cirrhosis were selected,according to the degree of varicose veins,they were divided into varicose-free group(47 cases),mild varicose group(27 cases),moderate varicose group(40 cases),severe varicose group(42 cases).The spleen SWE index(spleen Emean)and TE index(spleen stiffness)of each group were compared,ROC curve was drawn to analyze the value of spleen Emean and spleen stiffness in predicting the degree of esophageal and gastric varices in liver cirrhosis.Results There were statistically significant differences in spleen Emean and spleen stiffness in each group(all P<0.05),differences of spleen Emean and spleen stiffness in each group were statistically significant(all P<0.05).ROC curve analysis showed that the area under the curve(AUC)of Emean and spleen stiffness in predicting mild varicose veins were 0.764 and 0.648,respectively,there was no significant difference.When the cut-off value of Emean was 26.60 kPa,the sensitivity and specificity of predicting the degree of EGV in liver cirrhosis were 51.9%and 100%,respectively.When the cut-off value of spleen stiffness was 41.94 kPa,the sensitivity and specificity were 40.7%and 91.5%,respectively.The AUC of Emean and spleen stiffness in predicting moderate varicose veins were 0.985 and 0.872,respectively,and the difference was statistically significant(Z=3.304,P=0.001).When the cut-off value of Emean was 37.25 kPa,the sensitivity and specificity of predicting the degree of EGV in liver cirrhosis were 90.0%and 98.6%.When the cut-off value of spleen stiffness was 43.73 kPa,the sensitivity and specificity were 62.5%and 97.3%,respectirely.The AUC of Emean and spleen stiffness in predicting severe varicose veins were 0.994 and 0.926,respectively,and the difference was statistically significant(Z=3.041,P=0.002).When the cut-off value of Emean was 53.60 kPa,the sensitivity and specificity of predicting the degree of EGV in liver cirrhosis were 100%and 93.9%.When the cut-off value of spleen stiffness was 48.12 kPa,the sensitivity and specificity were 95.2%and 83.3%,respectively.Conclusion Both SWE and TE have a certain predictive value for the degree of EGV in liver cirrhosis,but the value of SWE for predicting moderate and severe EGV is slightly higher than TE.