联合弹性成像的超声衰减系数对脂肪肝定量评估的价值探索

The value of ultrasonic attenuation coefficient combined with elastography to quantitatively evaluate the steatosis degree of donor liver

目的探讨联合弹性成像的超声衰减系数(attenuation coefficient,ATT)在定量评估供肝脂肪变性中的应用价值。方法收集27例天津市第一中心医院自愿捐献器官移植供体,术前对所有供体肝脏行联合弹性成像超声检查,测量参数包括肝脏弹性成像参数,分别为杨氏模量值(E)、剪切波速度(Vs)、肝纤维化指数(index of fibrosis,F指数)、炎症指数(index of activity,A指数)及ATT。于术中取肝组织进行病理学检查,观察肝组织有无脂肪变。根据病理结果将供体分为脂肪肝组及无脂肪肝组,对两组间弹性成像参数及ATT进行对比分析。结果①本研究共27例器官移植供体,病理诊断脂肪肝7例,无脂肪肝20例。其中差异性比较:脂肪肝组ATT(0.54±0.06)明显高于无脂肪肝组(0.45±0.07)(P<0.05),其余弹性成像参数(E、Vs、F、A)组间均无明显差异(P>0.05);②相关性分析:ATT与供肝有无脂肪肝呈显著正相关(r=0.54,P<0.05),其余弹性成像参数与病理诊断有无脂肪肝均无明显相关性(P>0.05);③ATT诊断效能分析:经ROC曲线分析,ATT诊断供肝脂肪变的曲线下面积、敏感性、特异性分别为0.868、85.7%、85.0%。结论联合弹性成像的ATT能够定量评估供肝有无脂肪变性,具有一定的临床价值。

Objective To explore the application value of the ultrasonic attenuation coefficient(ATT)combined with elastography to quantitatively evaluate the steatosis degree of donor liver.Methods We collected 27 cases of brain death donors.Ultrasound examination was performed for all donor livers before operation.Measurement parameters include young's modulus(E),shear wave velocity(Vs),index of fibrosis(F index),index of activity(A index)and ultrasonic ATT for donor liver.During the operation,liver tissue was taken for pathological examination to observe whether the liver tissue had steatosis change.According to the pathological results,the donors were divided into the fatty liver group and the non-fatty liver group,the difference of ultrasound parameters between the two groups was compare.Results In this study,there were 27 brain-death donors,7 were pathologically diagnosed with fatty liver and 20 without.ATT in the fatty liver group(0.54±0.06)was significantly higher than that in the non-fatty liver group(0.45±0.07)(P<0.05),and there was no significant difference in other parameters(V,A,Vs,F)between the two groups(P>0.05).Moreover,ATT was significantly positively correlated with whether the donor liver is fatty liver or not(r=0.54,P<0.05),while other parameters have no significantly correlation with the pathological diagnosis of fatty liver(P>0.05).ROC curve was performed to analyze the diagnostic efficiency of ATT,the area under the curve,sensitivity and specificity of ATT in diagnosing steatotic change of donor liver were 0.868,85.7%and 85.0%,respectively.Conclusion ATT can quantitatively evaluate whether the donor liver has steatosis or not,it has certain clinical value.