肝癌患者剪切波弹性成像参数与病灶病理组织学的关系及肝脏硬度的重复性分析

Study on the relationship between shear wave elatography imaging parameters and lesion histopathology and repeatability analysis of liver hardness in patients with liver cancer

目的 探讨肝癌患者剪切波弹性成像(SWE)参数与病灶病理组织学的关系及肝脏硬度的重复性分析。方法 收集2019年11月至2023年1月116例肝脏肿瘤患者的临床病理资料。116例患者中,55例肝血管瘤,61例肝癌。使用SWE超声诊断仪获取并记录患者的肝硬度值(LSM)。采用Spearman等级相关分析LSM与肝癌的肝纤维化分期、肝脏炎症活动度、肝功能Child-Pugh分级的相关性。采用受试者工作特征(ROC)曲线评估SWE技术对肝血管瘤和肝癌的区分度及对肝癌不同临床病理特征的诊断效能。采用组内相关系数(ICC)分析不同操作者及同一操作者测量的一致性。结果 肝血管瘤的LSM为(19.49±7.54)kPa,肝癌的LSM为(39.17±14.35)kPa,差异有统计学意义(P<0.001)。不同肝功能Child-Pugh分级、肝功能炎症分级、肝功能硬化分级患者的LSM比较,差异有统计学意义(P<0.05)。LSM诊断肝癌和肝血管瘤的临界值为23.54 kPa,灵敏度为79.85%,特异度为91.16%,ROC曲线下面积(AUC)为0.900(95%CI:0.825~0.966)。LSM与肝纤维化分期(r=0.850,P<0.001)、肝脏炎症活动度(r=0.633,P<0.001)、肝功能Child-Pugh分级(r=0.367,P<0.001)呈明显正相关。SWE技术鉴别肝纤维化(≥F2期)、肝硬化(F4期)的AUC分别为0.621(95%CI:0.573~0.824)、0.773(95%CI:0.621~0.864);SWE技术鉴别肝脏炎症活动度≥A2期、A3期的AUC分别为0.605(95%CI:0.583~0.864)、0.759(95%CI:0.573~0.872);SWE技术鉴别肝功能Child-Pugh分级为C级的AUC为0.722(95%CI:0.615~0.906)。不同操作者测量肝血管瘤患者和肝癌患者LSM的组内和组间ICC均大于0.75。结论 SWE技术是一种操作简便、重复性好的肝脏硬度检测方法,可较好地区分肝癌和肝血管瘤,也可对肝癌患者的肝纤维程度、肝脏炎症活动度及Child-Pugh分级进行评估。操作者的经验对重复性的影响不明显。

Objective To investigate the relationship between shear wave elatography(SWE)imaging parameters and lesion histopathology and repeatability analysis of liver stiffness measurement(LSM)in patients with liver cancer.Methods The clinicopathological data of 116 patients with liver tumors from December 2019 to January 2023 were collected,including 55 cases of hepatic hemangioma and 61 cases of liver cancer.SWE ultrasound diagnostic instrument was used to obtain and record LSM.Spearman rank correlation analysis was used to analyze the correlation between LSM and Child-Pugh classification,hepatitis activity and staging of hepatic fibrosis.The receiver operating characteristic curve(ROC)was used to evaluate the differentiation between hemangioma and liver cancer and the diagnostic efficacy of SWE for different clinicopathological features of liver cancer.Intra-group correlation coefficient(ICC)was used to analyze the consistency of measurements of different operators and the same operator.Results The LSM of hepatic hemangioma was(19.49±7.54)kPa,while that of liver cance was(39.17±14.35)kPa,the difference was statistically significant(P<0.001).There was a statistically significant difference in LSM between patients with different liver function Child-Pugh grading,liver function inflammation grading,and liver function sclerosis grading(P<0.05).The critical point of LSM in the diagnosis of liver cancer and hepatic hemangioma was 23.54 kPa,with a sensitivity of 79.85%and a specificity of 91.16%.The area under the ROC curve(AUC)was 0.900(95%CI:0.825-0.966).LSM was positively correlated with staging of hepatic fibrosis(r=0.850,P<0.001),hepatitis activity(r=0.633,P<0.001)and Child-Pugh classification(r=0.367,P<0.001).The AUC of hepatic fibrosis(≥F2)and cirrhosis(F4)identified by SWE technique were 0.621(95%CI:0.573-0.824)and 0.773(95%CI:0.621-0.864),respectively,while the AUC of≥A2 and A3 hepatitis identified by SWE technique were 0.605(95%CI:0.583-0.864)and 0.759(95%CI:0.573-0.872),respectively.The AUC of Child-Pugh grade C identified by SWE technique was 0.722(95%CI:0.615-0.906).The intra-and inter-group ICC of LSM in patients with hepatic hemangioma and liver cancer measured by different operators were greater than 0.75.Conclusion SWE is a simple and reproducible method for detecting liver stiffness,which can well distinguish liver cancer from hepatic hemangioma,and can also evaluate the degree of liver fiber,hepatitis activity and Child-Pugh grade in patients with liver cancer.The influence of the operators′experience on repeatability is limited.