Evaluation of acoustic radiation force impulse imaging for determination of liver stiffness using transient elastography as a reference

AIM: To evaluate cut-off values and performance of acoustic radiation force impulse imaging (ARFI) using transient elastography [FibroScan■ (FS)] as a reference. METHODS: Six hundred and six patients were enrolled in this study.All patients underwent liver stiffness measurement with FS (FS-LS) and ARFI (with shear wave velocity quantification; ARFI-SWV) and the performance of ARFI in comparison to FS was determined. Sixtyeight patients underwent liver biopsy. RESULTS: Significantly higher success rates for the determination of liver stiffness were found using ARFI as compared to FS [604/606 (99.7%) vs 482/606 (79.5%); P < 0.001]. ARFI-SWV correlated significantly with FS-LS (r = 0.920, P < 0.001). ARFI-SWV increased significantly with the stage of fibrosis (1.09 ± 0.13 m/s for patients with no significant fibrosis (FS-LS < 7.6 kPa); 1.46 ± 0.27 m/s for patients with significant liver fibrosis (7.6 < FS-LS ≤ 13.0 kPa); and 2.55 ± 0.77 m/s for patients with liver cirrhosis (FS-LS > 13.0 kPa)). ARFI-SWV cut-off values were identified for no significant fibrosis (1.29 m/s; sensitivity 91.4% and specificity 92.6%) and for liver cirrhosis (1.60 m/s; sensitivity 92.3% and specificity 96.5%). The optimal cut-off value for predicting liver fibrosis (F ≥ 2) was 1.32 m/s (sensitivity 87.0% and specificity 80.0%) and for liver cirrhosis (F4) 1.62 m/s (sensitivity 100% and specificity 85.7%), for patients who underwent liver biopsy. An excellent inter-and intraobserver reproducibility was observed for ARFI-SWV determinations. CONCLUSION: An ARFI-SWV cut-off value of 1.29 m/s seems to be optimal for patients with no significant liver fibrosis and 1.60 m/s for patients with liver cirrhosis.

Primary biliary cirrhosis degree assessment by acoustic radiation force impulse imaging and hepatic fibrosis indicators

AIM: To evaluate the assessment of primary biliary cirrhosis degree by acoustic radiation force impulse imaging (ARFI) and hepatic fibrosis indicators. METHODS: One hundred and twenty patients who developed liver cirrhosis secondary to primary biliary cirrhosis were selected as the observation group, with the degree of patient liver cirrhosis graded by Child-Pugh (CP) score. Sixty healthy individuals were selected as the control group. The four indicators of hepatic fibrosis were detected in all research objects, including hyaluronic acid (HA), laminin (LN), type III collagen (PC III), and type IV collagen (IV-C). The liver parenchyma hardness value (LS) was then measured by ARFI technique. LS and the four indicators of liver fibrosis (HA, LN, PC III, and IV-C) were observed in different grade CP scores. The diagnostic value of LS and the four indicators of liver fibrosis in determining liver cirrhosis degree with PBC, whether used alone or in combination, were analyzed by receiver operating characteristic (ROC) curve. RESULTS: LS and the four indicators of liver fibrosis within the three classes (A, B, and C) of CP scores in the observation group were higher than in the control group, with C class > B class > A class; the differences were statistically significant (P < 0.01). Although AUC values of LS within the three classes of CP scores were higher than in the four indicators of liver fibrosis, sensitivity and specificity were unstable. The ROC curves of LS combined with the four indicators of liver fibrosis revealed that: AUC and sensitivity in all indicators combined in the A class of CP score were higher than in LS alone, albeit with slightly decreased specificity; AUC and specificity in all indicators combined in the B class of CP score were higher than in LS alone, with unchanged sensitivity; AUC values (0.967), sensitivity (97.4%), and specificity (90%) of all indicators combined in the C class of CP score were higher than in LS alone (0.936, 92.1%, 83.3%). CONCLUSION: The diagnostic value of PBC cirrhosis degree in liver cirrhosis degree assessment by ARFI combined with the four indicators of serum liver fibrosis is of satisfactory effectiveness and has important clinical application value.

Application of acoustic radiation force impulse imaging for the evaluation of focal liver lesion elasticity

BACKGROUND: Acoustic radiation force impulse (ARFI) imaging is a new elastography method for the evaluation of tissue stiffness. This study aims to evaluate the performance of ARFI in noninvasive assessment of the tissue stiffness of focal liver lesion (FLL) and to explore its potential value in the differential diagnosis of FLL. METHODS: ARFI was performed in 140 patients with 154 FLLs, which included 28 hemangiomas (ANGIs), 14 focal nodular hyperplasias (FNHs), 61 hepatocellular carcinomas (HCCs), 39 metastases and 12 cholangiocellular carcinomas (CCCs). Virtual touch tissue quantification (VTTQ) values were obtained, analyzed and compared. The area under the receiver operating characteristic curve (AUROC) and optimal cut-off values were obtained using a receiver operating characteristic (ROC) curve analysis to assess diagnostic performance. All cases were definitively diagnosed using histopathology, CT, MRI or contrast-enhanced ultrasound. RESULTS: The VTTQ median values of ANGI, FNH, HCC metastasis and CCC were 1.30, 1.80, 2.52, 3.08 and 3.89 m/s respectively. A significant increase in the VTTQ values of different lesions was observed: ANGI【FNH【HCC【metastasis 【CCC (P【0.001). The AUROC (95% CI) of VTTQ values was 0.94 (0.90-0.98) for ANGI, 0.91 (0.87-0.96) for malignant lesions and 0.87 (0.79-0.94) for CCC. The sensitivity and specificity for ANGI (86.5%, 89.3%, respectively), malignancy (81.3% 92.9%, respectively), and CCC (91.7%, 72.5%, respectively) were associated with VTTQ cut-off values of 1.76, 2.22 and 3.00 m/s respectively.CONCLUSIONS: ARFI can accurately and objectively assess the elasticity of lesions by obtaining the shear wave elastic value of FLL with VTTQ. Therefore, ARFI is a novel, simple, noninvasive and useful diagnostic method for the characterization of FLL.

Normal values of shear wave velocity in liver tissue of healthy children measured using the latest acoustic radiation force impulse technology

BACKGROUND Several studies have demonstrated the feasibility and effectiveness of using ultrasound elastography to assess liver tissue stiffness.Virtual touch imaging quantification(VTIQ)based on acoustic radiation force impulse imaging has been developed as a latest and noninvasive method for assessing liver stiffness in children.AIM To determine the standard value in healthy children,and to identify possible factors that might influence the VTIQ measurement.METHODS With the ethical approval,202 children between 1 month and 15 years old were included in this study.None of them had any liver or systematic diseases.All children had a normal ultrasound scan and normal body mass index(BMI)range.The subjects were divided into four age and BMI groups.The effects of gender,age,liver lobe,measurement depth,and BMI on liver elasticity were investigated.RESULTS A significant correlation was found between age and shear wave velocity(SWV)value.At measurement depths of 1.5 cm and 2.0 cm in the left lobe,there were significant differences among the age groups.SWV values were significantly negatively correlated with the measurement depth.Gender,liver lobe,and BMI showed no significant effect on the SWV values.Age and BMI may influence the quality of the elastogram.CONCLUSION VTIQ is a noninvasive technique that is feasible to measure liver stiffness in children.The afore-mentioned velocity value obtained utilizing VTIQ method could be used as reference value for normal liver stiffness in children.

Preliminary results of acoustic radiation force impulses (ARFI) ultrasound imaging of solid suspicious breast lesions

Objective： The aim of our study was to make the qualitative and quantitative analysis to breast lesions using acoustic radiation force impulses （ARFI）, and assess the diagnostic value of ARFI for differentiation between benign and malignant solid breast masses, meanwhile evaluate the influences of ARFI with breast imaging reporting and data system （BI-RADS） of suspicious masses. Methods： Seventy-five women with 86 breast lesions underwent conventional breast ultra- sound examination. Then B-mode BI-RADS features and assessments were recorded and standard breast US supplemented by ARFI elastographic examination were repeated. The data were recorded and analyzed as following： area ratio of breast lesion, the shear-wave velocity, the ratio of the shear-wave velocity between lesions and surrounding normal tissues, and according to the elastographic data reconsidered the BI-RADS category, all the results have been correlated with pathological results and make statistical evaluations of ARFI for differentiation between benign and malignant solid breast masses. Meantime our study has correlated the adjusted BI-RADS category of suspicious breast lesions with the pathological results and made assessment. Results： Thirty-eight patients were malignant breast carcinoma （31 invasive ductal carcinoma, 5 intraductal carcinoma in situ, 2 medullary carcinoma, 2 invasive Iobular carcinoma）, 48 patients were benign breast lesions （23 fibroadenoma, 12 benign nodular hyperplasia, 5 phyllodes tumor, 6 adenosis, 2 intraductal papilloma）. Underwent conventional breast ultrasound exam, 42 cases were BI-RADS category 3, 23 cases were BI-RADS category 4. When adding elastographic data, 46 cases were BI-RADS category 3 and 20 cases were BI-RADS category 4. Compared with pathological results showed for both the specificity of BIRADS features and the area under ROC curve has risen. Virtual touch tissue imaging （VTI） and virtual touch tissue quantification （VTQ） data showed the area ratio （AR） between elastographic lesions area and B-mode lesions area, SWV （maximal shear-wave velocity of lesions）, R-SWV （shear-wave velocity ratio between lesions and surrounding normal tissues） in benign breast lesions were lower than those in malignant lesions which has statistical significance and the cut-off point were 1.1,4.65 m/s, 5.18 respectively. Conclusion： The ARFI elastography can provide the reliable qualitative and quantitative analysis about hardness of breast lesions, supply the new BI-RADS category features to suspicious breast masses and serve as an effective diagnostic tool for differentiation between benign and malignant solid masses.

Acoustic radiation force impulse of the liver

Acoustic radiation force impulse(ARFI)imaging is a new and promising ultrasound-based diagnostic technique that,evaluating the wave propagation speed,allows the assessment of the tissue stiffness.ARFI is implemented in the ultrasound scanner.By short-duration acoustic radiation forces(less than 1 ms),localized displacements are generated in a selected region of interest not requiring any external compression so reducing the operator dependency.The generated wave scan provides qualitative or quantitative(wave velocity values)responses.Several non-invasive methods for assessing the staging of fibrosis are used,in order to avoid liver biopsy.Liver function tests and transient elastography are non-invasive,sensitive and accurate tools for the assessment of liver fibrosis and for the discrimination between cirrhotic and non-cirrhotic liver.Many published studies analyse ARFI performance and feasibility in studying diffuse liver diseases and compare them to other diagnostic imaging modalities such as conventional ultrasonography and transient elastography.Solid focal liver lesions,both benign and malignant,are common findings during abdominal examinations.The accurate characterization and differential diagnosis are important aims of all the imaging modalities available today.Only few papers describe the application of ARFI technology in the study of solid focal liver lesions,with different results.In the present study,the existing literature,to the best of our knowledge,about ARFI application on diffuse and focal liver pathology has been evaluated and results and statistical analyses have been compared,bringing to the conclusion that ARFI can be used in the study of the liver with similar accuracy as transient elastography in diagnosing significant fibrosis or cirrhosis and has got some advantages in respect to transient elastography since it does not require separate equipment,better displays anatomical structures and measurements can be successfully carried out almost in every patient.

Parameters affecting different acoustic radiation force impulse applications in the diagnosis of fibrotic liver changes

AIM: To analyze the virtual touch tissue quantification(VTTQ) and virtual touch imaging quantification(VTIQ) techniques, and identify possible factors that may influence VTTQ and VTIQ measurements.METHODS: One hundred and eighty-six(104 women/82 men) of 323 subjects met the inclusion criteria(age > 18 years, no history of chronic or gastrointestinal disease, body-mass index(BMI) < 30 kg/m2, a fasting period of at least three hours, no history of hepatotoxic pharmaceuticals, alcohol consumption < 24 g/d in men and < 12 g/d in women, and normal findings upon ultrasound examination of the abdomen). Measurements were taken at depths of 50 mm with VTTQ, 15 mm and 25 mm with VTIQ in the right hepatic lobe, and at 15 mm with only VTIQ in the left hepatic lobe. The examiner acquired six measurements per position, thereby giving 24 measurements in total.RESULTS: The 95% confidence intervals of mean were1.23-1.29 m/s for VTTQ and 1.29-1.37 m/s, 1.17-1.23 m/s, and 1.48-1.57 m/s for VTIQ in a depth of 15 mm and 25 mm in the right hepatic lobe and 15 mm in the left hepatic lobe. Only superficial measurements in the right hepatic lobe with the VTIQ method exhibited an effect of age on shear wave velocity. Measurements acquired using the 6C1 probe with the VTTQ method showed no dependence on BMI. By comparison, BMI influenced measurements taken with the VTIQ method using the 9L4 probe in the superficial and deep areas of the right hepatic lobe, as well as in the left hepatic lobe(P = 0.0160, P = 0.0019, P = 0.0173, respectively). Gender influenced measurements at depths of 50 mm with VTTQ and 25 mm with VTIQ in the right hepatic lobe(P = 0.0001, P = 0.0269). Significant differences were found between measurements with the 6C1(VTTQ) and 9L4 probes(VTIQ)(P = 0.0067), between superficial and deep measurements(P < 0.0001), and between the right and left lobes of the liver(P < 0.0001). CONCLUSION: Measurements in the right lobe and deep regions are preferable. Gender differences must be considered. BMI must be considered when assessing VTIQ technology.

Factors correlating with acoustic radiation force impulse elastography in chronic hepatitis C

AIM: To investigate the factors other than fibrosis stage correlating with acoustic radiation force impulse (ARFI) elastograpy in chronic hepatitis C.

A Modified Monte Carlo Model of Speckle Tracking of Shear Wave Induced by Acoustic Radiation Force for Acousto-Optic Elasticity Imaging

A modified Monte Carlo model of speckle tracking of shear wave propagation in scattering media is proposed. The established Monte Carlo model mainly concerns the variations of optical electric field and speckle. The two- dimensional intensity distribution and the time evolution of speckles in different probe locations are obtained. The fluctuation of speckle intensity tracks the acoustic-radiation-force shear wave propagation, and especially the reduction of speckle intensity implies attenuation of shear wave. Then, the shear wave velocity is estimated quantitatively on the basis of the time-to-peak algorithm and linear regression processing. The results reveal that a smaller sampling interval yields higher estimation precision and the shear wave velocity is estimated more efficiently by using speckle intensity difference than by using speckle contrast difference according to the estimation error. Hence, the shear wave velocity is estimated to be 2.25 m/s with relatively high accuracy for the estimation error reaches the minimum （0.071）.

Clinical evaluation of thyroid cancer in sound pulsed radiographic imaging and correlation analysis of OPN and OPN mRNA expression

Objective:To investigate the clinical assessment of thyroid carcinoma in acoustic pulse radiation imaging and the correlation analysis of osteopontin expression.Methods: A total of 71 lesions of 60 patients with thyroid carcinoma (TC) in Hainan were selected. All patients were graded by TI-RADS grading and confirmed by pathology after operation. The expression of OPN was detected by immunohistochemical S-P method. The expression of OPN mRNA was detected by fluorescence quantitative polymerase chain reaction. The correlation between OPN expression and acoustic pulse radiation imaging was analyzed.Results:(1) 60 patients (93.33%) with primary TC and 4 (6.67%) patients with secondary TC were found in 60 patients with TC. Thirty-seven patients (61.67% according to the pathological features, 32 cases (53.33%) had papillary TC, diffuse sclerosis 19 cases of diffuse sclerosis PTC (31.67%), follicular carcinoma in 9 cases (15.00%). (2) The expression of OPN mRNA in 37 cases of calcified TC was significantly higher than that in non-calcified TC, and the increase of OPN expression was in direct proportion to the distribution of gritty calcification.Conclusions: The distribution of calcified microsomes in TC was positively correlated with the expression of OPN, suggesting that enhanced OPN expression may be related to the formation of psammoma bodies, the increased hardness of nodules and the increased malignancy. Acoustic pulse radiation imaging technology for early diagnosis of TC and prognosis of TC was of great significance.

Application of ARFI technology to explore the clinical study of Gandou Tang in treating liver fibrosis of wilson's disease with damp-heat accumulation

Objective:Acoustic radiation force impulse(ARFI)was applied to measure Shear wave velocity(SWV)of liver in patients with Wilson's disease(WD).To investigate the relationship between SWV and the serological indexes of liver fibrosis,such as type Ⅳ collagen(CⅣ),hyaluronic acid(HA),type Ⅲ procollagen peptide(PⅢNP),laminin(LN),APRI score(Asparate Aminotransfer to Platelet Ratio Index),and FIB-4 index(FIB-4 index).The clinical efficacy of GandouTang(GDT)in the treatment of liver fibrosis in WD with damp-heat internalization was also observed.Methods:80 cases of WD patients who met the inclusion criteria were randomly divided into the treatment group and the control group,with 40 cases in each group.The control group was treated with Sodium Dimercaptopropylsulfonate(DMPS)and the treatment group was additionally treated with the traditional Chinese medicine GDT.One course for 8 days,a total of 6 courses.The levels of SwV and four serological indicators of liver fibrosis(PⅢNP,HA,CⅣ,LN),APRI score and FIB-4 index were compared before and after treatment.Pearson correlation test was used to analyze the correlation between SWV and HA,CⅣ,LN,PⅢNP,APRI score and FIB-4 index.The effects of GDT on SWV,liver fiber,APRI and FIB-4 were evaluated according to the treatment plan.Results:①The SWV was positively correlated with FIB-4(r=0.83),APRI(r=0.82),HA(r=0.87),CⅣ(r=0.71),LN(r=0.85)and PINP(r=0.77).②Before treatment,there were no significant differences in SWV level,PⅢNP,HA,CⅣ,LN,APRI and FIB-4 levels between two groups(P>0.05).After treatment,the levels of PⅢNP,HA,LN,SWV,APRI and FIB-4 in both groups were significantly decreased(P<0.05,P<0.01),and the levels in the treatment group were lower than those in the control group.There were no significant specific changes in CⅣ level(P>0.05).Conclusion:SWV value can reflect the degree of WD liver fibrosis,and is positively correlated with HA,PⅢNP,CⅣ,LN,FIB-4 index and APRI score.On the basis of the treatment of protecting liver and expelling copper with western medicine,plus the treatment of traditional Chinese medicine GDT can effectively improve the degree of liver fibrosis in WD patients with damp-heat accumulation.

基于声辐射力脉冲成像的诊断模型对胆道闭锁患儿肝纤维化的应用价值

目的分析基于声辐射力脉冲成像(ARFI)定量参数建立的无创诊断模型对胆道闭锁患儿肝纤维化的诊断价值。方法回顾性收集100例接受ARFI检查并行肝门-空肠吻合术(Kasai’s)治疗及肝组织活检的胆道闭锁患儿,男42例,女58例,平均年龄(68.79±8.79)d。根据活检病理结果分为肝纤维化组(71例)和非肝纤维化组(29例)。依据Metavir分级标准将肝纤维化分为5级:F0(29例)、F1(31例)、F2(24例)、F3(11例)、F4(5例)。2组临床资料和ARFI定量参数的比较采用t检验或χ^(2)检验;采用单因素方差分析比较肝纤维化不同分级间的剪切波速度(SWV)。采用多因素Logistic回归分析影响胆道闭锁患儿发生肝纤维化的独立危险因素,并构建基于ARFI定量参数的无创诊断模型。采用受试者操作特征(ROC)曲线评价模型的诊断效能,计算其曲线下面积(AUC)。结果肝纤维化组血清中性粒细胞(NEUT)、总胆红素(TBIL)、层黏蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-Col)浓度,以及SWV均高于非肝纤维化组(均P<0.05)。多因素Logistic回归分析结果显示,SWV、血清TBIL及LN、HA、PCⅢ、Ⅳ-Col浓度高是影响胆道闭锁患儿发生肝纤维化的危险因素(均P<0.05)。基于SWV的无创诊断模型诊断胆道闭锁患儿发生肝纤维化的最佳临界值为1.75 m/s,敏感度、特异度、准确度、阳性预测值、AUC分别为93.15%、70.09%、90.25%、88.80%、0.922。结论基于ARFI定量参数建立的无创诊断模型,可较为准确地诊断出胆道闭锁患儿是否存在肝纤维化,且具有较高的应用价值。

3种方法单独及联合诊断甲状腺微小结节的价值比较

目的 比较二维高频超声、声脉冲辐射力成像(ARFI)-声触诊组织定量(VTQ)技术及应变弹性成像3种方法单独及联合诊断甲状腺微小结节良恶性的价值。方法 回顾性分析2021年6月—2023年6月在陕西省宝鸡市人民医院就诊的99例(107个甲状腺微小实性结节)结节直径≤10.0 mm患者的临床资料,均采用二维高频超声、ARF-VTQ技术及应变弹性成像进行检查,获得超声资料评分及数据,以穿刺活检和手术病理结果为诊断“金标准”,比较3种超声检查方法单独及联合应用对甲状腺微小结节的诊断效能。结果 62例患者(共68个结节)选择FNAB,37例患者(共39个结节)选择手术。107个甲状腺微小结节中,诊断为恶性微小结节45个,良性微小结节62个。恶性微小结节与良性微小结节相比,结节内回声(等回声和高回声、极低回声和低回声)、边界、微钙化、纵横比>1及血供情况和供血动脉阻力指数(RI)比较,差异均有统计学意义(P<0.05)。二维高频超声诊断甲状腺微小结节C-TIRADS积分临界值≥2分(C-TIRADS 4b)时,诊断灵敏度为73.33%,特异度为79.03%,曲线下面积[AUC(95%CI)]为0.762(95%CI:0.670~0.839);ARFI-VTQ技术中,107个甲状腺微小结节SWV测值为0.52~7.55 m/s,平均(2.62±0.61)m/s,其中24个实性结节多次出现×.××m/s,最后测值以7.55 m/s记录。恶性微小结节SWV均值为(5.24±2.23) m/s,高于良性微小结节的(2.11±0.70) m/s,差异有统计学意义(t=10.258,P<0.05);当SWV临界值为3.19 m/s时,诊断灵敏度为77.78%,特异度为80.65%,AUC(95%CI)为0.792(95%CI:0.703~0.865);应变弹性成像检查中,当评分临界值≥3分时,诊断的灵敏度为75.56%,特异度为77.42%,AUC(95%CI)为0.765(95%CI:0.673~0.841)。三者联合应用诊断的阳性微小结节为44个,阴性微小结节63个,诊断灵敏度为93.33%,特异度为96.77%,AUC(95%CI)为0.951(95%CI:0.891~0.983)。三者联合诊断效能与二维高频超声检查、ARFI-VTQ、应变弹性成像单独检测比较,差异均有统计学意义(Z=4.861、4.393、4.842,P<0.05)。结论 二维高频超声联合ARFI-VTQ技术及应变弹性成像可提高甲状腺微小结节良恶性的诊断准确性。

超声弹性成像技术评估腰部“筋”伤的可行性临床研究

目的探讨超声弹性成像技术(声辐射力脉冲成像技术)量化评估腰部“筋”伤的临床可行性。方法选取90例被诊断为单侧慢性非特异性腰痛患者(经3个月强筋功法训练后已无腰痛症状)。在训练前后,采用彩色多普勒超声诊断仪检查所有患者L4~L5节段两侧多裂肌并测量多裂肌厚度、截面积,利用声辐射力脉冲成像技术测量多裂肌剪切波速度(SWV)。结果①最终共收集90例患者,其中男性26例、女性64例,平均年龄(28.49±5.81)岁,平均体质量指数(22.20±2.45)kg·m-2。②训练前,疼痛侧与非疼痛侧多裂肌的厚度、截面积及SWV的差异均具有统计学意义(P<0.05)。训练后,疼痛侧与非疼痛侧多裂肌的厚度、截面积及SWV的差异均无统计学意义(P>0.05)。③训练后,浅层与深层多裂肌的深度及SWV比较,差异具有统计学意义(P<0.05)。④训练后,两侧多裂肌厚度的平均值、截面积的平均值和SWV的平均值之间存在相关性(r=0.311,P=0.004;r=0.316,P=0.003)。⑤训练后,两侧多裂肌SWV重复测量的组内一致性良好(P<0.05)。结论声辐射力脉冲成像技术是量化评估腰骶部“筋”形态功能的可靠手段,可用于指导和评价慢性筋骨病从“筋”论治,适合临床推广应用。

超声弹性成像技术的临床应用进展

目前普遍认为组织硬度是反映病理学改变的评价标准之一,超声弹性成像(UE)是通过检测组织对声能的响应计算弹性模量以评估其硬度的影像学手段。目前UE临床应用广泛,常用于肝脏、肾脏、甲状腺、乳腺、前列腺、浅表包块及子宫等病变的良恶性鉴别,为指导临床治疗用药及评估患者预后提供重要影像学依据。未来进一步提高UE诊断的准确度,与其他成像技术和人工智能联合成多模态超声诊断技术,可进一步扩大对肺部、肌骨、心血管、颅脑等方面疾病的诊断范围。

ARFI-VTQ技术定量评价下肢肌间静脉单纯扩张与急性期血栓的探讨

目的 探讨ARFI-VTQ技术对下肢肌间静脉单纯扩张与急性期血栓的定量分析能力。方法 选取单纯下肢肌间静脉扩张患者29例(30肢)作为肌间静脉扩张组,单纯下肢肌间静脉急性期血栓患者29例(41肢)作为急性期血栓组,分析两组二维及多普勒声像图特征,并分别行ARFI-VTQ检查,获得两组患者各自SWV测值,比较两组患者测值差异性;绘制受试者工作特征曲线(ROC),获得区分下肢肌间静脉单纯扩张与急性期血栓的最佳结果。结果 肌间静脉扩张组超声检查表现:管腔内呈无回声,部分自发显影,呈流沙样改变;管腔可被压闭,挤压后可见血流信号显示;SWV测值0.84~1.59 m/s,平均(1.32±0.17)m/s,取样深度2.0~3.5 cm,平均(2.64±0.41)cm。急性期血栓组超声检查表现:管腔内呈极低回声或低回声;管腔不可压闭,无血流信号或少许血流信号;SWV测值1.54~2.41 m/s,平均(1.86±0.19)m/s,取样深度0.9~3.6 cm,平均(2.43±0.59)cm。绘制ROC曲线,ROC曲线下面积(AUC)99.5%(95%CI:0.985-1.000,P<0.001),以1.60 m/s为截断值,ARFI-VTQ技术诊断急性期血栓的灵敏度为95.0%,特异度为100%。结论 ARFI-VTQ技术能够定量分析单纯肌间静脉扩张与急性期肌间静脉血栓,在两者的鉴别诊断方面具有良好的敏感度及特异度。

多模态超声特征结合机器学习可预测乳腺浸润导管癌中Ki-67的表达水平

目的 探讨多模态超声特征结合机器学习预测乳腺浸润导管癌中Ki-67高表达的可行性。方法 回顾性分析155例乳腺浸润导管癌患者,155个病灶经病理证实。术前行常规超声和声辐射力脉冲成像,免疫组化染色记录Ki-67的表达,将患者分为Ki-67高表达组(n=105)和低表达组(n=50)。采用Logistic回归分析得出独立危险因素,采用随机森林及Logistic回归模型预测。结果 单因素分析显示Ki-67表达与肿块最大径、边界、腋窝淋巴结状态、阻力指数、声触诊组织成像及声触诊组织定量的差异有统计学意义(P<0.05)。多因素分析结果显示,最大直径、边界、声触诊组织定量及阻力指数对Ki-67为独立危险因素。随机森林模型结果显示,Ki-67表达影响因素的重要性排序依次是最大直径、声触诊组织定量、阻力指数及边界。随机森林及Logistic回归模型预测乳腺浸润导管癌中Ki-67高表达曲线下面积分别为0.871、0.866,Ki-67值与肿块直径呈正相关关系(r=0.319,P<0.001)。结论 多模态超声特征结合机器学习可用于预测乳腺浸润导管癌Ki-67的表达水平。

益气活血化浊法治疗Wilson病肝纤维化的疗效观察

【目的】评估益气活血化浊法治疗Wilson病(也称肝豆状核变性,Wilson’s disease,WD)肝纤维化的临床效果。【方法】采用回顾性研究方法,根据治疗方法的不同,将52例气虚血瘀型WD肝纤维化患者分为对照组24例和治疗组28例。对照组采用西药常规驱铜治疗,治疗组在对照组的基础上联合益气活血化浊法中药汤剂治疗,共治疗4周。观察2组患者治疗前后中医证候积分、统一肝豆状核变性评分量表(UWDRS)肝脏症状评分、血清肝纤维化指标[Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)]和CXC基序趋化因子配体10(CXCL10)水平以及基于声脉冲辐射力成像技术(ARFI)的肝脏超声点剪波弹性成像(pSWE)值的变化情况,并评价2组患者的临床疗效。【结果】(1)疗效方面:治疗4周后,治疗组的总有效率为85.71%(24/28),对照组为54.17%(13/24),组间比较(χ2检验),治疗组的疗效明显优于对照组(P<0.05)。(2)中医证候积分方面:治疗后,2组患者的中医证候积分均较治疗前降低(P<0.01),且治疗组对中医证候积分的降低幅度明显优于对照组(P<0.05)。(3)肝脏症状评分方面:治疗后,2组患者的UWDRS肝脏症状评分均较治疗前降低(P<0.01),但治疗后组间比较,差异无统计学意义(P>0.05)。(4)肝纤维化指标方面:治疗后,治疗组的血清HA、LN、CⅣ、PCⅢ水平均较治疗前降低(P<0.01),而对照组仅血清LN、PCⅢ水平较治疗前降低(P<0.05);组间比较,治疗组对血清HA、LN、PCⅢ水平的降低幅度均明显优于对照组(P<0.05或P<0.01),而对血清CⅣ水平的降低幅度有优于对照组趋势,但差异无统计学意义(P>0.05)。(5)趋化因子方面:治疗后,治疗组的血清CXCL10水平较治疗前明显降低(P<0.01),而对照组较治疗前有降低趋势,但差异无统计意义(P>0.05);组间比较,治疗组对血清CXCL10水平的降低幅度明显优于对照组(P<0.05)。(6)影像学方面:治疗后,2组患者的肝脏超声pSWE值均较治疗前降低(P<0.01),且治疗组对肝脏超声pSWE值的降低幅度明显优于对照组(P<0.01)。【结论】益气活血化浊法可以有效降低WD患者的中医证候积分,改善UWDRS肝脏症状评分,下调肝纤维化指标和血清CXCL10表达水平,降低肝脏pSWE值,提高临床疗效。

Noninvasive diagnosis of cirrhosis:A review of different imaging modalities

Progressive hepatic fibrosis can lead to cirrhosis,so its early detection is fundamental.Staging fibrosis is also critical for prognosis and management.The gold standard for these aims is liver biopsy,but it has several drawbacks,as it is invasive,expensive,has poor acceptance,is prone to inter observer variability and sampling errors,has poor repeatability,and has a risk of complications and mortality.Therefore,non-invasive imaging tests have been developed.This review mainly focuses on the role of transient elastography,acoustic radiation force impulse imaging,and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.

Prediction of liver cirrhosis, using diagnostic imaging tools

Early diagnosis of liver cirrhosis is important. Ultrasoundguided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography(US), computed tomography, and magnetic resonance imaging(MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed.