声脉冲辐射力成像评价肝纤维化与临床病理的对照研究  

Comparative study on clinical and pathological changes of liver fibrosis with acoustic radiation force impulse elastography imaging

作　　者：林森浩[1] 丁红[1] 毛丽娟[1] 沈文[1] 王文平[1] 黄备建[1] 何德明[2] 

机构地区：[1]复旦大学附属中山医院上海市影像医学研究所,上海200032 [2]复旦大学附属中山医院 病理科,上海200032

出　　处：《中华超声影像学杂志》2012年第10期855-858,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目（30872409）;上海市重点学科建设项目（B112）

摘　　要：目的探讨声脉冲辐射力成像评价临床肝病患者肝纤维化的价值。方法对99例欲行肝外科手术的患者术前进行声脉冲辐射力成像检查，得出反映肝组织硬度的剪切波速度（shearwavevelocity，Vs）。对患者肝组织病理进行肝纤维化分期、炎症活动程度分级以及脂肪变程度分级。将Vs与病理结果做比较。结果肝纤维化S0～S4期的Vs值分别为（1．14±0．22）m／s、（1．30±0．22）m／s、（1．36±0．38）m／s、（1．47±0．37）m／s以及（1．87±0．08）m／s，各组间差异具有统计学意义（P〈0．001）；Vs与肝纤维化分期之间具有一定的相关性（r=0．541，P〈0．001），Vs预测3期及以上肝纤维化的ROC曲线下面积为0．812（PG0．001），以1．40m／s为最佳临界值，敏感性、特异性分别为73．2％和81．4％。炎症活动程度分级G0～G3的Vs值分别为（1．17±0．16）m／s、（1．43±0．36）m／s、（1．59±0．53）m／s以及（1．89±0．59）m／s，各组间差异有统计学意义（P〈0．001）；Vs与炎症活动程度分级之间具有一定的相关性（r=0．383，P〈0．001）。脂肪变程度分级F0～F4的Vs值分别为（1．61±0．42）m／s、（1．47±0．58）m／s、（1．56±0．71）m／s、1．13m／s以及（0．94±0．95）m／s，各组间差异不具有明显统计学意义（P：0．286）；Vs与脂肪变程度分级之间亦不存在明显相关性（r=-0．177，P=0．080）。结论声脉冲辐射力成像评价肝纤维化具有一定的价值，但炎症活动程度对结果具有显著的影响。Objective To evaluate the clinical values of acoustic radiation force impulse （ARFI） elastography for liver fibrosis on hepatopath patients. Methods ARFI elastography was prospectively performed on 99 patients prepared to undergo hepatic surgery to get a shear wave velocity（Vs） which was the representative of liver stiffness. The fibrosis stages, inflammation grades and steatosis grades were evaluated histologically after surgery. Values of Vs were compared with the histological results. Results Values of Vs with fibrosis stage 0- 4 was （1.14± 0.22）m/s,（1.30 ± 0.22）m/s,（1.36± 0.38）m/s, （1.47 ± 0.37）m/s and （1.87 ± 0.08）m/s, respectively. A significant difference was observed among them （ P 〈0. 001）. There was a certain correlation between Vs and fibrosis stage（ r = 0. 541, P 〈0. 001 ）. Vs was a significant predictor of stage≥3 fibrosis with an area under the ROC curve of 0. 812, sensitivity 73.2%and specificity 81.4% when 1.40 m/s was the cutoff value（ P 〈0.001）. Values of Vs with inflammation grade 0 - 3 was （1.17 ± 0.16）m/s, （1.43 ± 0. 36） m/s, （1.59 ± 0. 53） m/s and （1.89 ± 0.59） m/s,respectlvely, which were significantly different （P 〈 0.001）. A certain correlation was observed between Vs and inflammation grade（ r = 0, 383, P 〈0. 001）. Values of Vs with steatosis grade 0 - 4 was （1.61 ± 0.42） m/s,（1.47 ± 0.58）m/s,（1.56 ±0.71）m/s,1.13 m/s and （0.94± 0.95）m/s. Obvious difference didn＇t exist between Vs and steatosis grade（ P = 0. 286）. Obvious correlation wasntt observedbetween them,either （ r = - 0. 177, P = 0. 080）. Conclusions ARFI elastography has a certain value for the evaluation of liver fibrosis, while inflammation grade may affect its performance.

关 键 词：超声检查 肝硬化 声脉冲辐射力成像 

分 类 号：R445.1[医药卫生—影像医学与核医学]