实时剪切波弹性成像在鉴别胆道闭锁和胆汁淤积的诊断价值  

Application value of real-time shear wave elastography in diagnosis of biliary atresia and cholestasis

作　　者：刘琴[1] 苏英姿[1] 任红雁[1] 张薇薇[1] 马亚 王峥嵘[1] LIU Qin;SU Ying-zi;REN Hong-yan;ZHANG Wei-wei;MA Ya;WANG Zheng-rong(Children’s Hospital of Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院

出　　处：《中国临床医学影像杂志》2019年第6期421-424,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨实时剪切波弹性成像技术在鉴别婴儿胆道闭锁与胆汁淤积中的应用价值。方法:选取2017年1—12月在首都儿科研究所附属儿童医院住院,临床确诊为胆道闭锁、胆汁淤积,以及保健科正常体检,无肝病史,腹部超声检查及肝功能均正常的婴儿。先行传统超声检查,再行实时剪切波弹性成像技术测量三组婴儿肝右叶Ⅴ、Ⅵ段包膜下0.5 cm处肝实质的杨氏模量值。采用方差分析比较三组婴儿的肝脏杨氏模量值,使用ROC曲线比较胆道闭锁组和胆汁淤积组的肝脏杨氏模量值,并探索其鉴别诊断界值。结果:应用SWE技术分别检测胆道闭锁组、胆汁淤积组、正常对照组婴儿的肝脏硬度值,采用SC6-1探头检测三组肝脏硬度杨氏模量分别为(15.8±8.9) kPa、(8.4±2.1) kPa、(4.9±0.6) kPa;采用SL10-2探头检测三组肝脏硬度杨氏模量分别为(13.5±7.7) kPa、(7.5±1.9) kPa、(4.4±0.6) kPa。采用ROC曲线比较胆道闭锁组和胆汁淤积组的肝脏硬度值,并计算其鉴别诊断界值:采用SC6-1探头:当肝脏硬度值为8.85 kPa时,诊断的灵敏度为100%,特异度为75%。使用SL10-2探头,当肝脏硬度值为7.60 kPa时,诊断的灵敏度为92%,特异度为75%。结论:胆道闭锁与胆汁淤积患儿的肝脏弹性存在差异,实时剪切波弹性成像技术可通过检测其肝脏硬度值,辅助鉴别诊断。Objective: To evaluate the accuracy of ultrasonic shear wave elastography in detecting biliary atresia and cholestasis in measuring the liver stiffness of infants. Methods: Color Doppler ultrasound diagnostic apparatus, SC6-1 convex array probe and SL10-2 linear array probe were used to switch to the SWE mode after selecting the appropriate incision in the right intercostal space of infants to avoid the large intrahepatic pipe structure, the elastic imaging sampling frame placed in the right lobe Ⅴ, Ⅵ subhepatic 0.5 cm within the liver parenchyma. Quantitative detection of Q-box diameter of 15~20 mm circular area was selected in the imaging area to display and record the mean of liver elastic modulus in the detection area.Each of the infants was tested 5 times at the same site, and the mean was taken. The ANOVA was used to compare the liver stiffness values of biliary atresia group, infant hepatitis group and control group. Receiver operating characteristic curve(ROC curve) was used to determine the diagnostic boundary value between the liver stiffness value of biliary atresia and infantile cholestasis. Results: The liver stiffness values of SC6-1 probe detection of biliary atresia, infantile cholestasis and normal control infant liver stiffness values were(15.8±8.9) kPa,(8.4±2.1) kPa,(4.9±0.6) kPa. The liver stiffness values of SL10-2 probe detection of biliary atresia, cholestasis and normal control infants were(13.5 ±7.7) kPa,(7.5±1.9) kPa,(4.4±0.6) kPa. When the liver stiffness detected by the SC6-1 probe was 8.85 kPa, the ROC curve diagnostic sensitivity and specificity of identifying the biliary atresia and cholestasis were 100% and 75% respectively. When the liver stiffness detected by the SL10-2 probe was 7.60 kPa, the ROC curve diagnostic sensitivity and specificity of identifying the biliary atresia and cholestasis were 92%and 75% respectively. Conclusion: Real-time shear wave elastography can effectively identify infants with biliary atresia and infantile cholestasis.

关 键 词：胆道闭锁 胆汁淤积 超声检查 多普勒 彩色 

分 类 号：R575.7[医药卫生—消化系统] R445.1[医药卫生—内科学]