凸阵探头实时组织弹性成像、声辐射力脉冲弹性成像与瞬时弹性成像诊断慢性乙肝相关肝纤维化程度的比较  

Comparison convex probe real-time elastography, acoustic radiation force impulse imaging and transient elastography in the diagnosis of chronic hepatitis B-related liver fibrosis

作　　者：孟彦娜 张娟娟 陈英红 李莹 于艳艳 李志艳[2] MENG Yan-na;ZHANG Juan-juan;CHEN Ying-hong;LI Ying;YU Yan-yan;LI Zhi-yan(Department of Ultrasound,Huaihe Hospital of Henan University,Kaifeng 475000,China;Department of Ultrasound,the 302nd Hospital of PLA)

机构地区：[1]河南省开封市河南大学淮河医院超声科,475000 [2]北京市解放军第302医院超声科

出　　处：《天津医药》2019年第12期1258-1262,共5页Tianjin Medical Journal

基　　金：河南省医学科技攻关项目（182102311206），河南省医学科技攻关项目(172102410008)

摘　　要：目的比较凸振探头实时组织弹性成像(C-RTE)、声辐射力脉冲弹性成像(ARFI)及瞬时弹性成像(TE)评估肝纤维化的诊断效能。方法选取167例慢性乙肝(CHB)患者,分别进行C-RTE、ARFI及TE检查及肝穿刺活检,以病理学结果为金标准。比较病理纤维化分期之间各弹性成像肝硬度检测指标差异,分析C-RTE、ARFI及TE与病理纤维化分期的相关性,构建受试者工作特征(ROC)曲线分析3种成像方法的诊断效能,并采用DeLong法比较不同检测方法的曲线下面积(AUC)。结果除C-RTE及ARFI诊断S0/S1和S3/S4之间,TE诊断S0/S1和S0/S2之间差异无统计学意义(P>0.05),余各组间比较差异均有统计学意义;C-RTE、ARFI及TE与病理肝纤维化分期的相关系数分别为0.72、0.65、0.68(P<0.001);C-RTE、ARFI及TE 3者诊断≥S1、≥S2、≥S3及S4期的曲线下面积分别为0.812、0.917、0.848及0.785;0.824、0.818、0.858及0.822;0.858、0.833、0.876及0.884,最佳临界值分别为1.3、1.74、2及2.64;5.3 kPa、7.2 kPa、8.9 kPa及19.4 k Pa;1.29 m/s、1.71 m/s、1.89 m/s及2.02 m/s;且在≥S2时,C-RTE的诊断效能优于ARFI及TE(Z分别为2.56和2.84,P<0.01)。结论 C-RTE对各级肝纤维化具有较高的诊断价值,值得临床推广。Objective To compare the diagnostic efficacy of convex probe real-time elastography(C-RTE),acoustic radiation force impulse imaging(ARFI) and transient elastography(TE) in evaluating liver fibrosis.Methods One hundred and sixty-seven patients with chronic hepatitis B(CHB) were included in this study.All patients were assessed by C-RTE,ARFI,TE and liver biopsy respectively.The pathological results were used as the gold standard.The correlation coefficient between C-RTE,ARFI,TE and pathological fibrosis stage was analyzed.The areas under receiver operating characteristic curve(AUROC) between the three methods were compared.Results Except for C-RTE and ARFI in the diagnosis of SO/S1,S3/S4,TE in the diagnosis of S0/S1,S0/S2,there were significant differences between other groups.The correlation coefficients bet ween C-RTE,ARFI,TE and liver fibrosis were 0.72,0.65 and 0.68,respectively(P<0.001).The areas under the curves(AUC) of C-RTE,ARFI and TE for diagnosing S≥1,S≥2,S≥3 and S=4 were 0.812,0.917,0.848 and 0.785;0.824,0.818,0.858 and 0.822;0.858,0.833,0.876 and 0.884,respectively.The optimal cut-off values were 1.3,1.74,2 and 2.64;5.3 kPa,7.2 kPa,8.9 kPa and 19.4 kPa;1.29 m/s,1.71 m/s,1.89 m/s and 2.02 m/s,respectively.The diagnostic efficiency of C-RTE was better than that of ARFI and TE,when S≥2,(Z=2.56,2.84,P <0.01).Conclusion C-RTE has higher diagnostic efficiency for liver fibrosis and is worthy of clinical promotion.

关 键 词：诊断 鉴别 弹性成像技术 肝硬化 乙型肝炎 慢性 活组织检查 针吸 

分 类 号：R445.1[医药卫生—影像医学与核医学] R333.4[医药卫生—诊断学]