切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 398 -401. doi: 10.3877/cma.j.issn.1674-0793.2019.05.015

所属专题： 文献；

论著

声触诊弹性测量与声脉冲辐射力成像检测肝脾硬度的比较研究
王青娟1, 郑剑1,†(), 古日珍1, 姚小虹1, 康斯亮1, 龙乐香1, 周丹1, 王小立2, 郑荣琴2   
  1. 1. 518115　深圳市龙岗区第三人民医院超声科
    2. 510630　广州，中山大学附属第三医院超声科
  • 收稿日期:2019-06-01 出版日期:2019-10-01
  • 通信作者: 郑剑
  • 基金资助:
    深圳市科创委基金资助项目(JCYJ20170307161018414); 广东省科技计划项目(2016A020215 072); 广东省医学科学技术研究基金资助项目(A2016128)

Comparison study of sound touch quantification and acoustic radiation force impulse imaging in measuring liver and spleen stiffness

Qingjuan Wang1, Jian Zheng1,†(), Rizhen Gu1, Xiaohong Yao1, Siliang Kang1, Lexiang Long1, Dan Zhou1, Xiaoli Wang2, Rongqin Zheng2   

  1. 1. Department of Ultrasound, the Third People’s Hospital ofLonggang District, Shenzhen 518115, China
    2. Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2019-06-01 Published:2019-10-01
  • Corresponding author: Jian Zheng
  • About author:
    Corresponding author: Zheng Jian, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

王青娟, 郑剑, 古日珍, 姚小虹, 康斯亮, 龙乐香, 周丹, 王小立, 郑荣琴. 声触诊弹性测量与声脉冲辐射力成像检测肝脾硬度的比较研究[J]. 中华普通外科学文献(电子版), 2019, 13(05): 398-401.

Qingjuan Wang, Jian Zheng, Rizhen Gu, Xiaohong Yao, Siliang Kang, Lexiang Long, Dan Zhou, Xiaoli Wang, Rongqin Zheng. Comparison study of sound touch quantification and acoustic radiation force impulse imaging in measuring liver and spleen stiffness[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(05): 398-401.

目的

对比研究声触诊弹性测量（STQ）和声脉冲辐射力成像（ARFI）检测肝、脾硬度的可行性。

方法

2018年1月至2019年4月间，采用STQ和ARFI技术对71名健康志愿者、深圳市龙岗区第三人民医院收治的99例慢性乙型肝炎患者行肝、脾硬度检测，对比分析两种检测方法的成功率、变异度、操作者内重复性，并对STQ和ARFI的肝、脾硬度测值进行比较。

结果

肝脏STQ、ARFI检测成功率分别为96.5%（164/170）、95.9%（163/170）（χ2<0.001，P=0.996），变异度分别为（6.48±4.72）%、（8.75±5.01）%（t=4.127，P<0.001）；脾脏STQ、ARFI检测成功率分别为94.7%（161/170）、92.9%（158/170） （χ2=0.215，P=0.643），变异度分别为（7.34±4.26）%、（11.04±4.77）%（t=6.282，P<0.001）。正常肝硬度STQ测值为（1.45±0.18）m/s，显著高于ARFI测值（1.15±0.30）m/s（t=7.565，P<0.001）；慢性乙型肝炎患者肝硬度STQ测值为（1.59±0.26）m/s，显著高于ARFI测值（1.24±0.30）m/s（t=14.005，P<0.001）。正常脾硬度STQ测值为（2.31±0.25） m/s，显著高于ARFI测值（1.96±0.45） m/s （t=5.555，P<0.001）；慢性乙型肝炎患者脾硬度STQ测值为（2.33±0.25） m/s，显著高于ARFI测值（2.08±0.42）m/s（t=5.396，P<0.001）。

结论

STQ和ARFI检测肝、脾硬度成功率较高、检测变异度低；与ARFI相比，STQ进一步提高了测值稳定性。STQ与ARFI的测值不能直接等同，在临床应用中需要注意区分。

关键词: 超声检查, 肝炎，乙型，慢性, 脾, 硬度, 声触诊弹性测量, 声脉冲辐射力成像
Objective

To compare sound touch quantification (STQ) and acoustic radiation force impulse imaging (ARFI) in measuring liver and spleen stiffness.

Methods

From January 2018 to April 2019, using STQ and ARFI technology, a total of one hundred and seventy subjects (71 healthy volunteers and 99 patients with chronic hepatitis B) were tested for liver and spleen stiffness. The success rate, variability and measured values of the two techniques were compared.

Results

The success rate of liver STQ and ARFI was 96.5% (164/170) and 95.9% (163/170) (χ2<0.001, P=0.996), and the variability was (6.48±4.72) %and (8.75±5.01) % (t=4.127, P<0.001), respectively. The success rate of spleen STQ and ARFI was 94.7% (161/170) and 92.9% (158/170) (χ2=0.215, P=0.643), and the variability was (7.34±4.26) % and (11.04±4.77) % (t=6.282, P<0.001), respectively. Normal liver STQ and ARFI values were (1.45±0.18) m/sand (1.15±0.30) m/s (t=7.565, P<0.001), and chronic hepatitis B patients were (1.59±0.26) m/s and (1.24±0.30) m/s (t=14.005, P<0.001). The normal spleen STQ and ARFI values were (2.31±0.25) m/sand (1.96±0.45) m/s (t=5.555, P<0.001), and chronic hepatitis B patients were (2.33±0.25) m/s and (2.08±0.42) m/s (t=5.396, P<0.001), respectively.

Conclusions

The success rate of STQ and ARFI is high and the variability is low. Compared with ARFI, STQ further improves the stability of measurement. In addition, the measured values of STQ and ARFI cannot be directly equivalent, which needs to be distinguished in clinical application.

Key words: Ultrasonography, Hepatitis B, chronic, Spleen, Hardness, Sound touch quantification, Acoustic radiation force impulse imaging
图1 声触诊弹性测量（STQ）检测成功标准　呼吸运动指数≥4颗星为检测成功（A），否则为检测不成功（B）
表1 170名受试者肝脏及脾脏STQ和ARFI检测失败原因分析[例(%)]
检测方法 失败 呼吸配合不好 变异度过大 脾脏体积小
肝STQ 6(3.5) 4(2.4) 2(1.2) -
肝ARFI 7(4.1) 3(1.8) 4(2.4) -
脾STQ 9(5.3) 5(2.9) 0(0) 4(2.4)
脾ARFI 12(7.1) 2(1.2) 7(4.1) 3(1.8)
表2 肝脏及脾脏STQ和ARFI的检测变异度和重复性
检测方法 变异度(%) 操作者内重复性(95%CI) 操作者间重复性(95%CI)
肝脏 脾脏 肝脏 脾脏 肝脏 脾脏
STQ 6.48±4.72 7.34±4.26 0.955(0.943~0.965) 0.907(0.882~0.928) 0.938(0.864~0.972) 0.641(0.212~0.836)
ARFI 8.75±5.01 11.04±4.77 0.941(0.925~0.954) 0.929(0.910~0.946) 0.845(0.673~0.926) 0.543(0.057~0.802)
统计值 t=4.127 t=6.282 Z=1.232 Z=1.227 Z=1.721 Z=0.507
P值 <0.001 <0.001 0.218 0.220 0.085 0.612
[1]
Kishimoto R, Kikuchi K, Koyama A, et al. Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers[J]. Eur Radiol, 2019. [Epub ahead of print]
[2]
Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease[J]. Gastroenterology, 2019, 156(6): 1717-1730.
[3]
Wang K, Lu X, Zhou H, et al. Deep learning Radiomics of shear wave elastography significantly improved diagnostic performance for assessing liver fibrosis in chronic hepatitis B: a prospective multicentre study[J]. Gut, 2019, 68(4): 729-741.
[4]
Wong GL, Liang LY, Kwok R, et al. Low risk of variceal bleeding in patients with cirrhosis after variceal screening stratified by liver/spleen stiffness[J]. Hepatology, 2019. [Epub ahead of print]
[5]
Gao Y, Zheng J, Liang P, et al. Liver fibrosis with two-dimensional US shear-wave elastography in participants with chronic hepatitis B: A prospective multicenter study[J]. Radiology, 2018, 289(2): 407-415.
[6]
Castéra L, Foucher J, Bernard PH, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations[J]. Hepatology, 2010, 51(3): 828-835.
[7]
Ferraioli G, Wong VW, Castera L, et al. Liver ultrasound elastography: An update to the world federation for ultrasound in medicine and biology guidelines and recommendations[J]. Ultrasound Med Biol, 2018, 44(12): 2419-2440.
[8]
Hu X, Qiu L, Liu D, et al. Acoustic radiation force impulse (ARFI) elastography for noninvasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis[J]. Med Ultrason, 2017, 19(1): 23-31.
[9]
Zhang L, Xu J, Wu H, et al. Screening breast lesions using shear modulus and its 1-mm shell in sound touch elastography[J]. Ultrasound Med Biol, 2019, 45(3): 710-719.
[10]
European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398.
[11]
Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version)[J]. Ultraschall Med, 2017, 38(4): e16-16e47.
[12]
Lim JK, Flamm SL, Singh S, et al. American Gastroenterological Association Institute guideline on the role of elastography in the evaluation of liver fibrosis[J]. Gastroenterology, 2017, 152(6): 1536-1543.
[13]
Shiha G, Ibrahim A, Helmy A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update[J]. Hepatol Int, 2017, 11(1): 1-30.
[14]
Barr RG, Ferraioli G, Palmeri ML, et al. Elastography assessment of liver fibrosis: society of radiologists in Ultrasound Consensus Conference Statement[J]. Radiology, 2015, 276(3): 845-861.
[15]
Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis[J]. Ultrasound Med Biol, 2003, 29(12): 1705-1713.
[16]
Piscaglia F, Salvatore V, Mulazzani L, et al. Ultrasound shear wave elastography for liver disease. A critical appraisal of the many actors on the stage[J]. Ultraschall Med, 2016, 37(1): 1-5.
[17]
郑剑，吴曼丽，张敏，等. 声触诊弹性成像和声触诊弹性测量检测肝脾硬度重复性研究[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(4): 366-369.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[12] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[13] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[14] 杨天池, 韩威, 邱枫, 祁佳慧. 术中胰腺超声弹性成像在胰腺质地评估中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 646-650.
[15] 肖体先, 刘骞, 宋京海. 乳房外Paget病脾转移一例报告[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 717-719.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号