American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases
American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases
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DOI：
10.1053/j.gastro.2017.03.016
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发表时间：
2017-05-01
期刊：
影响因子：
29.4
通讯作者：
Falck-Ytter, Yngve T.
中科院分区：
文献类型：
--
作者：
Singh, Siddharth;Muir, Andrew J.;Falck-Ytter, Yngve T.
慢性肝病（CLD），由慢性丙型肝炎引起；乙型肝炎；非酒精性脂肪肝（NAFLD）；和酒精性肝病是全球发病和死亡的主要原因。早期识别进展为肝脏相关并发症高风险的肝硬化患者可能有助于及时护理并改善预后。由于与肝活检等侵入性检查相关的风险和错误分类，用于肝纤维化评估的无创成像方式已越来越受欢迎。因此，美国胃肠病学协会优先考虑了弹性成像在慢性肺病中的作用的临床指南，重点关注振动控制瞬时弹性成像（VCTE）和磁共振弹性成像（MRE）。为了为这些临床指南提供信息，当前的技术审查是根据诊断准确性研究的建议评估、制定和评价分级 (GRADE) 框架制定的。本技术综述解决了与以下相关的重点问题：(1) VCTE 和 MRE 相对于非专有的基于血清的纤维化标志物的诊断性能比较，用于检测丙型肝炎病毒 (HCV)、乙型肝炎病毒 (HBV)、NAFLD 和酒精性肝病患者的肝硬化； (2) 特定 VCTE 定义的肝脏硬度截止值作为测试替代策略（替代肝活检）在 CLD 患者管理中做出关键决策时的表现； (3) 将特定的 VCTE 定义的肝脏硬度截止值作为分类测试来识别具有高风险食管静脉曲张 (EV) 或具有临床显着门静脉高压的可能性较低的患者（用于术前风险分层）。本技术综述不涉及用于评估纤维化（例如声辐射力脉冲成像或剪切波弹性成像）或脂肪变性（受控衰减参数或磁共振成像估计质子密度脂肪分数）的其他非侵入性方式的性能。
Chronic liver diseases (CLDs), due to chronic hepatitis C; hepatitis B; nonalcoholic fatty liver diseases (NAFLD); and alcoholic liver disease, are a leading cause of morbidity and mortality globally. Early identification of patients with cirrhosis at high risk of progression to liver-related complications may facilitate timely care and improve outcomes. With risks and misclassification associated with invasive tests, such as liver biopsy, noninvasive imaging modalities for liver fibrosis assessment have gained popularity. Therefore, the American Gastroenterological Association prioritized clinical guidelines on the role of elastography in CLDs, focusing on vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE). To inform these clinical guidelines, the current technical review was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework for diagnostic accuracy studies. This technical review addresses focused questions related to: (1) comparative diagnostic performance of VCTE and MRE relative to nonproprietary, serum-based fibrosis markers for detection of cirrhosis in patients with hepatitis C virus (HCV), hepatitis B virus (HBV), NAFLD, and alcoholic liver diseases; (2) performance of specific VCTE-defined liver stiffness cutoffs as a test replacement strategy (to replace liver biopsy) in making key decisions in the management of patients with CLDs; and (3) performance of specific VCTE-defined liver stiffness cutoffs as a triage test to identify patients with low likelihood of harboring high-risk esophageal varices (EVs) or having clinically significant portal hypertension (for presurgical risk stratification). This technical review does not address performance of other noninvasive modalities for assessing fibrosis (eg, acoustic radiation force pulse imaging or shear wave elastography) or steatosis (controlled attenuation parameter or magnetic resonance imagingLestimated proton density fat fraction).