Comparison of Transient Elastography and Acoustic Radiation Force Impulse for Non-Invasive Staging of Liver Fibrosis in Patients With Chronic Hepatitis C
Comparison of Transient Elastography and Acoustic Radiation Force Impulse for Non-Invasive Staging of Liver Fibrosis in Patients With Chronic Hepatitis C
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DOI：
10.1038/ajg.2011.341
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发表时间：
2011-12-01
影响因子：
9.8
通讯作者：
Camma, C.
中科院分区：
文献类型：
--
作者：
Rizzo, L.;Calvaruso, Vincenza;Camma, C.
目的：瞬态弹性成像（TE）足以诊断肝硬化，但其准确性为轻度阶段的纤维化是令人满意的。本研究的目的是比较的性能和不一致率的声辐射力脉冲（ARFI）和TE与肝活检在一个队列的慢性丙型肝炎（CHC）patients.METHODS：139例连续CHC患者参加了两个三级中心，并评估组织学（Metavir评分）和生化特征。结果：TE不可靠者9例（6.5%），ARFI无效者0例（0%）（P = 0.029）。根据受试者工作特征曲线下面积（AUROC），TE和ARFI显著纤维化（>= F2）的最佳截止值分别为>= 6.5 kPa（AUROC：0.78）和>= 1.3 m/s（AUROC：0.86）。对于重度纤维化（F3-F4），TE的这些截止值为8.8 kPa（AUROC：0.83），ARFI的这些截止值为1.7 m/s（AUROC：0.94）。对于肝硬化，TE的最佳截止值为≥ 11 kPa（AUROC：0.80），ARFI的最佳截止值为≥ 2.0 m/s（AUROC：0.89）。通过AUROC的成对比较，ARFI在诊断显著和严重纤维化方面明显比TE更准确（分别为P = 0.024和P = 0.002），而对于肝硬化，这种差异仅为边缘（P = 0.09）。通过部分AUROC分析，所有三个纤维化阶段的ARFI性能结果显著更高。TE和ARFI与肝活检的平均一致率分别为45.4%和54.7%。通过多变量分析，ARFI与丙氨酸氨基转移酶（ALT），体重指数，Metavir分级和肝脏脂肪变性无关，而TE与ALT值显著相关（P = 0.027）。结论：在CHC患者队列中，ARFI成像在无创性肝纤维化分期方面比TE更准确。
OBJECTIVES: Transient elastography (TE) is adequate for a diagnosis of cirrhosis, but its accuracy for milder stages of fibrosis is much less satisfactory. The objective of this study was to compare the performance and the discordance rate of acoustic radiation force impulse (ARFI) and TE with liver biopsy in a cohort of chronic hepatitis C (CHC) patients.METHODS: One hundred thirty-nine consecutive patients with CHC were enrolled in two tertiary centers, and evaluated for histological (Metavir score) and biochemical features. All patients underwent TE and ARFI.RESULTS: TE was unreliable in nine patients (6.5%), while in no cases (0%) were ARFI invalid measurements recorded (P = 0.029). By area under receiver operating characteristic curve (AUROC), the best cutoff values for TE and ARFI for significant fibrosis (>= F2) were >= 6.5 kPa (AUROC: 0.78) and >= 1.3 m/s (AUROC: 0.86), respectively. For severe fibrosis (F3-F4), these cutoff values were 8.8 kPa (AUROC: 0.83) for TE and 1.7 m/s (AUROC: 0.94) for ARFI. For cirrhosis, TE had its best cutoff at >= 11 kPa (AUROC: 0.80) and ARFI at >= 2.0 m/s (AUROC: 0.89). By pairwise comparison of AUROC, ARFI was significantly more accurate than TE for a diagnosis of significant and severe fibrosis (P = 0.024 and P = 0.002, respectively), while this difference was only marginal for cirrhosis (P = 0.09). By partial AUROC analysis, ARFI performance results significantly higher for all three stages of fibrosis. The average concordance rates of TE and ARFI vs. liver biopsy were 45.4 and 54.7%, respectively. By multivariate analysis, ARFI was not associated with alanine aminotransferase (ALT), body mass index, Metavir grade, and liver steatosis, while TE was significantly correlated with the ALT value (P = 0.027).CONCLUSIONS: In a cohort of patients with CHC, ARFI imaging was more accurate than TE for the non-invasive staging of both significant and severe classes of liver fibrosis.