Accuracy of routine clinical ultrasound for staging of liver fibrosis.
Accuracy of routine clinical ultrasound for staging of liver fibrosis.
复制标题
DOI：
10.4103/2156-7514.101000
复制
发表时间：
2012
影响因子：
0.9
通讯作者：
Siew EP
中科院分区：
文献类型：
--
作者：
Choong CC;Venkatesh SK;Siew EP
探讨常规临床超声对慢性病毒性肝炎肝纤维化分期的诊断准确性。回顾性分析156例慢性病毒性肝炎肝活检患者的超声图像。两名放射科医生在对活检结果和临床细节不知情的情况下，对肝纤维化的超声图像进行了评估。阅片者专门评估了三个特征-表面结节性、肝脏边缘和实质回声纹理-评分为0 - 3（0 =正常，1 =轻度，2 =中度，3 =重度）。以组织病理学为参考标准，确定每种超声特征检测轻度纤维化及以上（≥F1）、显著纤维化（≥F2）、重度纤维化（≥F3）和肝硬化（F4）的准确性。99例患者存在纤维化（F1=34，F2=20，F3=22和F4=23），57例患者不存在纤维化。表面结节、肝脏边缘和实质回声纹理检测显著纤维化的灵敏度分别为57%、15%和41%。对肝脏表面≥F1、≥F2、≥F3和F4分期的检测准确率分别为50.5%、59%、59%和65%，对肝脏边缘的检测准确率分别为51%、53%、54%和55%，对实质回声纹理的检测准确率分别为58%、59%、63%和63%。所有三个特征的综合评分检测≥F1、≥F2、≥F3和F4的准确度分别为56%、59%、62%和66%。常规临床超声不是慢性病毒性肝炎早期纤维化的敏感预测指标。表面结节是检测显著纤维化的最敏感的超声特征，常规临床超声对检测肝硬化最有用。
To determine the diagnostic accuracy of routine clinical ultrasound in the staging of liver fibrosis in chronic viral hepatitis. A retrospective evaluation of the ultrasound images of 156 patients with chronic viral hepatitis who underwent liver biopsy was performed. Two radiologists in consensus, blind to the biopsy results and clinical details, evaluated the ultrasound images for liver fibrosis. The readers specifically assessed three features — surface nodularity, liver edge, and parenchymal echotexture — with scores of 0 to 3 (0 = normal, 1 = mild, 2 = moderate, 3 = severe). Accuracies of each sonographic feature for the detection of mild fibrosis and above (≥F1), significant fibrosis (≥F2), severe fibrosis (≥F3), and cirrhosis (F4) were determined with histopathology as the reference standard. Fibrosis was present in 99 patients (F1=34, F2=20, F3=22, and F4=23) and absent in 57 patients. The sensitivities for the detection of significant fibrosis with surface nodularity, liver edge, and parenchymal echotexture were 57%, 15%, and 41%, respectively. The accuracies for the detection of ≥F1, ≥F2, ≥F3, and F4 stages were 50.5%, 59%, 59%, and 65% for liver surface, 51%, 53%, 54%, and 55% for liver edge, and 58%, 59%, 63%, and 63% for parenchyma echotexture, respectively. The combined scores from all three features had accuracies of 56%, 59%, 62%, and 66% for the detection of ≥F1, ≥F2, ≥F3, and F4, respectively. Routine clinical ultrasound is a not a sensitive predictor of early fibrosis in chronic viral hepatitis. Surface nodularity is the most sensitive sonographic feature for the detection of significant fibrosis and routine clinical ultrasound is the most useful for the detection of cirrhosis.