Pitfalls of Liver Stiffness Measurement: A 5-Year Prospective Study of 13,369 Examinations
Pitfalls of Liver Stiffness Measurement: A 5-Year Prospective Study of 13,369 Examinations
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DOI：
10.1002/hep.23425
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发表时间：
2010-03-01
期刊：
影响因子：
13.5
通讯作者：
de Ledinghen, Victor
中科院分区：
文献类型：
--
作者：
Castera, Laurent;Foucher, Juliette;de Ledinghen, Victor
基于瞬时弹性成像（TE、FibroScan）的肝脏硬度测量（ISM）在肝纤维化的无创评估中越来越受欢迎。然而，LSM 也有其局限性，尚未得到彻底评估。我们基于 13,369 次检查（134,239 次注射）前瞻性地调查了 5 年期间 LSM 失败和不可靠结果的频率和决定因素。 LSM 失败被定义为有效射击次数为零，不可靠检查被定义为有效射击次数少于 10 次、四分位距 (IQR)/LSM 大于 30% 或成功率低于 60%。所有检查中 3.1% 发生 LSM 失败（首次检查时为 4% [n = 7261]），并且首次检查时与体重指数 (BMI) 大于 30 kg/m(2) 独立相关（比值比 [OR], 7.5；95% 置信区间 [01, 5.6-10.2；P = 0.0001），操作员经历的检查少于 500 次 (OR 2.5) [1.6-4.0]； = 0.0001);年龄大于 52 岁（OR 2.3 [1.6-3.21；P = 0.0001），以及 2 型糖尿病（OR 1.6 [1.1-2.21；P = 0.009）。另外 15.8% 的病例（首次检查时为 17%）获得了不可靠的结果，并且在首次检查时与 BMI 大于 30 kg/m(2) (OR 3.3 [2.8-4.01; P = 0.0001)、操作员经验少于 500 次检查 (OR 3.1 [2.4-3.91; P = 0.0001)、年龄大于 52 岁年（或 1.8 [1.6-2.1]；P = 0.0001）、女性（OR 1.4 [1.2-1.61，P = 0.0001）、高血压（OR 1.3 [1.1-1.5]；P = 0.003）和 2 型糖尿病（OR 1.2 [1.0-1.5]；P = 0.05）。当在 2835 名患者的亚组中考虑代谢综合征和腰围时，腰围是 LSM 失败和不可靠结果的最重要决定因素。结论：根据我们的经验，近五分之一的病例中肝脏硬度测量结果无法解释。主要原因是肥胖，特别是腰围增加，以及操作人员经验有限。这些结果强调需要对特定患者亚群进行充分的操作员培训和技术改进。 （肝病学 2010；51：828-835。）
Liver stiffness measurement (ISM) based on transient elastography (TE, FibroScan) is gaining in popularity for noninvasive assessment of liver fibrosis. However, LSM has limitations, which have not yet been thoroughly evaluated. We prospectively investigated the frequency and determinants of LSM failure and unreliable results over a 5-year period, based on 13,369 examinations (134,239 shots). LSM failure was defined as zero valid shots, and unreliable examinations were defined as fewer than 10 valid shots, an interquartile range (IQR)/LSM greater than 30%, or a success rate less than 60%. LSM failure occurred in 3.1% of all examinations (4% at first examination [n = 7261]) and was independently associated at first examination with body mass index (BMI) greater than 30 kg/m(2) (odds ratio [OR], 7.5; 95% confidence interval [01, 5.6-10.2; P = 0.0001), operator experience fewer than 500 examinations (OR 2.5 [1.6-4.0]; P = 0.0001); age greater than 52 years (OR 2.3 [1.6-3.21; P = 0.0001), and type 2 diabetes (OR 1.6 [1.1-2.21; P = 0.009). Unreliable results were obtained in a further 15.8% of cases (17% at first examination) and were independently associated at first examination with BMI greater than 30 kg/m(2) (OR 3.3 [2.8-4.01; P = 0.0001), operator experience fewer than 500 examinations (OR 3.1 [2.4-3.91; P = 0.0001), age greater than 52 years (OR 1.8 [1.6-2.1]; P = 0.0001), female sex (OR 1.4 [1.2-1.61, P = 0.0001), hypertension (OR 1.3 [1.1-1.5]; P = 0.003), and type 2 diabetes (OR 1.2 [1.0-1.5]; P = 0.05). When metabolic syndrome and waist circumference were taken into account in a subgroup of 2835 patients, waist circumference was the most important determinant of LSM failure and unreliable results. Conclusion: In our experience, liver stiffness measurements are uninterpretable in nearly one in five cases. The principal reasons are obesity, particularly increased waist circumference, and limited operator experience. These results emphasize the need for adequate operator training and for technological improvements in specific patient subpopulations. (HEPATOLOGY 2010;51:828-835.)