Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis
Ultrasonographic evaluation of liver surface and transient elastography in clinically doubtful cirrhosis
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DOI：
10.1016/j.jhep.2009.12.031
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发表时间：
2010-06-01
影响因子：
25.7
通讯作者：
Bosch, Jaime
中科院分区：
文献类型：
--
作者：
Berzigotti, Annalisa;Abraldes, Juan G.;Bosch, Jaime
背景与目的：瞬时弹性成像（TE）和肝左叶表面（LLS）超声均可无创检测肝硬化（LC）。我们的目的是检查这些方法的诊断价值，在患者的怀疑，但不是一个明确的肝硬化diagnosis of cirrhosis.Methods：我们招募了90例临床怀疑肝硬化和一个强大的共存的鉴别诊断，需要进一步的侵入性评估。他们接受了肝静脉压力梯度（HVPG）测量+/-经颈静脉肝活检、LLS和TE。对LLS图像进行数字后处理，以获得数值（定量LLS，qLLS）。TE = 18 kPa诊断LC，12-18 kPa不确定。技术故障被认为是“不确定的”。肝硬化的诊断由组织学（84%）或临床数据和HVPG >= 10 mm Hg证实。用阳性和阴性似然比（+LR和-LR）评价诊断准确性。TE有14例技术失败，LLS有1例技术失败（p = 0.001）。TE和LLS的诊断准确性相似，但提供了互补信息：TE在排除LC方面比LLS略准确（-LR：0.08 vs. 0.10），而在排除LC方面准确性较低（+LR 5.05 vs. 11.15）。二者联合应用的诊断效能最高（+LR 9.15; -LR 0.06）。结论：LLS比TE更具有技术适用性。在临床怀疑肝硬化的患者中，LLS是诊断肝硬化的最佳非侵入性方法，而TE更适合排除肝硬化。两者的结合具有最佳的诊断准确性。(c)2010年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Both transient elastography (TE) and left lobe liver surface (LLS) ultrasound may non-invasively detect cirrhosis (LC). We aimed to examine the diagnostic value of these methods in patients with a suspicion but not a definite diagnosis of cirrhosis.Methods: We enrolled 90 patients with clinical suspicion of cirrhosis and a strong co-existing differential diagnosis requiring further invasive evaluation. They underwent hepatic venous pressure gradient (HVPG) measurement +/- transjugular liver biopsy, LLS and TE. Images of LLS were digitally post-processed to obtain a numerical value (quantitative LLS, qLLS). TE = 18 kPa diagnosed LC, and 12-18 kPa indeterminate. Technical failures were considered 'indeterminate'. Diagnosis of cirrhosis was confirmed by histology (84%) or by clinical data and HVPG >= 10 mm Hg. Diagnostic accuracy was evaluated by positive and negative likelihood ratios (+LR and -LR).Results: Cirrhosis was diagnosed in 44 patients. There were 14 technical failures with TE and 1 with LLS (p = 0.001). TE and LLS had similar diagnostic accuracy but gave complementary information: TE was mildly more accurate than LLS to rule out LC (-LR: 0.08 vs. 0.10), while it was less accurate to rule it in (+LR 5.05 vs. 11.15). Their combination offered the best diagnostic performance (+LR 9.15; -LR 0.06).Conclusions: LLS is more technically applicable than TE. In patients with clinical suspicion of cirrhosis, LLS is the best non-invasive method to diagnose cirrhosis, while TE is preferable to rule it out. The combination of both holds the best diagnostic accuracy. (c) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.