Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis
Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis
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DOI：
10.1111/apt.13841
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发表时间：
2017-01-01
影响因子：
7.6
通讯作者：
Singal, A. G.
中科院分区：
文献类型：
--
作者：
Simmons, O.;Fetzer, D. T.;Singal, A. G.
研究背景腹壁超声未能在肝硬变患者的早期阶段发现超过四分之一的肝细胞癌。目的评价和确定肝硬变患者超声质量的预测因素。方法我们对2015年4月至2015年10月期间因肝硬变相关指征而接受超声检查的患者进行了一项回顾性队列研究。三位受过团契培训的腹部放射科医生共同审查了所有的超声检查，并将检查质量归类为绝对足够、可能足够、可能不充分和绝对不足以排除肝脏病变。结果在941例患者中，191例(20.3%)超声检查不能排除肝细胞癌-134绝对不足和57例可能不足。在多变量分析中，质量不佳与男性(OR 1.68，95%CI 1.14-2.48)、体重指数分类(OR 1.67，95%CI 1.45-1.93)、Child-Pugh B或C级肝硬变(OR 1.93，95%CI 1.32-2.81)、酒精相关性肝硬化(OR 2.11，95%CI 1.33-3.37)、纳什肝硬变(OR 2.87，95%CI 1.71-4.80)和住院状态(OR 1.55，95%可信区间1.01-2.37)。超过1/3的Child-Pugh C级肝硬化症、BMI>；35或NASH肝硬化症患者的超声检查不充分。在容易出现超声检查不足的亚组中，包括肥胖患者、Child Pugh B或C级肝硬化者以及酒精或NASH相关肝硬化者，需要采用替代监测方式。
BackgroundAbdominal ultrasound fails to detect over one-fourth of hepatocellular carcinoma (HCC) at an early stage in patients with cirrhosis. Identifying patients in whom ultrasound is of inadequate quality can inform interventions to improve surveillance effectiveness.AimTo evaluate and identify predictors of ultrasound quality in patients with cirrhosis.MethodsWe performed a retrospective cohort study among patients who underwent ultrasound examination for a cirrhosis-related indication between April 2015 and October 2015. Three fellowship-trained abdominal radiologists collectively reviewed all ultrasound exams and categorised exam quality as definitely adequate, likely adequate, likely inadequate and definitely inadequate to exclude liver lesions. We performed multivariable logistic regression to determine characteristics associated with inadequate ultrasound quality.ResultsAmong 941 patients, 191 (20.3%) ultrasounds were inadequate for excluding HCC-134 definitely inadequate and 57 likely inadequate. In multivariable analysis, inadequate quality was associated with male gender (OR 1.68, 95% CI 1.14-2.48), body mass index category (OR 1.67, 95% CI 1.45-1.93), Child-Pugh B or C cirrhosis (OR 1.93, 95% CI 1.32-2.81), alcohol-related cirrhosis (OR 2.11, 95% CI 1.33-3.37), NASH cirrhosis (OR 2.87, 95% CI 1.71-4.80), and in-patient status (OR 1.55, 95% CI 1.01-2.37). Ultrasounds were inadequate in over one-third of patients with Child-Pugh C cirrhosis, BMI >35, or NASH cirrhosis.ConclusionsOne in five ultrasounds in patients with cirrhosis are inadequate for exclusion of HCC, which can contribute to surveillance failure. Alternative surveillance modalities are needed in subgroups prone to inadequate ultrasounds including obese patients, those with Child Pugh B or C cirrhosis, and those with alcohol-or NASH-related cirrhosis.