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发布于:2017-11-24 06:26:25  访问:215 次 回复:0 篇
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Introduction
In patients with chronic Cy3.5 maleimide (CHB) infection, evaluating the degree of liver fibrosis is important in determining their medical management and prognosis. As fibrosis progresses, there is increasing portal hypertension, loss of liver function and a higher risk of hepatocellular carcinoma. Liver biopsy (LB) is still considered the reference standard in the evaluation of liver fibrosis (Bravo et?al. 2001). However, LB is an invasive procedure and may occasionally cause severe complications, limiting its use for screening and frequent follow-up (Yoshioka and Hashimoto, 2012). Tracking not only the progression, but also the regression of liver fibrosis over?time could be of clinical significance. Therefore, considerable effort has been extended to develop non-invasive methods for the staging of liver fibrosis.
Transient elastography (TE) is a non-invasive method for staging liver fibrosis that evaluates liver stiffness by measuring the velocity of shear waves in the liver parenchyma generated by a mechanical push. TE is the oldest and most validated elastographic method used to assess liver fibrosis and has been recommended as a non-invasive method for the staging of hepatic fibrosis by the clinical practice guidelines of the European Association for the Study of the Liver 2012 (Myers et?al. 2012; Trembling et?al. 2014). However, TE can be difficult in obese patients or those with a narrow intercostal space and cannot technically be performed in patients with ascites (Cosgrove et?al. 2013).
Two-dimensional shear wave elastography (2-D SWE) is a newer ultrasound elastography technique based on shear waves that is available on a clinical diagnostic ultrasound scanner (Muller et?al. 2009). Like TE, 2-D SWE can measure liver stiffness based on shear wave velocity estimation, which is used to calculate Young\‘s modulus (Bamber et?al. 2013). Unlike TE, 2-D SWE can be conveniently performed using a conventional ultrasound scanner and can create a real-time, 2-D quantitative map of liver tissue stiffness under the guidance of very high frame rate B-mode imaging (Shiina et?al. 2015). Two-dimensional SWE has proven to be a reliable method for the non-invasive evaluation of liver stiffness (Ferraioli et?al. 2012, 2015; Gerber et?al. 2015; Hudson et?al. 2013; Woo et?al. 2015). Mutual validation or interchangeability among the two ultrasound elastography techniques may be important for patient care because different imaging techniques are frequently used to monitor disease progression in patients with chronic liver disease, and the results of both techniques can be expressed in kilopascals. Most published studies concerning the use of TE and other ultrasound elastographic techniques have focused on hepatitis C virus-related fibrosis. There have been few published studies comparing 2-D SWE and TE in the assessment of liver fibrosis with histologic confirmation in patients with CHB infection (Leung et?al. 2013; Zeng et?al. 2014).


Methods


Results
Two hundred ninety-seven patients were eligible for the study during the recruitment period. Forty patients were not included based on the exclusion criteria, including 4 patients younger than 18?y, 1 patient who declined to provide consent, 27 patients with biopsy samples less than 15?mm long or with fewer than six portal tracts under the microscope, 7 patients undergoing antiviral therapy and 1 patient with a liver transplant. Thus, direct comparisons of 2-D SWE and TE with a reliable reference standard were obtained in 257 patients. No patients with ascites were included in spinal cord study. Patient characteristics are summarized in Table?1.


Discussion
In this study, we examined the mutual validation of 2-D SWE and TE and evaluated the rates of reliable LSMs and the diagnostic accuracy of the two examinations in patients with CHB infection. The rates of successful measurements with TE (96.9%) and 2-D SWE (99.2%) did not significantly differ (p?=?0.117). The rates of reliable measurements were also high in our study, reaching 93.0% and 98.1% for TE and 2-D SWE, respectively. Our result regarding the rate of successful measurements of 2-D SWE was similar to that reported in a previous study on 2-D SWE in patients with CHB infection (98.9%) (Leung et?al. 2013). Two-dimensional SWE had a significantly higher success rate of reliable measurements than TE, which might have been due to the advantage of real-time B-mode imaging guidance in 2-D SWE.
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