河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (8): 956-960.doi: 10.3969/j.issn.1007-3205.2023.08.016

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超声剪切波频散成像术前评估肝细胞肝癌患者肝纤维化的初步临床研究

  

  1. 1.河北省优抚医院功能科，河北 石家庄 050051;2.河北省优抚医院放射科，河北 石家庄 050051;
    3.滨州医学院附属医院超声医学科，山东 滨州  256603

  • 出版日期:2023-08-25 发布日期:2023-08-28
  • 作者简介:温莉（1980-），女，河北石家庄人，河北省优抚医院主治医师，医学学士，从事超声诊断研究。
  • 基金资助:
    河北省邯郸市科技研发计划项目（ 19422083051ZC）

Preliminary clinical study of preoperative evaluation of hepatic fibrosis in patients with hepatocellular carcinoma by shear wave dispersion

  1. 1.Department of Function, the Special Care Hospital of Hebei Province, Shijiazhuang 050051, China; 
    2.Department of Radiology, the Special Care Hospital of Hebei Province, Shijiazhuang 
    050051, China; 3.Department of Ultrasound, the Affiliated Hospital of Binzhou 
    Medical University, Shandong Province, Binzhou 256603, China
  • Online:2023-08-25 Published:2023-08-28

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摘要： 目的 初步探讨超声剪切波频散成像（shear wave dispersion，SWD）术前评估肝细胞肝癌（hepatocellular carcinoma，HCC）患者肝纤维化的临床应用价值。
方法 回顾性收集河北省优抚医院和滨州医学院附属医院拟行肝切除术的HCC患者152例，对距肿瘤病灶＞2 cm处的肝实质行SWD检查获得肝实质的剪切波频散值，测量10次取中位值，术后根据Scheuer标准进行肝实质纤维化分级。采用ROC曲线分析SWD的诊断价值。
结果 术后肝肿瘤周围肝实质纤维化病理分期示S1期13例，S2期31例，S3期47例，S4期61例。肝实质剪切波频散值测值有较好的观察者内及观察者间一致性。剪切波频散值与肝纤维化分期呈正相关（r=0.570，P＜0.001）。S1-S4期肝实质剪切波频散值中位值分别为11.83 m/s·kHz-1，13.58 m/s·kHz-1，15.17 m/s·kHz-1，17.35 m/s·kHz-1,各组肝脏剪切波频散值分布差异有统计学意义（P＜0.05）。SWD诊断≥S2、≥S3、=S 4期的ROC曲线下面积分别为：0.875、0.812、0.784。以12.6 m/s·kHz-1为界值，诊断≥S2期的敏感度为83.70%、特异度为77.78%；以13.4 m/s·kHz-1为界值，诊断≥S3期的敏感度为74.13%、特异度为72.88%；以14.6 m/s·kHz-1为界值，诊断=S4期的敏感度为83.95%、特异度为62.00%。
结论 SWD可无创测量HCC患者肿瘤周围肝实质的剪切波频散值,可以反应肝实质纤维化的程度，为术前定量评估肝纤维化分期提供新方法。


关键词: 肝肿瘤, 肝纤维化, 超声检查

Abstract: Objective To evaluate the clinical application value of shear wave dispersion (SWD) in preoperative evaluation of liver fibrosis in patients with hepatocellular carcinoma (HCC). 
Methods A total of 152 patients with HCC from Special Care Hospital of Hebei Province and the Affiliated Hospital of Binzhou Medical University who planned to undergo hepatectomy were enrolled. SWD of liver parenchyma > 2 cm away from the tumor lesion was performed, and the median value was taken after 10 measurements. Hepatic parenchyma fibrosis was graded according to Scheuer standard, and the diagnostic value of SWD was analyzed by receiver operating characteristic (ROC) curve. 
Results Postoperative pathological examination of liver parenchyma around tumor revealed S1 stage in 13 cases, S2 stage in 31 cases, S3 stage in 47 cases and S4 stage in 61 cases.  The SWD of liver parenchyma showed good intraobserver and interobserver consistency. SWD was positively correlated with liver fibrosis grading (r=0.570, P＜0.001). The median SWD of liver was 11.83 m/s·kHz-1，13.58 m/s·kHz-1，15.17 m/s·kHz-1， and 17.35 m/s·kHz-1 for S1-S4, respectively, and there was significant difference in SWD of the liver among all groups (P＜ 0.05). The areas under ROC curves of SWD in diagnosis at ≥S2, ≥S3,＝S4 stage were 0.875, 0.812 and 0.784, respectively. With 12.6 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of SWD in diagnosing S≥2 were 83.70% and 77.78%, respectively. With 13.4 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of S≥3 were 74.13% and 72.88%, respectively. With 14.6 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of S=4 were 83.95% and 62.00% respectively. 
Conclusion WD can noninvasively measure SWD value of liver parenchyma in HCC patients, which can reflect the degree of liver parenchyma fibrosis, providing a new method for preoperative quantitative evaluation of liver fibrosis stage. 


Key words: liver neoplasms, hepatic fibrosis, ultrasonography 

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