| Objective:1,to verify whether the phase of the breath and the valsalva action have an effect on the elasticity of the liver;2,the effects of liver fibrosis and hepatic venous pressure on the elasticity of liver were investigated by using Budd-Chiari syndrome;3,to explore the value of liver shear wave elasticity in the diagnosis of portal cavernous and hepatic venular occlusive disease.Materials and methods:1,measure the elasticity of the liver after expiratory end,the inspiratory end,the valsalva action instantly,and the valsalva action after 5 seconds.The difference of elastic value between male and female groups and the difference of elasticity between different phases were compared;2,animal experiment:to measure the liver elasticity value of the isolated pig liver at Ocm,20cm,40cm,60cm,80cmH2O,and to analyze the correlation with the venous pressure.Clinical trials:to measure the preoperative,postoperative elastic value and hepatic vein pressure of the patients under ballon angioplasty;the fibrosis classification of patients was obtained by liver biopsy.The changes of elastic value before and after operation,and the relationship between elasticity value and intravenous.pressure and fibrosis were analyzed;3,compare the diagnostic efficacy of conventional ultrasound and conventional ultrasound +SWE in diagnosing cavernous transformation of the portal vein and hepatic venular occlusive disease.The ROC curve was constructed with the spleen/hepatic elastic ratio to the diagnosis of cavernous transformation of the portal vein.The ROC curve of hepatic venular occlusive disease was constructed with liver elastic value,and the area under the curve was calculated respectively,and the sensitivity and specificity were determined by the biggest Youden index.Result:1,there was no statistical difference in the elastic value between the end of expiratory and end of the inspiratory.Five seconds after valsalva action,the elastic value increased significantly.In addition,the male liver elasticity was higher than that of female;2,the elasticity of pig liver was gradually increased with the increase of pressure,and there was a significant positive correlation.The liver elasticity was significantly decreased in 32 patients with Budd-Chiari syndrome treated with balloon dilatation,and the elastic values were 35.17± 10.60kPa,20.15± 5.47kPa(P<0.001)for 2 days before surgery and 2 days after surgery.The correlation coefficient between the elasticity of the liver and the predilated venous pressure was r=0.701(P<0.001).There was no statistically significant correlation between the elasticity of 2 days before the expansion and the degree of fibrosis(r=-0.170,P=0.353),2 days after surgery and the degree of fibrosis(r=0.223,P=0.220).However,the postoperative elasticity difference was negatively correlated with the degree of fibrosis,with significant statistical significance(r=-0.502,P=0.003);3,conventional ultrasonography +SWE had better diagnostic accuracy(94.1%)than conventional ultrasound(85.3%)in diagnosing cavernous transformation of the portal vein.The area under the curve(AUC)was 0.958(P<0.001)with the spleen/liver elasticity ratio as diagnostic criteria.With 5.8 as the diagnostic threshold the sensitivity was 1.00 and the specificity was 0.824.Conventional ultrasound +SWE increased the diagnostic accuracy of hepatic venular occlusive disease from 41.9%of conventional ultrasound to 83.9%(P<0.001).The AUC of hepatic venular occlusive disease with liver elasticity was 0.923(P<0.001).The diagnosis of hepatic venular occlusive disease with liver elastic value of 40.5 was detected with a sensitivity of 75.0%and specificity of 93.3%.Conclusion:It is necessary to maintain a calm breathing during SWE examination,so as to avoid the effect on the accuracy of the results.It was found that that live elastic value of Budd-Chiari syndrome was positively correlated with the venous pressure,but no correlation with hepatic fibrosis.The liver elasticity measurement can be helpful to the diagnosis of Budd-Chiari syndrome,and it is expected to be an effective tool to evaluate the therapeutic effect of Budd-Chiari syndrome and to monitor the recurrence.The elasticity ratio of spleen/liver can provide a certain diagnostic value for the definite diagnosis of cavernous transformation of the portal vein.The elasticity of liver can be used as an important auxiliary means for hepatic venular occlusive disease. |
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