| Objective:Combining serum markers,routine ultrasound diagnosis,transient elastography(TE),linear probe real-time elastography(L-RTE)and liver biopsy to diagnose the value of the convex probe real-time elastography(C-RTE)and shear wave measurement(SWM)in hepatic fibrosis of chronic liver disease.Methods:Two hundred and eighty one hospitalized patients with chronic hepatitis from December 2015 to September 2016 in 302 military hospital were enrolled.All patients underwent liver biopsy,C-RTE,SWM,conventional ultrasound and serological examination.Because some patients did not perform TE examination,so 119 patients were included in the TE,C-RTE and SWM comparative study;Because some patients did not perform the L-RTE examination,so 74 patients were included in the C-RTE and SWM and L-RTE comparative study;Liver biopsy was used as the diagnostic gold standard to conduct the consistency study and statistical analysis.Results:1.The liver fibrosis index(LFI)of C-RTE had a high correlation with the pathological grade of liver fibrosis r = 0.73(p <0.001);the Vs value of SWM had a moderate correlation with the pathological grade of liver fibrosis r = 0.62(p <0.001).2.The study showed that the except for LFI of the C-RTE and Vs of the SWM between S0 and S1,the LFI and Vs between other two groups were different(p<0.05);For LFI,using the cutoff values of 1.3,1.75,2 and 2.25 for diagnosis of S?1,S?2,S?3 and S=4,the corresponding AUROCs were 0.84,0.92,0.83 and 0.83 respectively;and the sensitivity and the specificity of LFI were 86.74%,75%;75%,94.59%;68.48%,85.64%;76.19%,78.95% respectively.For Vs,using the cutoff values of 1.33m/s,1.71m/s,1.89m/s and 2.02m/s for diagnosis of S?1,S?2,S?3 and S=4,the corresponding AUROCs were 0.82,0.8,0.84 and 0.88 respectively;and the sensitivity and the specificity of Vs were 85.3%,75%;64.2%,82.88%;65.22%,90.26%;90.48%,74.44% respectively.Showing that diagnosing S?2,C-RTE had a higher diagnostic efficacy,and C-RTE and SWM had similar diagnostic efficacy when diagnosing S?1,S?3 and S=4.3.The study showed that LFI of C-RTE and Vs of SWM had a moderate positive correlation with inflammation grade,the correlation coefficient(r)was 0.45,0.50 respectively and the difference was statistically significant(p<0.001);The Vs had a low negative correlation with steatosis grade,the correlation coefficient(r)was-0.18,and the difference was statistically significant(p<0.01),But there was no difference between LFI and steatosis grade(p>0.05).4.The study showed that there was no difference between LFI and the distance between the ultrasound probe surface and the liver(p>0.05),but there was a significant difference between Vs and the distance between the ultrasound probe and the liver(p <0.001).The reliability index VsN was classified into three groups,in these groups,there was a significant difference in age,weight,BMI and the distance between the ultrasound probe surface and the liver.When the distance between the ultrasound probe surface and the liver was?20mm and the measuring depth between 30-40 mm,VsN tended to be significantly large(p<0.01);When VsN?50,the distance between the ultrasound probe and the liver?20mm and the measuring depth between 35-40 mm,the Vs values tended to be more reliable and stable(p<0.01).5.The study showed that when comparing TE,C-RTE and SWM,for TE,the except between S0 and S1,S0 and S2,S1 and S2,S3 and S4 stages of liver fibrosis,the values between other two groups were difference.For C-RTE and SWM the except for LFI and Vs between S0 and S1,S3 and S4,the LFI and Vs between other two groups were different(p<0.05).For TE,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.84,0.92,0.83 and 0.83 respectively;and the sensitivity and the specificity of TE were 5.3%,100.0%;73.53%,64.71%;79.49%,77.5%;100.0%,64.29% respectively.For C-RTE,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.91,0.91,0.83 and 0.84 respectively;and the sensitivity and the specificity of C-RTE were 85.47%,100.0%;75.0%,96.08%;69.23%,86.25%;71.43%,94.64% respectively.For SWM,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.76,0.8,0.86 and 0.84 respectively;and the sensitivity and the specificity of SWM were 60.68%,100.0%;66.18%,84.31%;84.62%,72.5%;100.0%,65.18% respectively.Showing that C-RTE and SWM had a higher diagnostic efficacy than TE,and diagnosing S?1 and S?2,C-RTE had a higher diagnostic efficacy than SWM,and C-RTE and SWM had similar diagnostic efficacy when diagnosing S?3 and S?4.6.The study showed that when comparing LFI1 of the C-RTE and Vs of SWM and LFI2 of L-RTE,for the C-RTE,the except for LFI1 between S1 and S2,S2 and S3,S3 and S4 stages of liver fibrosis,the values of LFI1 between other two groups were difference(p<0.05),For SWM,the except for Vs between S0 and S1,S3 and S4 stages of liver fibrosis,the values of Vs between other two groups were significant difference(p<0.01);For the L-RTE,the except for LFI2 between S1 and S2,S3 and S4 stages of liver fibrosis,the values of LFI2 between other two groups were difference(p<0.05).For the C-RTE,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.9,0.76,0.78 and 0.83 respectively;and the sensitivity and the specificity of C-RTE were 92.75%,80.0%;64.71%,86.96%;56.0%,91.84%;88.89%,78.46% respectively.For SWM,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.76,0.85,0.83 and 0.81 respectively;and the sensitivity and the specificity of SWM were 89.86%,60.0%;94.12%,69.57%;76.0%,79.59%;66.67%,86.15% respectively.For the L-RTE,the corresponding AUROCs for diagnosis of S?1,S?2,S?3 and S=4 were 0.96,0.73,0.8 and 0.78 respectively;and the sensitivity and the specificity of L-RTE were 91.30%,100.0%;92.16%,52.17%;92.0%,69.39%;88.89%,61.54% respectively.Showing that diagnosing S?1,the C-RTE and the L-RTE had a higher diagnostic efficacy than SWM,and diagnosing S?2,S?3 and S?4,the C-RTE and the L-RTE had similar diagnostic efficacy;When diagnosing S?2,the SWM had a higher diagnostic efficacy than the C-RTE and the L-RTE;When diagnosing S?3,S=4,the C-RTE,the SWM and the L-RTE had similar and moderate diagnostic efficacy.7.This study showed that in the multivariate linear regression equation,the correlations were found between LFI and the parameters such as age,ALT,TB,AST and ALB(p<0.05),and age had the largest effect on LFI(?=0.217),while TB had the least effect on LFI(?=0.148);The correlations were also found between Vs and the parameters such as gender,AST,ALB,portal trunk inner diameter,portal flow velocity index and spleen long(p<0.05),and spleen long had the largest effect on Vs(?=0.293),while portal trunk inner diameter had the least effect on Vs(?=0.13).Conclusions:1.The LFI of C-RTE and the Vs of SWM increased with the increasing of fibrosis grades;2.Liver steatosis and skin fold thickness had an effect on Vs,in addition,patients in the stage of inflammation could have an effect on LFI and Vs.Therefore,we should combine these parameters into consideration to evaluate the fibrosis grade.3.As a new technique of ultrasound elastography for liver,the diagnostic efficacy of hepatic fibrosis by the C-RTE and SWM was similar to that of the L-RTE.This study is expected to be a new noninvasive method for diagnosis of liver fibrosis and is very important in clinical diagnosis. |
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