The Value Of Shear Wave Elastography In Evaluation Of Liver Transplant Donor

Objective:To investigate the clinical value of shear wave elastography(SWE)combined with conventional ultrasound in the evaluation of donor quality of liver transplantation.Methods:Retrospectively analyze 121 cases of donation after cardiac death(DCD)and donation after brain death(DBD)liver transplantation during February 2014 to October 2017,including DBD 81 cases,DCD 40 cases.The donor of liver transplantation was evaluated by conventional ultrasound examination and the hardness of the donor was evaluated by SWE elastic imaging before the transplantation.The hardness was expressed in modulus(unit:Kpa),and the enumeration data was expressed by x±s.According to the corresponding diagnostic criteria,conventional ultrasound was used to diagnose liver transplant donors.The results were divided into fatty liver,hepatic congestion,liver fibrosis,hepatic necrosis,and normal liver.All donors was diagnosed by rapid intraoperative pathological diagnosis.According to pathological results,donors were divided into 48 experimental groups and 73 control groups.Experimental group was divided into 21 fatty liver(14 mild fatty liver,5 moderate fatty liver,2 severe fatty liver),5 liver fibrosis,18 hepatic congestion,4 hepatic necrosis.(1)The conventional ultrasound diagnosis was compared with the frozen pathological diagnosis and use chi-square test to determine the sensitivity and specificity of conventional ultrasound diagnosis of potential donor liver transplantation.(2)Use t-test to compare the difference in hardness between the experimental group and the control group;Rank sum test was used to compare the difference in hardness between the experimental groups(fatty liver,hepatic fibrosis,hepatic congestion and liver necrosis)and the control group.use rank sum test to compare the difference in hardness between mild fatty 'liver and moderate fatty liver.use rank sum test to compare the difference in hardness between moderate and severe fatty liver.P<0.05 was considered statistically significant.(3)to calculate the area under the curve,the elastic hardness at the highest Youden index was used as the cutoff value to distinguish between liver transplantation donor experimental and normal group(Between the experimental group and the control group,between each experimental group and the control group).Calculate the corresponding sensitivity and specificity.Study the value of SWE elastography in donor liver transplantation combining conventional ultrasound.Results:(1)Conventional ultrasound diagnosis of normal liver,fatty liver,hepatic congestion,hepatic fibrosis,hepatic necrosis were 51,17,15,3,and 3 cases,respectively.Pathological diagnosis of normal liver,fatty liver,hepatic congestion,hepatic fibrosis,and hepatic necrosis were 73,21,18,5,and 4 cases,respectively.Statistical analysis showed that the sensitivity of conventional ultrasound diagnosis of potential donors for liver transplantation was 77.0%,and the specificity was 69.9%.The diagnostic sensitivities of fatty liver,hepatic congestion,hepatic fibrosis,and hepatic necrosis were 80.9%,83.3%,60.0%,and 75.0%,respectively.(2)The hardness of the experimental group is higher than that of the control group(The hardness of the experimental and control groups was 5.55±1.56 Kpa and 3.64±0.70 Kpa,respectively).The difference in hardness between the two was statistically significant(P<0.05).The area under the curve is 0.86.The cutoff value of distinguishing between the experimental group and the control group is 4.07 Kpa.The corresponding sensitivity was 83.3%and the specificity was 79.5%;(3)The hardness of each experimental group is higher than that of the control group.fatty liver,The hardnesses of fatty liver,hepatic fibrosis,hepatic congestion,and hepatic necrosis were 5.5611.43 Kpa,6.67±1.36 Kpa,4.81±1.28 Kpa,and 7.46±1.61 Kpa,respectively.The difference in hardness between each experimental and control groups was statistically significant(P<0.05);The cutoff values for each experimental group(fatty liver group,hepatic congestion group)and control group were 4.07 Kpa and 4.16 Kp,respectively.The corresponding sensitivities were 85.7%and 72.2%,and the specificities were 79.5%and 80.8%,respectively.Hardness of moderate fatty liver group was higher than that of mild fatty liver group,In the medium fatty liver group,the hardness value was 6.36±1.58 Kpa,and in the mild fatty liver group,the hardness value was 5.04±1.13 Kpa.There was no significant difference in hardness between the two(P>0.05);Severe fatty liver has a higher hardness than moderate fatty liver.The hardness of severe fatty liver was 7.27±1.19 Kpa,and that of moderate fatty liver was 6.36±1.58 Kpa.There was no significant difference between the two(P>0.05).Conclusion:Conventional ultrasound examination can evaluate the quality of graft donors.SWE can quantitatively evaluate the liver tissue hardness,and has higher specificity for the identification of lesion group and normal group.SWE combined with conventional ultrasound can be used for non-invasive and quantitative assessment of donor liver transplantation quality,and has high clinical application value.