凸阵探头实时组织弹性成像、声辐射力脉冲弹性成像与瞬时弹性成像诊断慢性乙肝相关肝纤维化程度的比较

目的 比较凸振探头实时组织弹性成像（C-RTE）、声辐射力脉冲弹性成像（ARFI）及瞬时弹性成像（TE）评 估肝纤维化的诊断效能。方法 选取167例慢性乙肝（CHB）患者，分别进行C-RTE、ARFI及TE检查及肝穿刺活检， 以病理学结果为金标准。比较病理纤维化分期之间各弹性成像肝硬度检测指标差异，分析C-RTE、ARFI及TE与病 理纤维化分期的相关性，构建受试者工作特征（ROC）曲线分析3种成像方法的诊断效能，并采用DeLong法比较不同 检测方法的曲线下面积（AUC）。结果 除C-RTE及ARFI诊断S0/S1和S3/S4之间，TE诊断S0/S1和S0/S2之间差异 无统计学意义（P＞0.05），余各组间比较差异均有统计学意义；C-RTE、ARFI及TE与病理肝纤维化分期的相关系数 分别为 0.72、0.65、0.68（P＜0.001）；C-RTE、ARFI 及 TE 3 者诊断≥S1、≥S2、≥S3 及 S4 期的曲线下面积分别为 0.812、 0.917、0.848及0.785；0.824、0.818、0.858及0.822；0.858、0.833、0.876及0.884，最佳临界值分别为1.3、1.74、2及2.64； 5.3 kPa、7.2 kPa、8.9 kPa及19.4 kPa；1.29 m/s、1.71 m/s、1.89 m/s及2.02 m/s；且在≥S2时，C-RTE的诊断效能优于ARFI 及TE（Z分别为2.56和2.84，P＜0.01）。结论 C-RTE对各级肝纤维化具有较高的诊断价值，值得临床推广。

Comparison convex probe real-time elastography,acoustic radiation force impulse imaging and transient elastography in the diagnosis of chronic hepatitis B-related liver fibrosis

Objective To compare the diagnostic efficacy of convex probe real-time elastography (C-RTE), acoustic radiation force impulse imaging (ARFI) and transient elastography (TE) in evaluating liver fibrosis. Methods One hundred and sixty-seven patients with chronic hepatitis B (CHB) were included in this study. All patients were assessed by C-RTE, ARFI,TE and liver biopsy respectively. The pathological results were used as the gold standard. The correlation coefficient between C-RTE, ARFI, TE and pathological fibrosis stage was analyzed . The areas under receiver operating characteristic curve (AUROC) between the three methods were compared. Results Except for C-RTE and ARFI in the diagnosis of S 0/ S1, S3/ S4, TE in the diagnosis of S0/ S1, S0/ S2, there were significant differences between other groups . The correlation coefficients between C-RTE, ARFI, TE and liver fibrosis were 0.72, 0.65 and 0.68, respectively ( P＜0.001). The areas under the curves (AUC) of C-RTE, ARFI and TE for diagnosing S≥1, S≥2, S≥3 and S=4 were 0.812, 0.917, 0.848 and 0.785; 0.824, 0.818, 0.858 and 0.822; 0.858, 0.833, 0.876 and 0.884, respectively. The optimal cut–off values were 1.3, 1.74, 2 and 2.64; 5.3 kPa, 7.2 kPa, 8.9 kPa and 19.4 kPa; 1.29 m/s, 1.71 m/s, 1.89 m/s and 2 .02 m/s , respectively . The diagnostic efficiency of C-RTE was better than that of ARFI and TE, when S≥2, ( Z =2 .56,2.84, P ＜0 .01 ). Conclusion C-RTE has higher diagnostic efficiency for liver fibrosis and is worthy of clinical promotion .