超声剪切波频散成像技术在肝脏疾病中的应用及研究进展

doi:10.3877/cma.j.issn.1672-6448.2025.10.013

表1 SWD技术在MAFLD中的临床研究

参考文献	研究设计（例数）	研究对象	诊断标准	超声设备	参数（单位）	测量方法	结果/结论
李亚雪等^[13]	前瞻性（255）	138例MAFLD患者及117例健康成人	常规超声	Canon Aplio i900	SWDS（m·s^-1·kHz^-1）	测量部位：肝右叶S5段取样框大小：3 cm×3 cm ROI：肝包膜下1 cm 重复测量5次后取中位数	轻度、中度、重度MAFLD患者的平均SWDS值分别为（14.37±0.95）、（16.90±0.87）、（17.46±0.88）m·s^-1·kHz^-1，SWD诊断不同程度MAFLD的AUC为0.791~0.992，显示出较高的诊断效能
Gao等^[14]	前瞻性（21）	接受MRI-PDFF的成年患者	MRI-PDFF	Canon Aplio i800	SWDS（m·s^-1·kHz^-1）	测量部位：肋间 ROI：1 cm×1 cm 重复测量10次后取平均值	正常肝脏、MAFLD患者SWDS值分别为（10±1.53）、（12.33±0.87）m·s^-1·kHz^-1，与正常肝脏患者相比，MAFLD患者SWDS值显著升高
Platz Batista等^[15]	回顾性（15）	可疑MAFLD的患者	MRI-PDFF	Canon Aplio i800	SWDS（m·s^-1·kHz^-1）	ROI：1 cm×1 cm 重复5~6次后取平均值	在PDFF序列中，3例患者表现为轻度脂肪变性，1例表现为中度脂肪变性，11例未见脂肪变性。以PDFF为金标准，当SWDS以18.5 m·s^-1·kHz^-1为截断值时，可正确识别4例肝脏脂肪变性患者。SWD评估MAFLD的敏感度和特异度分别为75%和90.9%
汪许红等^[16]	回顾性（186）	MAFLD患者	常规超声	东芝 Aplio i800	SWDS（m·s^-1·kHz^-1）	测量部位：离肝包膜2~3 cm处肝右叶 ROI：2 cm×2 cm 重复测量5次后取平均值	SWD对≥S1期和≥S2期脂肪变性的诊断能力较差（AUC分别为0.641和0.621，P＜0.01），对≥S3期脂肪变性的诊断价值不高
D'Hondt等^[17]	前瞻性（48）	接受腹部MRI检查的患儿	MRI-PDFF	Philips Epiq-7G	SWDS（m·s^-1·kHz^-1）	测量部位：右肝 ROI：1 cm×1 cm 测量6次后取平均值	SWDS值在S0~S3期脂肪变性中分别为（13.56±2.64）、（15.68±1.93）、（13.14±0.95）、（15.39±3.99）m·s^-1·kHz^-1，S0期与S1~S3期、S0~S1期与S2~S3期差异均无统计学意义（P＞0.05）
Pirmoazen等^[18]	前瞻性（35）	疑似或确诊的MAFLD患者	MRI-PDFF	Philips Epiq-7	SWDS（m·s^-1·kHz^-1）	测量部位：肝包膜下2 cm	以MRI-PDFF≥6.4%为诊断MAFLD的阈值，正常肝脏与MAFLD的SWDS值分别为（12.94±1.44）、（13.30±1.59）m·s^-1·kHz^-1，二者差异无统计学意义（P＞0.05）

表1 SWD技术在MAFLD中的临床研究

参考文献	研究设计（例数）	研究对象	诊断标准	超声设备	参数（单位）	测量方法	结果/结论
李亚雪等^[13]	前瞻性（255）	138例MAFLD患者及117例健康成人	常规超声	Canon Aplio i900	SWDS（m·s^-1·kHz^-1）	测量部位：肝右叶S5段取样框大小：3 cm×3 cm ROI：肝包膜下1 cm 重复测量5次后取中位数	轻度、中度、重度MAFLD患者的平均SWDS值分别为（14.37±0.95）、（16.90±0.87）、（17.46±0.88）m·s^-1·kHz^-1，SWD诊断不同程度MAFLD的AUC为0.791~0.992，显示出较高的诊断效能
Gao等^[14]	前瞻性（21）	接受MRI-PDFF的成年患者	MRI-PDFF	Canon Aplio i800	SWDS（m·s^-1·kHz^-1）	测量部位：肋间 ROI：1 cm×1 cm 重复测量10次后取平均值	正常肝脏、MAFLD患者SWDS值分别为（10±1.53）、（12.33±0.87）m·s^-1·kHz^-1，与正常肝脏患者相比，MAFLD患者SWDS值显著升高
Platz Batista等^[15]	回顾性（15）	可疑MAFLD的患者	MRI-PDFF	Canon Aplio i800	SWDS（m·s^-1·kHz^-1）	ROI：1 cm×1 cm 重复5~6次后取平均值	在PDFF序列中，3例患者表现为轻度脂肪变性，1例表现为中度脂肪变性，11例未见脂肪变性。以PDFF为金标准，当SWDS以18.5 m·s^-1·kHz^-1为截断值时，可正确识别4例肝脏脂肪变性患者。SWD评估MAFLD的敏感度和特异度分别为75%和90.9%
汪许红等^[16]	回顾性（186）	MAFLD患者	常规超声	东芝 Aplio i800	SWDS（m·s^-1·kHz^-1）	测量部位：离肝包膜2~3 cm处肝右叶 ROI：2 cm×2 cm 重复测量5次后取平均值	SWD对≥S1期和≥S2期脂肪变性的诊断能力较差（AUC分别为0.641和0.621，P＜0.01），对≥S3期脂肪变性的诊断价值不高
D'Hondt等^[17]	前瞻性（48）	接受腹部MRI检查的患儿	MRI-PDFF	Philips Epiq-7G	SWDS（m·s^-1·kHz^-1）	测量部位：右肝 ROI：1 cm×1 cm 测量6次后取平均值	SWDS值在S0~S3期脂肪变性中分别为（13.56±2.64）、（15.68±1.93）、（13.14±0.95）、（15.39±3.99）m·s^-1·kHz^-1，S0期与S1~S3期、S0~S1期与S2~S3期差异均无统计学意义（P＞0.05）
Pirmoazen等^[18]	前瞻性（35）	疑似或确诊的MAFLD患者	MRI-PDFF	Philips Epiq-7	SWDS（m·s^-1·kHz^-1）	测量部位：肝包膜下2 cm	以MRI-PDFF≥6.4%为诊断MAFLD的阈值，正常肝脏与MAFLD的SWDS值分别为（12.94±1.44）、（13.30±1.59）m·s^-1·kHz^-1，二者差异无统计学意义（P＞0.05）

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