Multimodal method based on elastography to stage liver fibrosis in chronic hepatitis B patients

doi:10.3877/cma.j.issn.1672-6448.2022.09.018

Abstract

Abstract:

Objective

To investigate the clinical value of combined sound touch elastography (STE) and ultrasonography (US) score in staging liver fibrosis in chronic hepatitis B (CHB) patients.

Methods

A total of 153 CHB patients who underwent liver biopsy were enrolled into liver fibrosis groups (F1-F4 groups) according to the METAVIR grading standard, and 53 healthy volunteers were included as a control group (F0 group). All subjects received STE/STQ, two-dimensional ultrasound, and liver function biochemical index detection. Logistic regression was used to analyze whether STE/STQ and US quantitative scores were in the same order of magnitude. Receiver operating curve (ROC) analysis of STE, STQ, STE combined with US, and STQ combined with US in the diagnosis of liver fibrosis at each stage was performed.

Results

There were statistical differences in the liver STE value and liver STQ value among the F0-F4 groups [liver STE value: (5.71±0.68) kPa vs (6.64±0.96) kPa vs (8.00±1.59) kPa vs (10.14±1.82) kPa vs (13.94±2.83) kPa, F=166.28, P=0.002; liver STQ value: (5.98±1.09) kPa vs (7.01±1.42) kPa vs (8.40±2.54) kPa vs (10.14±1.99) kPa vs (14.91±3.09) kPa, F=123.77, P=0.003]. The spleen STE value only had statistical difference between the liver cirrhosis (F4) group and other groups [(25.69±5.31) kPa vs (16.30±4.29) kPa, (17.04±3.37) kPa, (17.00±3.79) kPa, and (17.41±5.31) kPa; P<0.05]. The ratio of

?

μ_US/μ_STE was close to 1, which means that STE and US quantitative scores were at the same level. According to the area under the ROC (AUROC), STE combined with US quantitative scoring showed the best diagnostic performance: ≥F1 stage liver fibrosis (AUROC: 0.944); ≥F2 stage liver fibrosis (AUROC: 0.955); ≥F3 stage liver fibrosis (AUROC: 0.976). For F4 liver cirrhosis, STQ combined with US quantitative scoring had the best diagnostic performance (AUROC: 0.979).

Conclusion

STE combined with US quantitative scoring shows the best diagnostic ability in different stages of liver fibrosis, while STQ combined with US quantitative scoring has the best performance in diagnosing liver cirrhosis.

Key words: Sound touch elastography, Sound touch quantitation, 2D ultrasound, Chronic hepatitis B, Liver fibrosis

Qinyuan Li, Changfeng Dong, Cheng Feng, Zhiyan Li, Li Liu, Binghao He, Wei Jiang, Wenshuo Tian, Shuai Yang. Multimodal method based on elastography to stage liver fibrosis in chronic hepatitis B patients[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(09): 976-982.

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References 20

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项目	F0组（n=53）	F1组（n=46）	F2组（n=33）	F3组（n=34）	F4组（n=40）
体质量指数（kg/m²）	21.5±2.6	22.9±3.2^a	23.5±3.1^a	24.3±5.2^a	23.9±3.6^a
软组织厚（mm）	13.8±2.8	15.6±3.3^a	16.1±3.5^a	17.9±3.9^abc	16.3±3.6^a
肝右叶斜径（mm）	127.3±8.6	133.1±12.4^a	130.6±9.0	131.0±23.2	127.1±13.5^b
门静脉内径（mm）	10.6±1.2	11.5±3.3^a	11.4±1.1	12.0±1.2	13.1±1.8^abc
脾厚度（mm）	32.4±4.0	32.5±4.7	33.9±3.8	36.0±6.5^a	47.7±8.2^abcd
脾长度（mm）	97.2±14.8	100.0±15.0	100.0±10.2	113.0±18.8^abc	142.8±21.9^abcd
脾静脉内径（mm）	6.2±1.6	5.8±1.3	6.1±1.1	6.5±1.7^b	9.6±2.4^abcd
血小板计数（×10³/mm³）	230±71	221±71	192±51^ab	178±56^abc	99.3±62.4^abcd
白蛋白（U/I）	46.3±2.4	46.5±2.2	45.5±3.4	44.8±2.9^b	42.1±8.3^abcd
球蛋白（U/I）	27.1±3.7	28.8±4.1	28.6±3.4	28.5±3.7	30.6±4.4^a
总胆红素（U/I）	15.8±7.0	17.2±18	16.7±9.6	16.9±7.3	27.7±14.6^abcd
ALT（U/I）	21±11	36±21	35±24	38±19	35.0±19.2^a
AST（U/I）	21±4	27±8	28±11	35±16^abc	37±18^abc
谷氨酰转肽酶（U/I）	34±52	34±22	35±21	49±30	59±48^abc
碱性磷酸酶（U/I）	82±38	67±14	72±20	91±24^b	80±25

项目	F0组（n=53）	F1组（n=46）	F2组（n=33）	F3组（n=34）	F4组（n=40）
体质量指数（kg/m²）	21.5±2.6	22.9±3.2^a	23.5±3.1^a	24.3±5.2^a	23.9±3.6^a
软组织厚（mm）	13.8±2.8	15.6±3.3^a	16.1±3.5^a	17.9±3.9^abc	16.3±3.6^a
肝右叶斜径（mm）	127.3±8.6	133.1±12.4^a	130.6±9.0	131.0±23.2	127.1±13.5^b
门静脉内径（mm）	10.6±1.2	11.5±3.3^a	11.4±1.1	12.0±1.2	13.1±1.8^abc
脾厚度（mm）	32.4±4.0	32.5±4.7	33.9±3.8	36.0±6.5^a	47.7±8.2^abcd
脾长度（mm）	97.2±14.8	100.0±15.0	100.0±10.2	113.0±18.8^abc	142.8±21.9^abcd
脾静脉内径（mm）	6.2±1.6	5.8±1.3	6.1±1.1	6.5±1.7^b	9.6±2.4^abcd
血小板计数（×10³/mm³）	230±71	221±71	192±51^ab	178±56^abc	99.3±62.4^abcd
白蛋白（U/I）	46.3±2.4	46.5±2.2	45.5±3.4	44.8±2.9^b	42.1±8.3^abcd
球蛋白（U/I）	27.1±3.7	28.8±4.1	28.6±3.4	28.5±3.7	30.6±4.4^a
总胆红素（U/I）	15.8±7.0	17.2±18	16.7±9.6	16.9±7.3	27.7±14.6^abcd
ALT（U/I）	21±11	36±21	35±24	38±19	35.0±19.2^a
AST（U/I）	21±4	27±8	28±11	35±16^abc	37±18^abc
谷氨酰转肽酶（U/I）	34±52	34±22	35±21	49±30	59±48^abc
碱性磷酸酶（U/I）	82±38	67±14	72±20	91±24^b	80±25

组别	例数	肝STE	肝STQ	脾STE
F0组	53	5.71±0.68	5.98±1.09	16.30±4.29
F1组	46	6.64±0.96^a	7.01±1.42^a	17.04±3.37
F2组	33	8.00±1.59^ab	8.40±2.54^ab	17.00±3.79
F3组	34	10.14±1.82^abc	10.14±1.99^abc	17.41±5.31
F4组	40	13.94±2.83^abcd	14.91±3.09^abcd	25.69±8.53^abcd
F值		166.28	123.77	21.84
P值		0.002	0.003	0.041

组别	例数	肝STE	肝STQ	脾STE
F0组	53	5.71±0.68	5.98±1.09	16.30±4.29
F1组	46	6.64±0.96^a	7.01±1.42^a	17.04±3.37
F2组	33	8.00±1.59^ab	8.40±2.54^ab	17.00±3.79
F3组	34	10.14±1.82^abc	10.14±1.99^abc	17.41±5.31
F4组	40	13.94±2.83^abcd	14.91±3.09^abcd	25.69±8.53^abcd
F值		166.28	123.77	21.84
P值		0.002	0.003	0.041

分期	AUROC	诊断界值	正确率（%）	敏感度（%）	特异度（%）	阳性预测值（%）	阴性预测值（%）	阳性似然比	阴性似然比
≥F1
STE	0.918	≥5.74	85.02	95.42	55.56	85.88	81.08	2.15	0.08
STQ	0.872	≥5.50	82.35	97.33	40.74	82.02	75.86	1.64	0.07
STE+US	0.944	≥6.54	89.86	94.77	75.93	91.77	83.67	3.94	0.07
STQ+US	0.897	≥6.50	83.57	93.46	55.56	85.63	81.08	2.10	0.11
≥F2
STE	0.948	≥7.24	90.34	89.62	91.09	91.35	89.32	10.06	0.11
STQ	0.904	≥7.28	83.82	87.50	80.00	81.98	97.92	5.11	0.22
STE+US	0.955	≥9.09	90.82	87.74	94.06	93.94	87.96	14.77	0.13
STQ+US	0.920	≥9.38	86.96	84.91	89.11	89.11	86.41	7.80	0.17
≥F3
STE	0.970	≥8.79	91.30	89.04	92.54	86.67	93.94	11.93	0.12
STQ	0.945	≥9.70	87.75	83.33	90.15	82.19	90.30	8.46	0.18
STE+US	0.976	≥12.24	92.27	84.93	96.27	92.54	92.14	22.76	0.16
STQ+US	0.955	≥11.37	90.34	89.04	91.04	84.42	94.88	9.94	0.12
F4
STE	0.969	≥11.24	92.27	90.00	92.81	75.00	97.48	12.53	0.11
STQ	0.974	≥12.11	93.63	82.05	96.36	84.21	95.27	22.56	0.19
STE+US	0.970	≥15.24	93.24	87.50	94.61	79.55	96.93	16.24	0.13
STQ+US	0.979	≥15.05	93.72	90.00	94.61	80.00	98.11	16.70	0.11

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