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Objective:To study the value of sound touch elastography (STE) linear combined with ultrasound score (US) in the diagnosis of chronic hepatitis B (CHB) liver fibrosis, and to investigate whether their combination can improve the diagnostic efficiency of subdividing the degree of CHB liver fibrosis. Furthermore, a comparison with STE linear combined with the serological model was performed to seek the optimal linear combination model.Methods:A total of 313 subjects were enrolled from September 2018 to December 2021 in Shenzhen Third People′s Hospital Affiliated to Guangdong Medical University, including 259 patients with CHB who had completed liver biopsy and 54 healthy volunteers. CHB patients were divided into liver fibrosis group (F1-F4 group) according to METAVIR classification standard, and healthy volunteers were used as the control group. All subjects underwent liver ultrasound examination, STE and blood biochemical indexes of liver function. The US was performed according to the liver ultrasound examination, and the liver stiffness measurement (LSM) was measured by STE, aspartate aminotransferase and platelet ratio index (APRI) was calculated by blood biochemical index. Fisher discriminant analysis was used to establish the linear combination (LC) diagnostic marker of US and LSM, and the linear combination (LC2) diagnostic marker of LSM and APRI, successively. Spearman rank correlation coefficient was used to analyze the correlations between US, LSM, APRI, LC2, LC and pathological results. The ROC curves of US, LSM, APRI, LC2 and LC for diagnosing CHB liver fibrosis were plotted, and the diagnostic efficiency of above diagnostic markers was evaluated according to the accuracy, sensitivity, specificity and area under the ROC curve (AUC).Results:The formula for the linear combination of US and LSM was LC=0.986 0×US+ 0.166 7×LSM, and LC was highly positively correlated with pathological findings ( rs=0.851, P<0.001), higher than US, LSM, LC2 and APRI ( rs=0.825, 0.775, 0.802, 0.586, all P<0.001). LC showed the best diagnostic efficiency. The AUCs for diagnosing ≥F1, ≥F2, ≥F3 liver fibrosis and =F4 cirrhosis were 0.945, 0.911, 0.954, 0.955, respectively, which superior to the AUCs of US (0.913, 0.879, 0.934 and 0.916, respectively), the AUCs of LSM (0.860, 0.871, 0.934 and 0.952, respectively) and the AUCs of LC2(0.899, 0.883, 0.941, 0.946, respectively). Compared with US, the AUC of LC diagnosis of ≥F1, ≥F2, ≥F3 liver fibrosis and =F4 cirrhosis increased by 3.2%, 3.2%, 2.0% and 3.9%, respectively, with all significant differences ( P<0.05). Compared with LSM, the AUC of LC increased by 8.5%, 4.0%, 2.0% and 0.3%, respectively, with significant difference ( P<0.05) except for stage =F4 cirrhosis.Compared with LC2, the AUC of LC increased by 4.6%, 2.8%, 1.3% and 0.9%, respectively, and there were significant differences in the diagnosis of ≥F1 and ≥F2 liver fibrosis ( P<0.05). Moreover, the overall efficiency of LC2 was not significantly improved than LSM, the difference was not significant ( P>0.05). Conclusions:US, LSM, LC2 and LC can be used to diagnose the degree of CHB liver fibrosis, but LC is better than US or LSM and LC2 alone, especially in the subdivision of mild liver fibrosis, which is a promising new diagnostic marker to subdivide the degree of CHB liver fibrosis.
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Objective To explore the value of ultrasound elastography in the non-invasive monitoring of liver elasticity of stable recipients at different stages after liver transplantation. Methods Clinical data of 73 stable recipients after liver transplantation were collected. According to the time after liver transplantation, all patients were divided into the early group (n=25) and medium-to-long group (n=48). In addition, 38 healthy subjects were assigned into the control group. The ultrasound indexes and liver function indexes were statistically compared among each group. The ultrasound elastography indexes of liver and spleen were analyzed, and their correlation with liver function indexes was analyzed. Results Compared with the control group, the ultrasound indexes, alanine aminotransferase (ALT), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were significantly increased in the early group (all P < 0.05), and the ultrasound indexes in the medium-to-long group were significantly increased, whereas the GGT level was significantly decreased (all P < 0.05). Compared with the early group, the right oblique diameter of liver, ALT, GGT and ALP levels were significantly decreased in the medium-to-long group (all P < 0.05). Compared with the control group, the sound touch elastography (STE) and sound touch quantify (STQ) values of liver and STE value of spleen in the early group and medium-to-long group were significantly increased (all P < 0.05). Compared with the early group, the ultrasound elastography indexes of liver and spleen in the medium-to-long group were remarkably decreased (all P < 0.05). The ultrasound elastography indexes of liver were weakly correlated with the ALT, aspartate aminotransferase (AST) and GGT levels, significantly correlated with ALP level. The STE value of spleen was weakly correlated with the ALP level. The STE value of liver was significantly correlated with the STQ value of liver. The STE and STQ values of liver were weakly correlated with the STE value of spleen. Conclusions The characteristics of liver elasticity in stable recipients after liver transplantation are various among different stages. Persistent monitoring of liver elasticity may provide a novelnon-invasive monitoring method during follow-up after liver transplantation.
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Objective To discuss the diagnostic accuracy of 2B-mode feature model in grading the degree of hepatic fibrosis compared to acoustic radiation force impulse (ARFI) and liver biopsy.Methods A total of 140 patients was enrolled in the study and divided into four groups (F1-F4) according to pathological grading using METAVIR scores system,and 47 healthy volunteers were enrolled as the control group (F0) at random.All of subjects underwent standard ultrasound examination and acoustic radiation force impulse (ARFI).Ultrasound raw images were obtained and analyzed with 2B-mode feature intelligent model and then compared to the value of liver stiffness (ARFI).Results The area under the receiver operating characteristic (ROC) curve of grading of liver fibrosis (F2) using 2B-mode feature intelligent model was training =0.973 2,and testing =0.751 1,which was superior to the area under the ROC curve (F2) using ARFI with training =0.840 1,and testing =0.656 4.Conclusions 2B-mode feature intelligent model could be used for grading of liver fibrosis in patients with chronic hepatitis B (CHB).There is great potential in the quantitative diagnosis of liver fibrosis stage using 2B-mode ultrasound.
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Objective To evaluate the value of acoustic radiation force impulse (ARFI) elastography in assessment of nonalcoholic fatty liver disease (NAFLD) and hepatic fibrosis in rats.Methods Models with various degrees of NAFLD severity were conducted in 110 rats by feeding high fat emulsion.The right liver lobe of rat models were processed and embedded in a fabricated gelatin solution to measure the shear wave velocity (SWV) by ARFI.And the other liver lobes were used for histologic assessment.Based on NAFLD activity score (NAS),the final pathologic NAFLD diagnosis were considered as normal group (NAS=0),simple steatosis (SS) group (1≤NAS≤2),borderline (3≤NAS≤4) group and nonalcoholic steatohepatitis (NASH) group (NAS≥5).The diagnostic accuracy of the SWV parameters in evaluating NAFLD severity and fibrosis stages was studied using ROC curves.Results The difference of SWV values among normal group,SS group,borderline group and NASH group was statistically significant (F=31.53,P＜0.001).Taking SWV≥ 2.54 m/s as the diagnostic standard to differentiate normal rats from rats with SS,and SWV≥2.90 m/s to differentiate SS from NASH in rats,the area under ROC curve (AUC) was 0.922 (95％CI [0.871,0.973],P＜0.001) and 0.882 (95％ CI [0.807,0.956],P＜0.001) respectively.The sensitivity and specificity were 93.5 ％ and 100 ％ for differentiating normal and SS groups,83.3 ％ and 84.2 ％ for differentiating SS and NASH groups.Taking SWV≥3.48 m/s as cutoff to predict fibrosis (≥F2 stage),the AUC was 0.963 (95％CI [0.909,1.000],P＜0.001),the sensitivity was 92.9％ and the specificity was 97.6％.Taking SWV≥3.61 m/s as cutoff to predict severe fibrosis (≥F3 stage),the AUC was 0.997 (95％CI [0.990,1.000],P＜0.001),sensitivity was 100％ and specificity was 98.9％.The same high validity was maintained as in the prediction of cirrhosis (F4 stage) with the cutoff as SWV≥4.50 m/s,and the AUC was 0.993 (95％CI [0.982,1.000],P＜0.001),the sensitivity was 100 ％ and the specificity was 96.8％.Conclusion ARFI elastography is a promising method for differentiating the different severity of NAFLD and staging the degree of hepatic fibrosis with NAFLD in rat models.
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Objective To investigate the diagnostic value of the acoustic radiation force impulse (ARFI) imaging technology and AST/PLT ratio index (APRI) for the assessment of the liver fibrosis in non-alcoholic fatty liver disease (NAFLD) patients.Method One hundred and thirty-six patients with NAFLD were included from May 2012 to May 2015 in the Third People's Hospital of Shenzhen.The subjects underwent liver biopsy,liver function and blood count test,as well as real-time ultrasonic elastography examination.The measurements of real-time ultrasonic elastography by ARFI technology used an ultrasonic instrument ACUSON S2000.The APRI was calculated according to the following formula,APRI=AST/PLT.ARFI and APRI were compared by correlation with liver fibrosis stage in NAFLD.Referring to the histologic fibrosis stage on liver biopsy,all the ARFI and the APRI value were assessed by using receiver operating characteristic (ROC) curve analysis.The corresponding cut-off values,sensitivity and specificity were also calculated and compared.One hundred and thirty-six patients with non alcoholic fatty liver disease were included in this study.Both of ARFI and APRI index were measured and calculated,and the results were compared with the pathological examination as gold standard.Results All patients underwent ARFI test.Compared with the patients with S0 and S 1,the ARFI of S4 were decreased significantly and the difference was statistically significant (both P ＜ 0.05).There was no significant difference in APRI index (P ＞ 0.05) among different stages of fibrosis.ROC curve of different diagnosis methods were drawn..The area under the ROC curve of diagnosing S2,S3 and S4 or higher stages nonalcoholic fatty liver disease by ARFI were 0.714,0.765,0.853,and corresponding value of APRI were 0.653,0.577 and 0.611.Compared with the APRI index,the area under the ROC curve of the ARFI technique in evaluating the degree of liver fibrosis in non alcoholic fatty liver disease was increased significantly,and the area under the curve of S4 was the highest.The cut-offARFI index of diagnosing severe hepatic fibrosis was 1.362 m/s.Conclusions As a non-invasive technology,ARFI is more accurate in evaluating liver fibrosis in patients with NAFLD than APRI.ARFI technology has potential value for quantitative evaluation of the liver fibrosis for NAFLD.
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Objective To explore the clinical value of echocardiography in evaluating the cardiovascular safety of drugs for AIDS patients treated by highly active antiretroviral therapy(HAART).Methods 45 HIV-infected patients accepted three times of echocardiography respectively before the treatment,and after 48 weeks of HAART and 96 weeks of HAART.All kinds of echocardiographic parameters were measured.Results There were statistically significant differences among baseline group pretreatment [V-LVOT:( 115.0 ± 13.8 ) cm/s,EDT:(166.8 ± 26.7) cm/s,E':(26.8±6.7)cm/s],48 weeks [V-LVOT:( 113.0 ± 12.9)cm/s,EDT:(172.9±31.0)cm/s,E':(23.8 ±5.0)cm/s] of HAART and96 weeks[V-LVOT:(107.0±13.3)cm/s,EDT:(140.4 ± 19.3)cm/s,E':(22.7±6.4)cm/s]of HAART for parameters of V-LVOT,EDT and E'( all P ＜ 0.05 ),other echocardiographic parameters showed no statistically significant differences(all P＞0.05).Conclusion Short-term of HAART was provided with cardiovascular safety,the invasive echocardiography could accurately evaluate the cardiac function and structure of AIDS patients with HAART.
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Objective To study a kind of quantitative diagnosis method with ultrasound tissue characterization on liver fibrosis of the patients with chronic hepatitis B.Methods Measuring the gray scales of the two dimensional ultrasonography of the patients and compare the gray scales with the fibrosis degrees on histopathology of the patients and finding the differences among every two groups.Results The differences of the gray scales compared with the fibrosis degrees on histopathology were meaningful on statistics( F = 34.3, P