Three-dimensional microscopic quantitative ultrasound for evaluating hepatitis B related liver cirrhosis

doi:10.3877/cma.j.issn.1674-1358.2019.06.003

Abstract

Abstract:

Objective

To evaluate the diagnosis value of 3D microscopic ultrasound sonography for hepatitis B related liver cirrhosis (LC) and liver function decompensation.

Methods

Total of 270 patients were admitted to the Fourth People’s Hospital of Qinghai Province from January 2016 to December 2017, which were divided into chronic hepatitis B group (102 cases), compensatory LC group (84 cases) and decompensation LC group (84 cases). 3D microscopic ultrasound sonography, 2D shear waved elastography (2D-SWE) and blood routine examination were performed on each patient. Aspartate aminotransferase-to-platelet ratio index (APRI) were calculated. 3D microscopic ultrasound sonography scores, 2D-SWE scores and APRI were compared among the three groups, respectively. Receptor operation curves were built to compare the predictive values of 3D microscopic ultrasound sonography scores, 2D-SWE scores and APRI for LC and for liver function decompensation of LC patients.

Results

The score of 3D microscopic ultrasound sonography and liver hardness among the three groups were significantly different (F = 313.52, 173.36; both P < 0.001). The area under receptor operation curve (AUROC) of 3D microscopic ultrasound sonography for predicting cirrhosis was 0.925 (95%CI: 0.885-0.965, P < 0.001); with the cut-off value of 11.5 scores, the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting cirrhosis were 85.7% and 90.2%, respectively. The AUROC of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis was 0.850 (95%CI: 0.795-0.905, P < 0.001). With the cut-off value of 16.5 scores, the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis were 60.7% and 89.3%, respectively.

Conclusions

A quantitative diagnostic standard based on 3D microscopic ultrasound sonography was established in this study, which could be used in the auxiliary diagnosis of LC and liver function decompensation.

Key words: Ultrasound sonography, Shear-wave elastography, Liver cirrhosis, Chronic hepatitis B

Jinhuan Wang, Guoying Yu, Hongmei Zu, Xiulan Yang, Jianying Guo, Ruihua Ding, Yuhua Pang, Song Yang. Three-dimensional microscopic quantitative ultrasound for evaluating hepatitis B related liver cirrhosis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(06): 472-477.

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References 25

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项目	1分	2分	3分	4分
肝实质回声	细颗粒状	粗颗粒状	窄条纹状	宽条纹状或网格状
胆囊壁	光滑	稍毛糙	毛糙	略增厚
肝包膜	被膜细平整	轻度增厚、回声增强	肝被膜增厚、呈细水纹状、欠平整	被膜明显增厚、节段状不连续或锯齿状
肝静脉管壁	细而光滑	稍增厚	厚或毛糙	不光滑呈小波纹状
三维显微超声肝实质图像	单个、不规则多面形高回声区，分布较均匀，其周围可见肝间隔与肝间隙图像。	多个不规则片状、岛屿状高回声，相对均匀，无结节，可见粗细较规则，边缘光整的管壁回声及肝间隙图像，且间隙小	片状、条索状高回声区增多，间隙不规则增宽，肝静脉内壁不光整，可见结节	片状、条索状高回声区，分布较密集；低回声区扩大，条索状高-低回声区纵横交错，低回声结节增多

项目	1分	2分	3分	4分
肝实质回声	细颗粒状	粗颗粒状	窄条纹状	宽条纹状或网格状
胆囊壁	光滑	稍毛糙	毛糙	略增厚
肝包膜	被膜细平整	轻度增厚、回声增强	肝被膜增厚、呈细水纹状、欠平整	被膜明显增厚、节段状不连续或锯齿状
肝静脉管壁	细而光滑	稍增厚	厚或毛糙	不光滑呈小波纹状
三维显微超声肝实质图像	单个、不规则多面形高回声区，分布较均匀，其周围可见肝间隔与肝间隙图像。	多个不规则片状、岛屿状高回声，相对均匀，无结节，可见粗细较规则，边缘光整的管壁回声及肝间隙图像，且间隙小	片状、条索状高回声区增多，间隙不规则增宽，肝静脉内壁不光整，可见结节	片状、条索状高回声区，分布较密集；低回声区扩大，条索状高-低回声区纵横交错，低回声结节增多

组别	例数	男/女（例）	平均年龄（±s，岁）	ALT [M（P25，P75），U/L]	AST [M（P25，P75），U/L]	TBil [M（P25，P75），μmol/L]
CHB组	102	76/26	41.03 ± 12.82	43.00（27.00，77.25）	40.30（26.75，68.75）	17.90（13.88～25.45）
代偿期LC组	84	66/18	44.96 ± 10.37	57.00（37.00，101.50）	44.00（35.00，69.75）	23.60（14.55～35.98）^a
失代偿期LC组	84	63/21	49.14 ± 13.39	38.00（25.75，57.25）^b	43.35（31.85，61.50）	3.00（19.55～53.00）^ab
统计量	?	χ² = 0.473	F = 10.105	H = 13.209	H = 5.224	H = 30.076
P值	?	0.789	< 0.001	< 0.001	0.073	< 0.001

组别	例数	男/女（例）	平均年龄（±s，岁）	ALT [M（P25，P75），U/L]	AST [M（P25，P75），U/L]	TBil [M（P25，P75），μmol/L]
CHB组	102	76/26	41.03 ± 12.82	43.00（27.00，77.25）	40.30（26.75，68.75）	17.90（13.88～25.45）
代偿期LC组	84	66/18	44.96 ± 10.37	57.00（37.00，101.50）	44.00（35.00，69.75）	23.60（14.55～35.98）^a
失代偿期LC组	84	63/21	49.14 ± 13.39	38.00（25.75，57.25）^b	43.35（31.85，61.50）	3.00（19.55～53.00）^ab
统计量	?	χ² = 0.473	F = 10.105	H = 13.209	H = 5.224	H = 30.076
P值	?	0.789	< 0.001	< 0.001	0.073	< 0.001

组别	例数	三维显微定量超声（±s，分）	2D-SWE （±s，kPa）	APRI指数[M（P25，P75）]
CHB组	102	9.62 ± 1.93	7.48 ± 1.62	0.81（0.40，1.44）
代偿期LC组	84	14.08 ± 2.25	15.45 ± 5.94	1.18（0.68，2.07）^a
失代偿期LC组	84	17.54 ± 2.33	23.24 ± 8.25	1.44（0.77，2.63）^a
统计量	?	F = 313.520	F = 173.360	H = 22.355
P值	?	< 0.001	< 0.001	< 0.001

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