| Abstract | Uvod i cilj: Supersonic Shear Wave Shear elastografija ( SWE ) je nova ultrazvučna metoda kvantitativne elastografije u stvarnom vremenu za neinvazivnu procjenu fibroze jetre (FJ) u bolesnika s kroničnim virusnim hepatitisom ( KVH ) . Cilj ovog rada bio je istražiti je moguće razlikovati stadije FJ u bolesnika s KVH pomoću SWE. ----- Bolesnici i metode: U studiju su uključeni bolesnici s KVH B ili C kojima je rađena SWE jetre (SWEJ) na ultrazvučnom aparatu Aixplorer firme Supersonic Imagine. Mjerenja su vršena interkostalnim pristupom na desni režnanj jetre, uz zadržavanje daha u ekspiriju, te je provedeno 5 mjerenja u svakog bolesnika. Bolesnici s vrijednostima ALT > 3x iznad gornje granice normale, kolestazom i kongestijom jetre nisu bili uključeni u studiju. Tvrdoća jetre (TJ) izražena je u kPa kao prosjek 5 mjerenja i uspoređena sa patohistološkim stadijem FJ (prema Ishakovoj klasifikaciji) dobivenim biopsijom jetre (BJ). Težina FJ klasificirana je kao blaga (F0-2), umjerena (F3-4) ili teška (F5-6, odnosno kompenzirana ciroza). U podskupini bolesnika s dekompenziranom cirozom dijagnoza se temeljila na kliničkim, biokemijskim, ultrazvučnim i endoskopskim kriterijima, te su ovi pacijenti zasebno analizirani. ----- Rezultati: Od 105 bolesnika s KVH B (N=24) i C (N=81) SWEJ uspješno je provedena u 82 bolesnika (neuspjeh mjerenja 22 %). Nije bilo značajnijih razlika u etiologiji i spolu između bolesnika s blagom, umjerenom i teškom fibrozom, dok su bolesnici u višim stadijima fibroze bili značajno stariji (36,5 vs 43,4 vs 58,6 godina, p < 0,001 ). Tvrdoća jetre bila je značajno različita između skupina : 6,3 vs 10,0 vs 16,2 kPa u bolesnika s blagom, umjerenom i teškom fibrozom (p<0,001). Prijelomne vrijednosti za stadije fibroze F ≥ 3 i F ≥ 5 bile su redom 8,1 kPa (senzitivnost 95,5 %, specifičnost, 100 %, AUC 0,993) i 11 kPa (senzitivnost 87%, specifičnost 92,7%, AUC 0,955). Tvrdoća jetre je bila također značajno različita između bolesnika s kompenziranom (Ishak F5-6) i dekompenziranom cirozom (16,2 vs 33,7 kPa, p< 0.001; prijelomna vrijednost 25,2 kPa, senzitivnost 88,9%, specifičnost 95,7%, AUC 0,953). U 46 bolesnika izmjerena je i tvrdoća slezene (TS), te je nađena značajna razlika između necirotičnih stadija fibroze (F0-4) i kompenzirane ciroze (F5-6) ( 21,2 vs 26,7 kPa, p=0,001; prijelomna vrijednost 24 kPa, senzitivnost 66,7%; specifičnost 85%, AUC 0,795), kao i između kompenzirane i dekompenzirane ciroze (26,7 vs 37,0 kPa, p=0,001; prijelomna vrijednost 38 kPa, senzitivnost 54,6 %, specifičnost 100 %, AUC 0,845). ----- Zaključak: Metoda SWE pokazala se vrlo pouzdanom za neinvazivnu procjenu težine FJ u bolesnika s KVH. Tvrdoća jetre i tvrdoća slezene bile su značajno različite između bolesnika s kompenziranom cirozom i necirotičnim stadijima fibroze, kao i između bolesnika s kompenziranom i dekompenziranom cirozom uz bolju izvedivost SWE jetre. |
| Abstract (english) | Background and aim: Supersonic Shear wave elastography (SWE) is new quantitative real-time ultrasound based elastography method for non-invasive assessment of liver fibrosis (LF) in patients (pts) with chronic viral hepatitis (CVH) with only preliminary results on its clinical performance published so far. We aimed to investigate if it was possible to distinguish between the LF stages by using SWE in pts with CVH. ----- Patients and methods: Naive CVH B or C fasting pts underwent SWE of the liver (SWEL) on Aixplorer Ultrasound system (SuperSonic Imagine), by intercoastal approach on the right liver lobe following expiration, with 5 measurement performed per patient. Patients with ALT values >3x ULN, cholestasis and liver congestion were not included in the study. The result were expressed in kPa as the average of 5 measurements and compared to LF stage as assessed by liver biopsy (LB). The LF was classified as mild (Ishak stages F0-2), moderate (F3-4) or severe (F5-6, i.e. compensated cirrhosis). In a subgroup of patients with decompesated cirrhosis the diagnosis relied upon clinical, biochemical, ultrasound and endoscopic criteria and these pts were analysed separatelly. ----- Results: Out of 105 pts with CVH B (N=24) and C (N=81) SWEL was succesfully performed in 82 pts (failure rate 22%). There were no significant differencies in ethiology and gender between the pts with mild, moderate and severe fibrosis, while the later group was signifficantly older (36,5 vs 43,4 vs 58,6 years respectivelly; p<0,001). Liver stiffness (LS) as assessed by SWE was signifficantlly different between the groups: 6,3 vs 10,0 vs 16,2 kPa for mild, moderate and severe fibrosis respectivelly (p<0,001). Cut-off values for Ishak F≥3 and F≥5 were 8,1 (sens. 95,5%, specif. 100%, AUC 0,993) and 11 kPa (sens. 87%, specif. 92,7%, AUC 0,955). LS was significantlly different between the pts with compensated (Ishak F5-6) and decompensated cirrhosis (16,2 vs 33,7 kPa, p<0,001; cut-off 25,2, sens. 88,9%, specif. 95,7%, AUC 0,953). In 46 pts spleen stiffness (SS) was also assessed by SWE and signifficant difference was observed between the non-cirrhotic LF stages (F0-4) and compensated cirrhosis (F5-6) (21,2 vs 26,7 kPa, p=0,001; cut-off 24 kPa, sens.66,7% specif. 85%, AUC 0,795) as well as compensated vs decompensated cirrhosis (26,7 vs 37,0 kPa, p=0,001; cut-off 38kPa, sens. 54,6%, specif. 100%, AUC 0,845). ----- Conclusion: The performance of Supersonic SWE for non-invasive assesment of LF in CVH pts was excellent especially for differentiation between the mild and more advanced stages of LF. Both LS and SS were significantly different between the compensated cirrosis and non-cirrhotic stages of LF, as well as between the compensated and decompensated cirrhosis with better performance of liver SWE. |
