Analiza odnosa tvrdoće jetre i slezene metodom kvantitativne ultrazvučne elastografije u bolesnika s cirozom

master's thesis

• Title (english): Analysis of liver and spleen stiffness in patients with liver cirrhosis by quantitative ultrasonography elastography
• Author: Ida Tješić-Drinković
• Mentor: Ivica Grgurević (mentor)
• Committee member: Tajana Filipec Kanižaj (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Ivica Grgurević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Ciroza je završni stadij kroničnih jetrenih bolesti različite etiologije. Njen tijek i
komplikacije ovise o očuvanosti jetrene funkcije i stupnju portalne hipertenzije (PH).
U posljednje vrijeme raste interes za ultrazvučnom elastografijom kao neinvazivnom
metodom za procjenu stadija ciroze i postojanja njenih komplikacija.
Cilj istraživanja je utvrditi mogu li se na temelju tvrdoće jetre (LS) i slezene (SS)
razlikovati pacijenti s kompenziranom i dekompenziranom cirozom, te mogu li se tim
metodama otkriti komplikacije PH-e poput ascitesa i ezofagealnih varikoziteta (EV).
LS-e i SS-e izmjerene su metodom dvodimenzionalne ultrazvučne elastografije u
stvarnom vremenu (RT-2D-SWE) na uređaju Aixplorer®, proizvođača Supersonic
Imagine, u 111 pacijenata s dokazanom cirozom jetre različite etiologije. Mjerenja su
uspoređena s kliničkim Child-Turcotte-Pugh (CTP) stadijem, prisutnošću EV-ta i
ascitesa.
Uočena je značajna korelacija između LS i SS u svih bolesnika, koja je bila najjača u
stadiju CTP A (r=0,662; p<0,001). Utvrđena je značajna razlika u LS i SS između
pacijenata s različitim kliničkim stadijima ciroze (p<0,001). Prijelomna vrijednost za
razlikovanje kompenzirane od dekompenzirane ciroze iznosila je 31 kPa za LS
(površina ispod krivulje, engl. Area under the ROC curve-AUC 0,857) i 35 kPa za SS
(AUC 0,782). Utvrđena je i značajna razlika LS i SS između bolesnika sa i bez EV-ta
(p<0,001) uz prijelomnu vrijednost 24 kPa za LS (AUC 0,747) i 31 kPa za SS (AUC
0,797). Značajna razlika u LS i SS postojala je i između bolesnika sa i bez ascitesa
(p<0,001) uz prijelomnu vrijednosti 31 kPa za LS (AUC 0,843) i 35 kPa za SS (AUC
0,785).
Temeljem ovih rezultata zaključuje se da je RT-2D-SWE korisna metoda za
razlikovanje kompenzirane od dekompenzirane ciroze, te procjenu prisutnosti EV-ta i
ascitesa.

Abstract (english)

Cirrhosis is the end stage of chronic liver disease regardless of the etiology. Disease
progression depends on the remaining liver function and the degree of portal
hypertension (PH). As current diagnostic methods are to invasive for long term follow
up, new noninvasive methods, i.e. ultrasound elastography, are considered for liver
cirrhosis staging and complications.
The aim of the study is to investigate possible relation of liver (LS) and spleen (SS)
stiffness assessed by real time 2 dimensional shear wave elastography (RT-2DSWE)
to clinical stage of liver cirrhosis and the presence of portohypertensive
complications such as oesophageal varices (EV) and ascites.
111 patients with proven liver cirrhosis of different etiologies underwent liver and
spleen elastography (SWEHEP and SWELIEN, respectively) on Aixplorer®
Ultrasound system. The results were compared to Child-Turcotte-Pugh (CTP) stage
of liver cirrhosis and the presence of EV and ascites, proven previously with other
methods. LS and SS correlated to each other in all patients, most significantly in CTP
stage A (r=0,662; P<0,001). Liver and spleen stiffness differed significantly between
patients with compensated and decompensated cirrhosis (p<0,001), with respective
cut-off values of 31 kPa for LS (Area under the ROC curve -AUC 0,857) and 35 kPa
for SS (AUC 0,782). LS and SS differed significantly in patients without and with EV
or ascites (p<0,001 both) with LS and SS cut off values 24 kPa (AUC 0,747) and 31
kPa (AUC 0,797) respectively for EV; and 31 kPa LS (AUC 0,843) and 35 kPa (AUC
0,785), respectively for ascites.
These results suggest that RT-2D-SWE is a valuable method to discriminate between
compensated and decompensated liver cirrhosis. Furthermore, SWE can
discriminate patients with or without EV and/or ascites.

• Keywords: ciroza; komplikacije; portalna hipertenzija; varikoziteti; shear wave elastografija
• Keywords (english): cirrhosis; complications; portal hypertension; varices; shear wave elastography
• Language: croatian
• URN:NBN: urn:nbn:hr:105:866968
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-26 12:01:46