Assessment of liver fibrosis by quantitative ultrasound elastography in patients with chronic viral hepatitis

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 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