BACKGROUND:Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems. OBJECTIVE:This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB. METHODS:A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were calculated. RESULTS:The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P = 0.0001, P < 0.0001, P = 0.0139, and P = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.1232 and P = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P = 0.002 and P = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.233 and P = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P = 0.003; F1 and F4, P = 0.007; F2 and F3, P = 0.013; F2 and F4, P = 0.015). CONCLUSION:2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis.

中文翻译：

---

与组织病理学相当的二维剪切波弹性成像测量的肝硬度主要落在严重的肝纤维化上

背景：二维剪切波弹性成像（2D-SWE）多年来一直用于慢性乙型肝炎（CHB）患者的肝脏评估，但其在不同人群和不同超声系统中的有效性仍不清楚。目的：本研究调查了 2D-SWE 在评估 CHB 患者肝纤维化中的有效性。方法：经机构伦理委员会批准后进行前瞻性调查，纳入133例CHB患者中的116例进行肝活检，并选择50例肝脏健康的患者作为对照。将肝脏硬度测量 (LSM) 的 2D-SWE 评估与组织病理学结果进行比较。设定 LSM 的截止值以确定纤维化程度、受试者工作特征曲线下面积 (AUROC)、灵敏度、并计算特异性。结果：区分健康肝脏与 CHB 肝脏和任何肝纤维化的最佳 LSM 截止值为 6.485 kPa，AUROC 为 0.927，敏感性为 94%，特异性为 19.8%。F1、F2、F3 和 F4 的最佳 LSM 截止值分别为 6.19 kPa、6.485 kPa、7.46 kPa 和 9.62 kPa，相应的 AUROC 分别为 0.516、0.625、0.779 和 0.881。F1 和 F3、F1 和 F4、F2 和 F3、F2 和 F4 之间的 AUROC 比较均存在显着差异（分别为 P = 0.0001、P < 0.0001、P = 0.0139 和 P = 0.0003）；F1 和 F2 之间以及 F3 和 F4 之间的 AUROC 比较没有显着差异（分别为 P = 0.1232 和 P = 0.2462）。健康肝脏与 F0 之间以及健康肝脏与 F0 和 F1 组合之间的 LSM 比较存在显着差异（分别为 P = 0.002 和 P = 0.001）。F1 和 F2 之间以及 F3 和 F4 之间的 LSM 比较没有显着差异（分别为 P = 0.233 和 P = 0.072）。纤维化评分组之间的其他比较存在显着差异（F1 和 F3，P = 0.003；F1 和 F4，P = 0.007；F2 和 F3，P = 0.013；F2 和 F4，P = 0.015）。结论：2D-SWE 使用特定的诊断超声系统对严重肝纤维化和肝硬化的评估是有效的，但在诊断轻度肝纤维化方面有限。纤维化评分组之间的其他比较存在显着差异（F1 和 F3，P = 0.003；F1 和 F4，P = 0.007；F2 和 F3，P = 0.013；F2 和 F4，P = 0.015）。结论：2D-SWE 使用特定的诊断超声系统对严重肝纤维化和肝硬化的评估是有效的，但在诊断轻度肝纤维化方面有限。纤维化评分组之间的其他比较存在显着差异（F1 和 F3，P = 0.003；F1 和 F4，P = 0.007；F2 和 F3，P = 0.013；F2 和 F4，P = 0.015）。结论：2D-SWE 使用特定的诊断超声系统对严重肝纤维化和肝硬化的评估是有效的，但在诊断轻度肝纤维化方面有限。