铁负荷患者肝纤维化的无创评估。

IF 2.4 3区医学 Q2 ACOUSTICS

Ultrasound in Medicine and Biology Pub Date : 2024-12-16 DOI:10.1016/j.ultrasmedbio.2024.11.017

Siddhi Hegde , Theodore T. Pierce , Firouzeh Heidari , Arinc Ozturk , Eugene Cheah , Kathleen Pope , Maria A. Blake , Angela Shih , Joseph Misdraji , Anthony E. Samir

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引用次数: 0

摘要

目的：评估超声二维剪切波弹性成像（US 2D-SWE）在血清学铁超载（SIO）患者和组织学肝铁超载（LIO）亚组中预测临床显著纤维化（CSF）的诊断性能。方法：对SIO（女性血清铁蛋白≥200ng /mL，男性血清铁蛋白≥300ng /mL）成人进行单中心回顾性横断面研究，怀疑慢性肝病，1年内非局灶性肝活检结果和US 2D-SWE检查。组织病理学纤维化分期≥2，肝铁≥2+分别为CSF和LIO。采用单因素logistic回归评估杨氏模量（YM）和血清铁蛋白对脑脊液的预测。敏感度和特异度均为由约登指数确定的最佳YM阈值。结果：共纳入272例，其中女性211例（77.6%），脑脊液88例（32.4%），平均（±标准差）年龄50.0（13.6）岁。中位YM预测SIO患者脑脊液（AUC 0.73, 95%可信区间（CI） 0.66 -0.80，优势比（OR） 1.12）， p < 0.001。最佳YM阈值为11 kPa（敏感性58%，特异性79%）。47例LIO患者（女性39例，平均年龄52.5±11.6岁，17例（36.2%）脑脊液）的亚组分析显示，中位YM预测脑脊液（AUC 0.85, 95% CI 0.73-0.97, OR 1.39）， p < 0.001。最佳YM阈值为11 kPa（敏感性77%，特异性87%）。结论：2D-SWE是一种很有前途的、广泛可用的、无创的诊断铁超载肝纤维化的工具，包括当磁共振弹性成像可能由于铁相关的假影而无法诊断时。

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Noninvasive Assessment of Liver Fibrosis in Patients With Iron Overload

Objective

We assessed the diagnostic performance of ultrasound two-dimensional shear wave elastography (US 2D-SWE) to predict clinically significant fibrosis (CSF) in patients with serologic iron overload (SIO) and the subgroup with histologic liver iron overload (LIO).

Methods

A single-center retrospective cross-sectional study of adults with SIO (serum ferritin ≥ 200 ng/mL in females and ≥ 300 ng/mL in males) and suspected chronic liver disease with nonfocal liver biopsy results and US 2D-SWE exams within 1 year was performed. Histopathological fibrosis stage ≥2 and liver iron ≥2+ was considered CSF and LIO, respectively. Univariate logistic regression to assess prediction of CSF by Young's modulus (YM) and serum ferritin was performed. Sensitivity and specificity were reported at optimal YM threshold determined by the Youden Index.

Results

272 cases were included (211 (77.6%) females, 88 (32.4%) CSF cases) with mean (± standard deviation) age of 50.0 (13.6) years. Median YM predicted CSF in patients with SIO (AUC 0.73, 95% confidence intervals (CI) 0.66 −0.80, odds ratio (OR) 1.12), p < 0.001. Optimal YM threshold was 11 kPa (sensitivity 58%, specificity 79%). Subgroup analysis of 47 LIO cases (39 women, mean age 52.5 ± 11.6 years, 17 (36.2%) CSF) showed that median YM predicted CSF (AUC 0.85, 95% CI 0.73–0.97, OR 1.39), p < 0.001. Optimal YM threshold was 11 kPa (sensitivity 77%, specificity 87%).

Conclusion

2D-SWE is a promising, widely available, and noninvasive tool for diagnosing liver fibrosis in iron overload, including when magnetic resonance elastography may be nondiagnostic due to iron-related artifact.

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来源期刊

Ultrasound in Medicine and Biology 医学-核医学

CiteScore

6.20

自引率

6.90%

发文量

325

审稿时长

70 days

期刊介绍： Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological systems, including bioeffects. Papers that simply utilize standard diagnostic ultrasound as a measuring tool will be considered out of scope. Extended critical reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, book reviews, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community.