利用超音波聲波輻射脈衝評估脾臟硬度與肝硬化患者之相關性

Using Acoustic Radiation Force Impulse to Evaluate Spleen Stiffness and Correlate with Liver Cirrhotic Patient

林純萱(Chun-Hsuan Lin) ； 許敦韋(Tun-Wei Hsu) ； 王信凱(Hsin-Kai Wang)

《北市醫放雜誌》 5卷1期 (2015/12) Pp. 29-36

https://doi.org/10.6663/TPART.2015.5.1.29

摘要

脾臟(spleen)是人體中常被忽略與遺忘的器官，在許多腫瘤學、血液學、感染及代謝中，血液或肝臟疾病的變化，脾臟的檢查可以提供相關的診斷線索。其中肝硬化病人(cirrhotic patients)，因為門靜脈高壓之故造成脾臟鬱血，常影響脾臟功能異常，因此藉由脾臟的檢查結果，可以增加肝臟疾病診斷的敏感度與正確性。超音波聲波輻射脈衝(Acoustic radiation force impulse, ARFI)是一種新的超音波影像技術，超音波的探頭會發出由聲波形成的脈衝壓力波傳入體內，波傳導的速度會隨組織纖維化的程度而增加；而肝硬化病人，因為門靜脈高壓影響脾臟功能異常。所以利用ARFI 量測脾臟硬度時數據相對增高，同時也用ARFI 測量肝臟硬化程度，來推論脾臟異常診斷的正確性是否高於肝臟本身硬化診斷正確性，以及兩者相關性。結果顯示正常受試者與肝硬化患者分別在肝臟與脾臟的AFRI 數值都有組間顯著差異(p＜0.001)。ROC 曲線的結果顯示肝臟與脾臟的硬化數值幾乎對肝硬化的程度有很好的鑑別力(Area Under Curve, AUC: liver stiffness:0.967; spleen stiffness: 0.960)，敏感度(sensitivity)為liver stiffness: 0.920%; spleen stiffness:0.960%，而在專一性(specificity)為liver stiffness: 100.00%; spleen stiffness: 0.846%，最後用來鑑別肝硬化的臨界值(cut-off value)在肝臟的ARFI 數值是1.575 m/s, 脾臟的ARFI 數值是2.600 m/s。在相關性上，肝臟與脾臟的AFRI 數值之間有顯著正相關。從我們的研究顯示，ARFI 是一種易於操作且可以重複測量的診斷工具。肝硬化患者除了在常規超音波影像的定性檢查以外，增加肝臟以及脾臟的ARFI 的定量量測，可以提高診斷的正確性與敏感度。

關鍵字

肝硬化 ； 超音波聲波輻射脈衝 ； 脾臟硬度 ； 敏感度 ； 專一性

並列摘要

The spleen is called ＂silent and forgotten organ＂ in the abdomen, but in many oncology, hematology, infectious and metabolic, blood or liver disease changes, the results of spleen diagnosis also provide clues of related pathologies The cirrhotic patients with portal hypertension because, often affect spleen dysfunction. Therefore, by checking the results of the spleen, liver disease could increase the sensitivity and accuracy of diagnosis. Acoustic radiation force impulse technology (ARFI) ultrasound imaging is a new technology, ultrasound probe emits a pulsed pressure wave formed by sound waves passed in vivo, the degree of wave conduction velocity will vary Fibrosis increase; therefore we can measure in patients with cirrhosis, portal hypertension because spleen dysfunction. Therefore, using ARFI measurement of stiffness will increase the spleen, liver fibrosis are also measured, inferred abnormal spleen clues diagnostic accuracy is higher than the liver itself fibrosis diagnostic accuracy and relevance. The results showed that in normal subjects and patients with cirrhosis were significant differences (p ＜0.001) between the liver and spleen AFRI value. ROC curve results show the value of liver and spleen stiffness almost to the extent of cirrhosis of the liver have a good discrimination (Area Under Curve, AUC: liver stiffness: 0.967; spleen stiffness: 0.960), sensitivity of liver stiffness: 0.920%; spleen stiffness: 0.960%, while the specificity as liver stiffness: 100.00%; spleen stiffness: 0.846%, and finally used to identify the cut-off value to diagnosis liver cirrhosis in the liver is ARFI 1.575 m/s, ARFI value spleen was 2.600 m/s. In correlation, there are significant positive correlation between the liver and the spleen AFRI value. From our research shows that the spleen ARFI is an easy to operate and can be repeated diagnostic tool measurement. In addition to qualitative cirrhotic patients than conventional ultrasound imaging examination, an increase in liver and spleen ARFI quantitative measurements can improve the accuracy and sensitivity of the diagnosis.

並列關鍵字

liver cirrhosis ； acoustic radiation force impulse ； spleen stiffness ； sensitivity and specificity