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目的:分析应用声辐射力脉冲成像(Acoustic Radiation Force Impulse Imaging,ARFI)技术进行肝病诊断过程中不同探针及不同嵌入深度对其诊断准确性的影响。方法:于2012~2014年,选取经ARFI诊断过的98例丙型肝炎(Hepatitis C Virus,HCV)患者,对两种探针(凸阵探头C4-1 MHz和线阵探头L9-4 MHz)诊断下的相关数据进行前瞻性研究分析,并与瞬时弹性成像(Fibroscan)进行对比。对不同嵌入深度的ARFI弹性成像的变异性进行了系统评估。结果:根据Fibroscan成像结果,33例患者(34%)患有肝硬化,其余患者中27例(27%)患有严重的肝纤维化,38例(39%)未患。C4-1的传播速率平均为1.68±0.59 m/s,L9-4为1.93±0.76 m/s。两种探针检测结果彼此相关显著(P<0.001,r=0.71),且二者均与Fibroscan结果显著相关(P<0.001,r分别为0.79和0.81)。对于肝硬化或严重肝纤维化患者而言,L9-4探针诊断结果高于C4-1探针,差异具有统计学意义(P<0.001)。在诊断肝硬化疾病中,C4-1和L9-4探针的AUROC值分别为0.97和0.91,截断水平分别为1.68和2.01 m/s。C4-1和L9-4嵌入深度分别为3~6 cm和2~3.5 cm。结论:线阵探头和凸阵探头在应用ARFI成像评估肝脏硬度中具有较高的准确性,相较而言,线阵探头诊断结果更高。且ARFI的测量操作不宜靠近肝被膜。
OBJECTIVE: To analyze the effect of different probes and different depth of embedding on diagnosis accuracy of liver disease by using Acoustic Radiation Force Impulse Imaging (ARFI). METHODS: From 2012 to 2014, 98 patients with hepatitis C virus (HCV) who had been diagnosed by ARFI were enrolled. Two types of probe (convex probe C4-1 MHz and linear probe L9-4 MHz) The data from the diagnosis were prospectively analyzed and compared with Fibroscan. The variability of ARFI elastography with different embedding depths was systematically evaluated. Results: According to Fibroscan imaging, 33 patients (34%) had cirrhosis and 27 (27%) had severe hepatic fibrosis in the remaining patients, while 38 (39%) did not. The average propagation velocity of C4-1 was 1.68 ± 0.59 m / s and L9-4 was 1.93 ± 0.76 m / s. The results of the two probes correlated significantly with each other (P <0.001, r = 0.71), and both were significantly correlated with Fibroscan results (P <0.001, r = 0.79 and 0.81, respectively). For patients with cirrhosis or severe liver fibrosis, the diagnostic results of the L9-4 probe were higher than those of the C4-1 probe, the difference was statistically significant (P <0.001). In the diagnosis of cirrhosis, the AUROC values for the C4-1 and L9-4 probes were 0.97 and 0.91, respectively, with cutoffs of 1.68 and 2.01 m / s, respectively. The embedding depths of C4-1 and L9-4 are 3 ~ 6 cm and 2 ~ 3.5 cm, respectively. Conclusion: Both linear and convex array probes have a high accuracy in assessing liver stiffness using ARFI imaging, compared to the higher results of linear array probes. And ARFI measurement should not be close to the liver capsule.