| Background and ObjectiveJaundice is a kind of common symptom which is caused by many diseases, according to the causes, jaundice generally is divided into hemolytic jaundice, hepatic jaundice,obstructive jaundice，et al; Obstructive jaundice is caused by the blockage of extrahepaticor intrahepatic bile ducts. There are many reasons for liver and biliary duct blockage, andaccording to the pathology character, obstructive jaundice can be roughly divided intobegnign and malignant etiological factor. The benign obstructive etiological factor includesstone, inflammation, bile duct stenosis, and malignant obstructive factor include pancreatichead carcinoma, ampulla carcinoma, hilar cholangiocarcinoma, etc. The clinical diagnosisof obstructive jaundice mainly relies on blood biochemical indexes and imaging examinat-ion, and the bilirubin level and various enzymes changing of blood biochemical indexescan reflect the degree of liver damage, so there are important reference significance topatients, treatment and prognosis; Imaging examinations include ultrasonography,computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP),pancreatic and endoscopic retrograde cholangiopancreatography (ERCP) and othermethods, these methods can observe the bile duct expansion and the obstructive location.In these imaging examination methods, ultrasonography possesses the simple, safe, lowcost, no pain and repeatable characteristics, and it is often selected the first examinationmethod for the obstructive jaundice; But ultrasonography is difficult to distinguish thedegree of liver damage caused by obstructive jaundice except the liver cirrhosis with thelong-term jaundice. In order to make a comprehensive diagnosis of the obstructivejaundice disease, clinicians must be combined the blood biochemical examination with theultrasound examination. In recent years, with the rapid development of new ultrasoundtechnology, another new ultrasonic technology: ultrasonic elastography, which was putforward by Ophir, etc since1991, has been get widely attention and rapidly development.As a kind of new imaging mode, ultrasonic elasticity imaging is different from previousultrasonic technology principle, it is based on the physical properties that biological tissuehas elastic and hardness, and detecting the organizational hardness difference is the mainaim of the technology. The elasticity image comes from the elastic propertie’s differencebetween the lesion and surrounding normal tissues, the information acquisition ofultrasonic elastography is an important complement to the traditional ultrasound, and it also has broken the limitations of conventional ultrasound. Real-time tissue elastography(RTE) is one of ultrasonic elasticity imaging technology, in2003Japanese Hitachicompany first realized the ultrasonic elasticity information visualization technology in theworld, which can change the echo signal into real-time color image, and the echo signalcomes from the moving before and after organization compression. Since then, elasticityscore which accords to the color distribution of the tissue elastic image and strain radiowhich comes from the relative rate of lesion with the surrounding tissue become prevalentin the various organs clinical research. But elasticity score mainly relies on the experienceof researchers, so it has the defect of subjectivity, and the strain radio is a semi-quantitivemethod that only reflect the relative stiffness of the lesion. In order to further improve theRTE diagnostic performance and make the results more objective, Japan Hitachi companydeveloped a new technology software which has the strain histogram measurementfunction and was on the basis of the latest research, it can show histogram display and canbe used to extract total11kinds of measurement characteristics and can quantitativelyanalysis the elastic image, thus it provides a new ultrasound technology which can evaluatethe tissue diffuse lesions objectively and quantitatively. When the strain histogrammeasurement function applied in the field of liver disease, with hepatitis fibrosis intensifiestissue elastography present a hardness dispersion progress trend. Through the verification,there is a correlation between the liver fibrosis index and the pathological diagnosis of liverfibrosis classification, the liver fibrosis index is from the characteristics of multipleregression analysis calculations, besides, the strain characteristics also has relation to theliver fibrosis, so we can see that the strain histogram measurement function is effective toliver fibrosis classification. When the bile duct is hindered by the stones, inflammation ortumor, there must appear obstructive jaundice, then obstructive jaundice will damage livercompensatory function and cause liver diffuse lesion. So far, liver hardness changecaused by obstructive jaundice has been less researched by RTE, if RTE can quantitativelyreflect the liver texture and function, it combines the two advantages of blood biochemicalexamination and the traditional ultrasound examination, that would not only widen thescope of ultrasound clinical application but also reduce the multiple examination cost ofthe patients, all of these would make the patients feel convenient and help the cliniciansintegrally judgment of the disease. This research will take real-time elastography strainhistogram measurement function to obstructive jaundice patients, preliminary discussionthe quantitative diagnostic value on obstructive jaundice by strain histogram measurement function, and the research compared the strain characteristics changes before and afterultrasound-guided percutaneous transhepatic cholangiographic drainage (PTCD) toobstructive jaundice patients before surgery, preliminary discussion liver elasticity changebefore and after PTCD.Method1. the preliminary quantitative application value of RTE in obstructive jaundice:This study was carried out in the eastern hepatobiliary surgery hospital in the periodfrom March to August2012. The study included86obstructive jaundice patients withouthepatitis or schistosomiasis history or other liver diffuse disease. According to the totalbilirubin, the obstructive jaundice patients are divided into mild, moderate, and severejaundice group; The study included another35patients without clinical jaundice andhepatitis or schistosomiasis history or other liver Diffuse disease as control group. Allpatients underwent RTE imaging, the quantitative results of RTE were compared withserum total bilirubin.2. The preliminary quantitative application value of RTE in preoperative obstructivejaundice patients before and after PTCD:This study was carried out in the period from March to December2012, and included54patients with treatment of PTCD, and these patients all prepared for surgery after PTCD.All patients underwent RET imaging, the quantitative results of RTE before and afterPTCD were compared.Result1. the preliminary quantitative application value of RTE in obstructive jaundice:Mann-Whitney U test was used to analyze the parameters of with or without clinicaljaundice, including mean and the blue area percentage. There was statistically significantdifference on mean and the blue area percentage between the groups with or withoutclinical jaundice, the mean average rank was85.19,51.16, Z=-4.839, P <0.001; The bluearea percentage average rank time was37.97,70.37, Z=4.608, P<0.001.Kruskal-Wallis test analysis was used to analyze the parameters of without clinicaljaundice, mild, moderate, and severe jaundice group. There were statistically significantdifference on mean and the blue area percentage among these groups, the average rank was85.19,60.34,43.87,34.83, chi-square value is29.785, P<0.001; The blue area percentage average rank was37.97,60.93,77.43,88.83, chi-square value is28.214, P <0.001. Thenfurther comparison among the four groups, there were statistically difference on mean andthe blue area percentage on each two groups except the moderate and severe jaundicegroup.Spearman correlation analysis are used to analyze the parameters of different degreeof objective jaundice, including mean and the blue area percentage. The correlationcoefficient between mean and jaundice degree was r=-0.5, P<0.001, there existed asignificant negative correlation, the higher of jaundice degree, the lower of the mean. Thecorrelation coefficient between the blue area percentage and jaundice degree was r=0.5, P<0.001, There is a significant positive correlation between them.2. The preliminary quantitative application value of RTE in preoperative obstructivejaundice patients before and after PTCD:Independent sample t-test and matching sample t-test were used to analyze theparameters of before and after PTCD, and the measurement data was recorded bymean±SD, the statistically significant difference is P <0.05. There were statisticallysignificant difference on the total bilirubin(TB), alanine aminotransferase(ALT), asparicaminotransferase (AST) of54preoperative obstructive jaundice patients before PTCD andafter a week successfully bile drainage. The average TB, ALT, AST before PTCD were(302.80±117.88)umol/L,(145.82±123.18)U/L,(120.74±94.09)U/L; After one week biledrainage, the average TB, ALT, AST were (196.99±93.81）umol/L,(75.48±51.06)U/L,(58.09±34.09)U/L, matching t value were9.31,5.41,5.32, and there were statisticallysignificant difference on mean and the blue area percentage between before PTCD andafter bile drainage a week. Before PTCD, the average mean and average blue areapercentage were (110.02±7.34）,(21.78±6.60); After one week bile drainage, the averagemean and blue area percentage is(113.56±6.65),(17.80±6.01), P value all lower then0.001.The research showed that the mean increases and the blue area percentage decreases afterone week bile drainage.Conclusion1. The preliminary quantitative research of real-time ultrasound elastography onobstructive jaundice has expanded the application extent of strain histogram measurementfunction. Traditional ultrasonography only can check the objective lesion location but cannot assess the liver function and the effect of cholestasis to the liver texture, the research showed that RTE can quantitatively reflect the liver elastic change with jaundice degreeincreasing. So, it is possible that traditional ultrasonography combining with RTE not onlyclearly reflect obstruction position but also can access the jaundice degree of obstructivejaundice.2. The preliminary quantitative research of real-time ultrasound elastographyconfirmed that RTE can quantitatively reflect the bile drainage effect before and afterPTCD treatment, together with liver function, RTE has positive meaning to the treatmentand the disease prognosis, it is worth further study. |
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