| Objective:To explore the value of the seperate and combined use of.acoustic pulse radiation force imaging technology(ARFI) and pulsed wave doppler(PW) in the detection of hepatic fibrosis induced by nonalcoholic fatty liver disease(NAFLD) Methods:308 patients diagnosed as non-alcoholic fatty liver(NAFLD) between 2014.8-2015.8 were recruited from a Xiamen hospital, while 30 healthy volunteers with no alcoholic liver disease, viral infection history or any other hepatic diseases were selected for comparison. Hepatic parameters were measured using ARFI and PW for both group, including portal vein diameter and various hemodynamic parameters of both hepatic and splenic blood vessels. Hepatic circulation index(HCI) was calculated and recorded based on the measurement above: HCI = PPV×PHA / SPPI(PPV:Portal vein blood flow Peak Velocity; PHA: Hepatic Artery flow Peak Velocity; SPPI: splenic artery pulsatility index). Liver biopsy was then performed on the same day at the previously examined location. Hepatic tissues were sent to two pathologist for analysis and confirmation of liver fibrosis, using diagnostic standard of chronic hepatitis B(Xi’an, 2000). Statistic analysis of hemodynamic parameters obtained from ARFI and PW were carried out and the pathology results are referred as the gold standard for diagnosis of hepatic fibrosis. Result:(1)ARFI diagnostic results show that with the deepening of liver fibrosis, liver VTQ shear wave velocity value increases. Multiple comparisons showed that the differences between any two staging groups were statistically significant, except S0 and S1. The blood shear wave velocity measured by ARFI is positively related to the pathological stage pf hepatic fibrosis( r = 0.875, P = 0.000).(2) PW diagnostic results show that portal vein diameter in S4 group was signific antly higher than in S0, S1, S2, S3 groups(P <0.05 and that of S1, S2, S3 higher than S0(P <0.05). Portal peak flow in S4 group was significantly lower in S0, S1, S2, S3 g roups(P <0.05), that of S3 Group lower than S0, S1, S2(P <0.05); S0 lower than S1, S2(P <0.05). Hepatic artery peak velocity in S4 group was significantly higher compa ried with S0, S1, S2, S3(P <0.05), that of S3 Group higher than S0, S1, S2(P <0.05). Differences of splenic artery pulsatility index among groups are not statistically signif icant(P> 0.05). The difference of hepatic artery peak velocity and portal vein peak vel ocity ratio(A / P) between any two different staging groups ar statistically significant(P <0.05), excepts for group S1 and S2, group S2 and S3(P> 0.05). HCI decreases wit h the worsening of the hepatic fibrosis.(3)The ROC curve analysis of ARFI technology assessment for fibrosis in NAFLD showed that area under the curve for group S1, S2, S3, S4 were 0.823, 0.868, 0.917 and 0.974 respectively. The ROC curve analysis of PW in evaluating fibrosis in NAFLD showed that the area under cure for group S1, S2, S3, S4 were 0.82, 0.86, 0.917 and 0.974 respectively. The ROC curve analysis of combined use of ARFI and PW in evaluating fibrosis in NAFLD showed that the area under cure for group S1, S2, S3, S4 were 0.829, 0.899, 0.928 and 0.987 respectively.(4) Comparative analysis shows combined use of ARFI and PW improves the diagnostic accuracy. When used seperately, the detection rate with the use of ARFI technology is higher than PW. Conclusion:(1)The median blood shear wave velocity measured by ARFI in NAFLD patients is positively related to the severity of fibrosis, so is portal hemodynamic parameters measured by PW.(2) Parameters obtained from ARFI and rapid PW can reflect the severity of liver fibrosis. The diagnosis accuracy using ARFI technology is higher than that with PW, ARFI technology can direct the quick response of liver lesions.(3) The combined use of ARFI and PW in diagnosing hepatic fibrosis in NFLD is promising and worth further investigation. |
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