The Value Of Virtual Touch Tissue Quantification Technique In Predicting Risk Of Esophageal Varices In Patients With Hepatic Cirrhosis

BackgroundEsophageal varices(EV)is one of the important complications caused by portal hypertension in patients with hepatic cirrhosis.EV is the most common gastrointestinal varicose veins in clinic.Patients are often diagnosed EV by acute gastrointestinal varicosity burst bleeding in clinic.Endoscopy is still the gold standard in the diagnosis of gastrointestinal varicose veins or the bleeding currently.“Prevention and management of gastroesophageal varices and variceal hemorrhage in hepatic cirrhosis” of American gastroenterol and hepatology in 2007 and “Tentative scheme of endoscopic diagnosis and treatment of gastrointestinal varicose veins and gastrointestinal hemorrhage” of the Chinese medical association digestive endoscopy learning branch are put forward: for all patients who are diagnosed of hepatic cirrhosis need for gastrointestinal endoscopy as soon as possible,for screening and confirmation if the patients need preventive treatment.However,the patients with high risk esophageal varices account for only 15-25%,most of the patients did not be with varicose veins or only mild varicose veins which need not preventive treatment.Therefore,application of non-invasive methods which can be applied to early diagnosis and evaluation of EV and its degree in patients with hepatic cirrhosis can make the most of the patients effectively avoid unnecessary invasive upper gastrointestinal endoscopy,especially in low risk esophageal varices of patients with hepatic cirrhosis.This researching field is a hot spot no mater inland or abroad.Acoustic Radiation Force Impulse(ARFI)technology is a noninvasive ultrasound elasticity imaging technology which can evaluate organizations hardness,with the function of virtual touch tissue quantification(VTQ)to measure the shear wave velocity(SWV)which is produced by the sound through the viscera essence,andquantitative evaluation the degree of tissue fibrosis.In recent years,VTQ technology as noninvasive ultrasound elasticity imaging methods of assessing liver fibrosis get the attention of inland and abroad.“Portal Hypertensive Bleeding in Cirrhosis: Risk Stratification,Diagnosis,and Management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases”has put the liver stiffness(LS)as one of noninvasive and important indicators in monitoring of the clinically significant portal hypertension(CSPH).On the other hand,scholars both inland and abroad use the LS,spleen stiffness(SS)and spleen length and other parameters research the prediction and evaluation the diagnostic value of EV and esophageal variceal bleeding(EVB)of VTQ technology,with certain forward-looking,but sensitivity and specificity are dis-satisfactory.Combined application of two-dimensional ultrasound and VTQ technology to evaluate the risk assessment of EV in liver cirrhosis have not yet seen inland and abroad.AimThis study applies the two-dimensional ultrasound and VTQ technique testing shear wave velocity of liver and shear wave velocity of spleen,hepatic portal vein diameter and blood flow velocity,spleen vein diameter and blood flow velocity in patients with hepatic sclerosis.Analysis the risk factors that affect the presence of esophageal varices.Discusses the diagnosis efficiency and clinical value of application of two kinds of ultrasonic technology in the risk of EV in hepatic cirrhosis.Using ROC curve provides the cut-off values for clinical diagnosis of EV in liver cirrhosis.MethodsThis research according to the diagnostic criteria of chronic hepatitis B prevention guide(2015 edition)selected 154 cases of patients,95 cases of male,female 59 cases,aged 29-80 years,the average age of 55±10 years old.All patients are undertaken endoscope and grouped according to their results: 52 cases with no EV are grouped in no varices group(NEV,n=52)other 102 cases with EV are grouped in varices group(EV,n=102).Record gender,age,height and weight of each patient and calculate the BMI.All patients who are strictly more than 8 hours on empty stomachs are taken venous blood for detecting liver function.Using Siemens Acuson S2000 type ultrasonic diagnostic instrument(equipped with VTQ software)check the patients.All checked inspection strictly keep empty stomachs more than 8 hours,lying on the back to check on the bed,fully exposed belly.At first,the conventional ultrasound examination is performed in every patients been checked to observe the outline and essential echo of liver and spleen,measurement of the right liver oblique,diameter and thick diameter of spleen,hepatic portal vein diameter and blood flow velocity,spleen vein diameter and blood flow velocity.Using ARFI with the function of VTQ technique measure the value of SWV of liver and spleen in patients with hepatic sclerosis.The SPSS22.0 statistical software analyzed by independent sample t-text and X2text;Using Logistic regression analysis to screen independent risk factors influencing the EV.Drawing ROC and provide the best cut-off value.Using De Long of Med Calc medical statistics software march AUC between the comparison.Result1,The parameters of EV and NEV group comparison.(1)The comparison of clinical datas and liver function classificationChild-Pugh grades of liver function of patients in group of EV were obviously higher than those in group of NEV,with statistical difference(P < 0.05);In two groups,the age,gender and BMI have obvious statistical difference(P > 0.05).(2)The comparison of parameters of two-dimensional ultrasound and spectrum doppler ultrasound.The inner diameter of hepatic portal vein and splenic vein in group of EV were bigger than those in NEV group,with statistical difference(P < 0.05);The blood flow velocity of hepatic portal vein and splenic vein in group of EV were lower than that in group of NEV,with statistical difference(P < 0.05).(3)The comparison of SWV value.The SWV value of liver and spleen in group of EV was obviously higher than that in NEV group,with statistical difference(P < 0.05).2,Logistic regression analysis screening independent influence risk factors of EV.The results of logistic regression analysis showed that hepatic portal veindiameter,the value of SWV of liver and spleen are the independent risk factors in predicted EV,and values of OR were 2.396,1.007 and 2.396,respectively(P < 0.05).3,The diagnostic performance and its clinical value of combined application of two-dimensional ultrasound and VTQ technology in noninvasive assessment risk of EV in hepatic cirrhosis.Drawing ROC curves of hepatic portal vein diameter,liver and spleen SWV which were independent influence risk factors of EV in liver cirrhosis,the area under the curves(AUC)were 0.88(95% CI: 0.824 0.936),0.911(95% CI: 0.866 0.957)and0.866(95% CI: 0.863 0.953);Using Youden index maximum tangent point for point to determine the best cut-off values,respectively were 14.05 mm,2.013 m/s and 2.937m/s;Sensitivity were respectively 73.6%,82.4% and 79.6%.Specificity were87.1%,90.3% and 87.6% respectively.The positive predictive value were 75%,80.8%and 75% respectively and negative predictive value were 86.3%,91.2% and 90.2%respectively.The accuracy rate were 82.5%,87.7% and 85.1% respectively.Conclusion1,The grade of liver function,diameters and blood flow velocity of hepatic portal vein and spleen vein and SWV values of liver and spleen play supporting roles in judging whether EV happened.2,Diameter of hepatic portal vein,SWV values of liver and spleen were independent risk factors of EV.3,The ROC curves analysis showed that diameter of hepatic portal vein,SWV values of liver and spleen have good diagnostic performance in assessing the risk of EV.Liver SWV value has a unique advantage.Hint of two-dimensional ultrasound and VTQ technology combined application were expected to become noninvasive,simple,dynamic,objective indicators in evaluating risk of EV in liver cirrhosis.