MR弹性成像与超声内镜用于肝硬化食管胃底静脉曲张诊断的比较

摘要/Abstract

摘要： 目的比较磁共振(MR)弹性成像与超声内镜检查对肝硬化食管胃底静脉曲张的诊断价值。方法选取2019年2月至2020年2月于河池市人民医院行肝静脉压力梯度及常规内镜检查并确诊为肝硬化食管胃底静脉曲张的80例患者,同期行肝静脉压力梯度及常规内镜检查后确诊为无食管胃底静脉曲张的肝硬化患者74例。采用MR弹性成像测量肝硬度值(HS)和脾硬度值(SS),采用超声内镜测量总横断面表面积、脾静脉直径、门静脉直径。采用受试者工作特征曲线(ROC曲线)分析MR弹性成像与超声内镜指标对肝硬化食管胃底静脉曲张的诊断价值。结果肝硬化食管胃底静脉曲张组HS为(5.16±0.45)kPa、SS为(8.67±1.08)kPa、总横断面表面积为(0.64±0.14)cm²、脾静脉直径为(15.42±1.79)mm、门静脉直径为(16.71±1.84)mm,高于肝硬化组的(4.42±0.58)kPa、(6.84±1.04)kPa、(0.45±0.10)cm²、(12.81±1.64)mm、(14.62±2.13)mm,差异均有统计学意义(P<0.05)。重度肝硬化食管胃底静脉曲张患者HS、SS、总横断面表面积、脾静脉直径、门静脉直径高于中度和轻度患者(P<0.05),中度肝硬化食管胃底静脉曲张患者HS、SS、总横断面表面积、脾静脉直径、门静脉直径高于轻度患者(P<0.05)。HS、SS、总横断面表面积、脾静脉直径、门静脉直径诊断肝硬化食管胃底静脉曲张的曲线下面积(AUC)分别为0.812、0.839、0.888、0.860、0.954,两两比较显示HS、SS与门静脉直径的AUC差异均有统计学意义(P<0.05),截断值分别为4.963 kPa、7.927 kPa、0.541 cm²、14.602 mm、16.054 mm,特异度分别为83.8%、85.1%、83.8%、89.2%、91.9%,敏感度分别为67.5%、73.8%、81.3%、72.5%、88.8%;联合检测的AUC为0.998,特异度为98.6%,敏感度为98.8%。结论 MR弹性成像与超声内镜检查对肝硬化食管胃底静脉曲张均有一定的诊断价值,超声内镜检查的诊断价值更高。

关键词: 肝硬化, 食管胃底静脉曲张, 磁共振弹性成像, 超声内镜, 诊断

Abstract: Objective To compare the value of magnetic resonance (MR) elastography and endoscopy in the diagnosis of esophageal and gastric varices in liver cirrhotic patients.Methods From February 2019 to February 2020, eighty patients who underwent hepatic venous pressure gradient (HVPG) examination and routine endoscopy and were diagnosed with cirrhosis complicated with esophageal and gastric varices were selected as the EGV group, which were further subdivided into mild, moderate and severe EGV groups according to their severities of the varices. At the same period of time, 74 liver cirrhotic patients without esophageal and gastric varices after HVPG examination and routine endoscopy were selected as the non-EGV group. MR elastography was used to measure liver stiffness (HS) and spleen stiffness (SS). Ultrasound endoscopy was used to measure the total cross-sectional surface area, the diameter of the splenic vein, and the diameter of the portal vein. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of MR elastography and endoscopic ultrasound in the diagnosis of cirrhosis with esophagus and gastric varices.Results The HS [(5.16±0.45) kPa], SS [(8.67±1.08) kPa], total cross-sectional surface area [(0.64±0.14) cm²], splenic vein [(15.42±1.79) mm], and portal vein [(16.71±1.84) mm] in patients of EGV group were higher than those of [(4.42±0.58) kPa, (6.84±1.04) kPa, (0.45±0.10) cm², (12.81±1.64) mm, (14.62±2.13) mm] respectively in the non-EGV group (all P<0.05). The parameters of patients in severe EGV group were higher than those of moderate and mild EGV groups (P<0.05), and the parameters of moderate EGV group were higher than those of mild EGV group (P<0.05). The areas under the curve (AUC) of HS, SS, total cross-sectional surface area, splenic vein, and portal vein for diagnosing cirrhosis complicated with esophagus and gastric varices were 0.812, 0.839, 0.888, 0.860, 0.954, respectively. By pairwise comparison it was shown that the AUCs of HS and SS were statistically significantly different from the AUC of portal vein diameter (P<0.05). The cut-off values were 4.963 kPa, 7.927 kPa, 0.541 cm², 14.602 mm, 16.054 mm, the specificities were 83.8%, 85.1%, 83.8%, 89.2%, 91.9%, and the sensitivities were 67.5%, 73.8%, 81.3%, 72.5%, 88.8%, respectively. The AUC of the combined detection was 0.998, with a specificity of 98.6%, and a sensitivity of 98.8%.Conclusion MR elastography and ultrasound endoscopy have certain diagnostic values for esophageal and gastric varices in cirrhotic patients, and ultrasound endoscopy is of a higher diagnostic value.

Key words: Liver cirrhosis, Esophageal and gastric varices, Magnetic resonance elastography, Ultrasound endoscopy, diagnosis

陈丽芬, 姚朝光, 蓝婧, 黄理, 覃冬林, 欧琴, 吴晓云, 黄霜湘. MR弹性成像与超声内镜用于肝硬化食管胃底静脉曲张诊断的比较[J]. 肝脏, 2022, 27(4): 447-450.

CHEN Li-fen, YAO Chao-guang, LAN Jing, HUANG Li, QIN Dong-lin, OU Qin, WU Xiao-yun, HUANG Shuang-xiang. A comparison between MR elastography and endoscopic ultrasonography for the diagnosis of esophageal and gastric varices in liver cirrhotic patients[J]. Chinese Hepatolgy, 2022, 27(4): 447-450.

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