usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494Vidar Ltd.usfd-260Research ArticleУльтразвуковая диагностика заболеваний внутренних органовGeneral UltrasoundИспользование компрессионной эластографии для неинвазивной оценки фиброза печени: результаты многоцентрового исследованияStrain Elastography in Non-Invasive Assessment of Liver Fibrosis: Results of Multicenter ResearchПостноваНадежда АнатольевнаPostnovaN. A.npostnova17@mail.ruБорсуковА. В.BorsukovA. V.noemail@neicon.ruМорозоваТ. Г.MorozovaT. G.noemail@neicon.ruИльясовБ. Б.IliasovB. B.noemail@neicon.ruАндреевБ. В.AndreevB. V.noemail@neicon.ruФГБУ “Государственный научный ценшр Российской Федерации - Федеральный медицинский биофизический центр имени А.И. Бурназяна” ФМБА России; ФКУЗ “Главный клинический госпиталь Министерства внутренних дел Российской Федерации”РоссияBurnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency; Central Clinical Hospital of the Ministry of Internal Affairs of the Russian FederationRussian FederationФГБОУ ВО “Смоленская государственная медицинская академия” Министерства здравоохранения Российской ФедерацииРоссияSmolensk State Medical UniversityRussian FederationГАУ РО “Областной консультативно-диагностический центр”РоссияRegional Consultative Diagnostic CenterRussian Federation201630032024061021Copyright © Постнова Н.А., Борсуков А.В., Морозова Т.Г., Ильясов Б.Б., Андреев Б.В., 20242024Постнова Н.А., Борсуков А.В., Морозова Т.Г., Ильясов Б.Б., Андреев Б.В.Postnova N.A., Borsukov A.V., Morozova T.G., Iliasov B.B., Andreev B.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.vidar.ru/jour/article/view/260

Цель исследования - определение возможности оценки степени фиброза по данным компрессионной эластографии в сравнении с гистологически определенной стадией фиброза печени. Компрессионная эластография выполнена 62 пациентам (19 женщин, 43 мужчины) в возрасте от 21 до 74 лет с различными диффузными заболеваниями печени (хронический гепатит - 41, цирроз печени - 13, стеатогепатит - 7, первичный склерозирующий холангит - 1). Значения эластографического индекса фиброза печени значимо повышались с увеличением выраженности фиброзных изменений по METAVIR: F0-F1 (n = 20) - 2,3 (2,0-2,5) (медиана, 25-75-й процентили); F2 (n = 14) - 2,7 (2,2-3,1); F3 (n = 12) - 3,2 (2,9-3,4); F4 (n = 16) - 4,4 (3,7-5,0). Коэффициент корреляции между стадиями METAVIR и эластографическим индексом фиброза печени составил 0,778 (P < 0,0001). По результатам ROC-анализа для разграничения стадий F0-1 от F2-4 оптимальное пороговое значение эластографического индекса фиброза - 2,606 (площадь под кривой - 0,887). Чувствительность теста “ эластографи-ческий индекс фиброза >2,606 - стадии фиброза по METAVIR F2-4” - 85,7%, специфичность - 90,0%. Для разграничения стадий F0-2 от F3-4 оптимальное пороговое значение эластографического индекса фиброза - 2,863 (площадь под кривой - 0,905). Чувствительность теста “эластографи-ческий индекс фиброза >2,863 - стадии фиброза по METAVIR F3-4” - 92,9%, специфичность - 79,4%. Для разграничения стадий F0-3 от F4 оптимальное пороговое значение эластографического индекса фиброза - 3,594 (площадь под кривой - 0,924). Чувствительность теста “эластографи-ческий индекс фиброза >3,594 - стадия фиброза по METAVIR F4” - 81,3%, специфичность - 91,3%. Использование компрессионной эластографии представляется элементом комплексного ультразвукового исследования печени одновременно с проведением стандартного ультразвукового исследования в В-режиме, позволяя достоверно дифференцировать начальные и выраженные стадии фиброза.

Aim of the study was to assess the value of strain elastography in liver fibrosis staging. 62 patients (19 women and 43 men) aged from 21 up to 74 years old with different liver diseases (chronic hepatitis - 41, liver cirrhosis - 13, steatohepatitis - 7, and primary sclerosing cholangitis - 1) underwent strain elastography (HI VISION Preirus, Hitachi, Japan). Strain elastography data was compared with the liver morphology results. Liver fibrosis index increased significantly according to the METAVIR score: F0-1 (n = 20) - 2.3 (2.0-2.5) (median, 25-75th percentiles); F2 (n = 14) - 2.7 (2.2-3.1); F3 (n = 12) - 3.2 (2.9-3.4); F4 (n = 16) - 4.4 (3.7-5.0). Correlation coefficient between the METAVIR score and liver fibrosis index was 0.778 (P < 0.0001). According to the ROC-analysis cut-off value of liver fibrosis index for differentiation between the F0-1 and F2-4 was 2.606 (AUC - 0.887). Sensitivity of test «liver fibrosis index >2.606 - F2-4» - 85.7%, specificity - 90.0%. Cut-off value of liver fibrosis index 2.863 (AUC - 0.905) was the optimal for differentiation F0-2 from F3-4. Sensitivity of test “liver fibrosis index >2.863 - F3-4” - 92.9%, specificity - 79.4%. Cut-off value of liver fibrosis index 3.594 (AUC - 0.924) was optimal for differentiation F0-3 from F4. Sensitivity of test “liver fibrosis index >3.594 - F4” - 81.3%, specificity - 91.3%. Strain elastography is a part of ultrasound examination of the liver allowing to differentiate initial and advanced stages of fibrosis.

ультразвуковая диагностикаультразвуковая эластографиякомпрессионная эластографиядиффузные заболевания печенифиброз печениultrasound diagnosticsultrasound elastographystrain elastographydiffuse liver diseaseliver fibrosisReferencesBlachier M., Leleu H., Peck-Radosavljevic M. et al. The burden of liver disease in Europe: a review of available epidemiological data // J. Hepatol. 2013. V. 58. No. 3. P. 593-608.Blachier M., Leleu H., Peck-Radosavljevic M. et al. The burden of liver disease in Europe: a review of available epidemiological data // J. Hepatol. 2013. V. 58. No. 3. P. 593-608.Zatonski W.A., Sulkowska U., Manczuk M. et al. Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe // Eur. Addict. Res. 2010. V. 16. No. 4. P. 193-201.Zatonski W.A., Sulkowska U., Manczuk M. et al. Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe // Eur. Addict. Res. 2010. V. 16. No. 4. P. 193-201.Bell B.P., Manos M.M., Zaman A. et al. The epidemiology of newly diagnosed chronic liver disease in gastroenterology practices in the United States: results from population-based surveillance // Am. J. Gastroenterol. 2008. V. 103. No. 11. P. 2727-2736.Bell B.P., Manos M.M., Zaman A. et al. The epidemiology of newly diagnosed chronic liver disease in gastroenterology practices in the United States: results from population-based surveillance // Am. J. Gastroenterol. 2008. V. 103. No. 11. P. 2727-2736.Marcellin P. Hepatitis B and hepatitis C in 2009 // Liver Int. 2009. V. 29. Suppl. 1. P. 1-8.Marcellin P. Hepatitis B and hepatitis C in 2009 // Liver Int. 2009. V. 29. Suppl. 1. P. 1-8.Friedman S.L. Mechanisms of hepatic fibrogenesis // Gastroenterology. 2008. V. 134. No. 6. P. 1655-1669.Friedman S.L. Mechanisms of hepatic fibrogenesis // Gastroenterology. 2008. V. 134. No. 6. P. 1655-1669.Pinzani M., Rombouts K., Colagrande S. Fibrosis in chronic liver diseases: diagnosis and management // J. Hepatol. 2005. V. 42. Suppl. 1. P. S22-S26.Pinzani M., Rombouts K., Colagrande S. Fibrosis in chronic liver diseases: diagnosis and management // J. Hepatol. 2005. V. 42. Suppl. 1. P. S22-S26.Dienstag J.L. The role of liver biopsy in chronic hepatitis C // Hepatology. 2002. V. 36. No. 5. Suppl. 1. P. S152-S160.Dienstag J.L. The role of liver biopsy in chronic hepatitis C // Hepatology. 2002. V. 36. No. 5. Suppl. 1. P. S152-S160.Cadranel J.F., Rufat P., Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF) // Hepatology. 2000. V. 32. No. 3. P. 477-481.Cadranel J.F., Rufat P., Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF) // Hepatology. 2000. V. 32. No. 3. P. 477-481.Bedossa P., Dargere D., Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C // Hepatology. 2003. V. 38. No. 6. P. 1449-1457.Bedossa P., Dargere D., Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C // Hepatology. 2003. V. 38. No. 6. P. 1449-1457.Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group // Hepatology. 1994. V. 20. No. 1. P. 15-20.Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group // Hepatology. 1994. V. 20. No. 1. P. 15-20.Pinzani M. Non-invasive evaluation of hepatic fibrosis: don’t count your chickens before they’re hatched // Gut. 2006. V. 55. No. 3. P. 310-312.Pinzani M. Non-invasive evaluation of hepatic fibrosis: don’t count your chickens before they’re hatched // Gut. 2006. V. 55. No. 3. P. 310-312.Colombo S., Buonocore M., Del Poggio A. et al. Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis // J. Gastroenterol. 2012. V. 47. No. 4. P. 461-469.Colombo S., Buonocore M., Del Poggio A. et al. Head-to-head comparison of transient elastography (TE), real-time tissue elastography (RTE), and acoustic radiation force impulse (ARFI) imaging in the diagnosis of liver fibrosis // J. Gastroenterol. 2012. V. 47. No. 4. P. 461-469.Bamber J., Cosgrove D., Dietrich C.F. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology // Ultraschall Med. 2013. V. 34. No. 2. P. 169-184.Bamber J., Cosgrove D., Dietrich C.F. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology // Ultraschall Med. 2013. V. 34. No. 2. P. 169-184.Cosgrove D., Piscaglia F., Bamber J. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications // Ultraschall Med. 2013. V. 34. No. 3. P. 238-253.Cosgrove D., Piscaglia F., Bamber J. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications // Ultraschall Med. 2013. V. 34. No. 3. P. 238-253.Kudo M., Shiina T., Moriyasu F. et al. JSUM ultrasound elastography practice guidelines: liver // J. Med. Ultrason. 2013. V. 40. No. 4. P. 325-357.Kudo M., Shiina T., Moriyasu F. et al. JSUM ultrasound elastography practice guidelines: liver // J. Med. Ultrason. 2013. V. 40. No. 4. P. 325-357.Sandrin L., Fourquet B., Hasquenoph J.M. et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis // Ultrasound Med. Biol. 2003. V. 29. No. 12. P. 1705-1713.Sandrin L., Fourquet B., Hasquenoph J.M. et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis // Ultrasound Med. Biol. 2003. V. 29. No. 12. P. 1705-1713.Castera L., Forns X., Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography // J. Hepatol. 2008. V. 48. No. 5. P. 835-847.Castera L., Forns X., Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography // J. Hepatol. 2008. V. 48. No. 5. P. 835-847.Friedrich-Rust M., Ong M.F., Мartens S. et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis // Gastroenterology. 2008. V. 134. No. 4. P. 960-974.Friedrich-Rust M., Ong M.F., Мartens S. et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis // Gastroenterology. 2008. V. 134. No. 4. P. 960-974.Fujimoto K., Kato M., Kudo M. et al. Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C // Oncology. 2013. V. 84. Suppl. 1. P. 3-12.Fujimoto K., Kato M., Kudo M. et al. Novel image analysis method using ultrasound elastography for noninvasive evaluation of hepatic fibrosis in patients with chronic hepatitis C // Oncology. 2013. V. 84. Suppl. 1. P. 3-12.Tatsumi C., Kudo M., Ueshima K. et al. Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography // Intervirology. 2008. V. 51. Suppl. 1. P. 27-33.Tatsumi C., Kudo M., Ueshima K. et al. Noninvasive evaluation of hepatic fibrosis using serum fibrotic markers, transient elastography (FibroScan) and real-time tissue elastography // Intervirology. 2008. V. 51. Suppl. 1. P. 27-33.Fujimoto K., Tatsumi C., Ueshima K. et al. Evaluation of liver fibrosis in diffuse liver disease using real-time tissue elastography // Hitachi Realtime Tissue Elastography: Publications and International Communications. Clinical Abstracts. Режим доступа: // http://www.hitachi-medicalsystems.eu/fileadmin/hitachi_en/downloads/hi-rte-publications-and-communications-clinicalabstracts-2013/HI-RTE%20publications%20and%20communications%20clinical%20abstracts%20-%20Applications%20in%20Liver%20Disease%2031-03-13.pdf, свободный. Загл. с экрана. 23.09.2016.Fujimoto K., Tatsumi C., Ueshima K. et al. Evaluation of liver fibrosis in diffuse liver disease using real-time tissue elastography // Hitachi Realtime Tissue Elastography: Publications and International Communications. Clinical Abstracts. Режим доступа: // http://www.hitachi-medicalsystems.eu/fileadmin/hitachi_en/downloads/hi-rte-publications-and-communications-clinicalabstracts-2013/HI-RTE%20publications%20and%20communications%20clinical%20abstracts%20-%20Applications%20in%20Liver%20Disease%2031-03-13.pdf, свободный. Загл. с экрана. 23.09.2016.Gheonea D.I., Saftoiu A., Ciurea T. et al. Real-time sono-elastography in the diagnosis of diffuse liver diseases // World J. Gastroenterol. 2010. V. 16. No. 14. P. 1720-1726.Gheonea D.I., Saftoiu A., Ciurea T. et al. Real-time sono-elastography in the diagnosis of diffuse liver diseases // World J. Gastroenterol. 2010. V. 16. No. 14. P. 1720-1726.Schenk J.P., Alzen G., Klingmuller V. et al. Measurement of real-time tissue elastography in a phantom model and comparison with transient elastography in pediatric patients with liver diseases // Diagn. Interv. Radiol. 2014. V. 20. No. 1. P. 90-99.Schenk J.P., Alzen G., Klingmuller V. et al. Measurement of real-time tissue elastography in a phantom model and comparison with transient elastography in pediatric patients with liver diseases // Diagn. Interv. Radiol. 2014. V. 20. No. 1. P. 90-99.Постнова Н.А., Борсуков А.В., Морозова Т.Г. и др. Компрессионная эластография печени: методика, особенности получения эластограмм, анализ ошибок и артефактов (лекция) // Радиология-практика. 2015. № 2. С. 45-54.Постнова Н.А., Борсуков А.В., Морозова Т.Г. и др. Компрессионная эластография печени: методика, особенности получения эластограмм, анализ ошибок и артефактов (лекция) // Радиология-практика. 2015. № 2. С. 45-54.Wu T., Ren J., Cong S.Z. et al. Accuracy of realtime tissue elastography for the evaluation of hepatic fibrosis in patients with chronic hepatitis B: a prospective multicenter study // Dig. Dis. 2014. V. 32. No. 6. P. 791-799.Wu T., Ren J., Cong S.Z. et al. Accuracy of realtime tissue elastography for the evaluation of hepatic fibrosis in patients with chronic hepatitis B: a prospective multicenter study // Dig. Dis. 2014. V. 32. No. 6. P. 791-799.Paparo F., Cevasco L., Zefiro D. et al. Diagnostic value of real-time elastography in the assessment of hepatic fibrosis in patients with liver iron overload // Eur. J. Radiol. 2013. V. 82. No. 12. P. e755-e769.Paparo F., Cevasco L., Zefiro D. et al. Diagnostic value of real-time elastography in the assessment of hepatic fibrosis in patients with liver iron overload // Eur. J. Radiol. 2013. V. 82. No. 12. P. e755-e769.Yada N., Kudo M., Morikawa H. et al. Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis // Oncology. 2013. V. 84. Suppl. 1. P. 13-20.Yada N., Kudo M., Morikawa H. et al. Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis // Oncology. 2013. V. 84. Suppl. 1. P. 13-20.Kim Y.W., Kwon J.H., Jang J.W. et al. Diagnostic usefulness of real-time elastography for liver fibrosis in chronic viral hepatitis B and C // Gastroenterol. Res. Pract. 2014. P. 210407.Kim Y.W., Kwon J.H., Jang J.W. et al. Diagnostic usefulness of real-time elastography for liver fibrosis in chronic viral hepatitis B and C // Gastroenterol. Res. Pract. 2014. P. 210407.Regev A., Berho M., Jeffers L.J. et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection // Am. J. Gastroenterol. 2002. V. 97. No. 10. P. 2614-2618.Regev A., Berho M., Jeffers L.J. et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection // Am. J. Gastroenterol. 2002. V. 97. No. 10. P. 2614-2618.Rousselet M.C., Michalak S., Dupre F. et al. Sources of variability in histological scoring of chronic viral hepatitis // Hepatology. 2005. V. 41. No. 2. P. 257-264.Rousselet M.C., Michalak S., Dupre F. et al. Sources of variability in histological scoring of chronic viral hepatitis // Hepatology. 2005. V. 41. No. 2. P. 257-264.Болезни печени и желчевыводящих путей: Руководство для врачей / Под ред. В.Т. Ивашкина. Изд. 2-е. М.: Издательский дом “М-Вести”, 2005. С. 205-217.Болезни печени и желчевыводящих путей: Руководство для врачей / Под ред. В.Т. Ивашкина. Изд. 2-е. М.: Издательский дом “М-Вести”, 2005. С. 205-217.Шифф Ю.Р., Соррел М.Ф., Мэддрей У.С. Введение в гепатологию. Болезни печени по Шиффу / Пер. с англ. под ред. В.Т. Ивашкина, А.О. Буеверова, М.В. Маевской. М.: ГЭОТАР-Медиа, 2011. С. 124-125.Шифф Ю.Р., Соррел М.Ф., Мэддрей У.С. Введение в гепатологию. Болезни печени по Шиффу / Пер. с англ. под ред. В.Т. Ивашкина, А.О. Буеверова, М.В. Маевской. М.: ГЭОТАР-Медиа, 2011. С. 124-125.

The authors declare that there are no conflicts of interest present.