探讨剪切波弹性成像(SWE)结合常规超声对供肝质量评估的临床应用价值。

2014年2月至2017年10月昆明医科大学附属甘美医院实施公民逝世后器官捐献肝移植共121例，供肝获取前所有供者均行常规超声及SWE检查。根据术中快速病理检查结果将供者分为正常组和异常组，异常组包括脂肪肝、肝淤血、肝纤维化和肝坏死。采用成组t检验分别比较异常组、脂肪肝组、肝纤维化组与正常组供肝杨氏模量值。绘制受试者工作特征曲线，以约登指数最高时的杨氏模量值作为区分正常和异常供肝的截断值，计算相应敏感度和特异度。

根据术中快速病理检查结果，121例供者分为正常组73例，异常组48例；异常组包括脂肪肝组21例、肝淤血组18例、肝纤维化组5例和肝坏死组4例。异常组和正常组供肝杨氏模量值分别为(5.55±1.56)kPa和(3.64±0.70)kPa，差异有统计学意义(t＝7.964，P<0.05)。截断值＝4.07 kPa时，约登指数最高＝0.628，SWE诊断供肝病变的敏感度为83.3%，特异度为79.5%。脂肪肝组和肝纤维化组供肝杨氏模量值分别为(5.56±1.43)和(6.67±1.36)kPa，均高于正常组，差异均有统计学意义(t＝5.974和4.933，P均<0.05)。肝淤血组和肝坏死组杨氏模量值分别为2.46～7.11 kPa和5.62～9.11 kPa。

SWE可以定量评估肝组织硬度，对异常和正常肝脏的鉴别具有较高特异度。SWE结合常规超声检查可以对供肝质量进行无创、定量评估，具有较高的临床应用价值。

To investigate the clinical value of shear wave elastography (SWE) combined with conventional ultrasound in the evaluation of donor liver quality.

From February 2014 to October 2017, 121 cases of donation after citizens′ death for liver transplantation were performed in Calmette Hospital Affiliated to Kunming Medical University, and all the donors were performed with ultrasound and SWE before the graft harvest. The donors were divided into normal group and abnormal group according to the intraoperative rapid pathological results. The abnormal group included fatty liver, liver fibrosis, liver congestion and liver necrosis. The group t test was used to compare the Young′s modulus between abnormal group, fatty liver group, liver fibrosis group and normal group. The area under the ROC curve was calculated. The Young′s modulus at the highest Youden index was used as the cut-off value to distinguish between normal and abnormal donor livers, and the corresponding sensitivity and specificity were calculated.

There were 73 cases in normal group and 48 cases in abnormal group (21 cases of fatty liver, 18 cases of liver congestion, 5 cases of liver fibrosis, and 4 cases of liver necrosis) according to the results of intraoperative rapid pathological examination. The Young′s modulus of donor livers in abnormal group and normal group were (5.55±1.56) kPa and (3.64±0.70) kPa, respectively, with significant difference (t=7.964, P<0.05). When the cut-off value was 4.07 kPa, the Youden index was 0.628, which was the highest, and the sensitivity and specificity of SWE in the diagnosis of donor liver lesions were 83.3% and 79.5%, respectively. The Young′s modulus of fatty liver group and liver fibrosis group were (5.56±1.43) and (6.67±1.36) kPa, both of them were higher than that of normal group (t=5.974 and 4.933, P all<0.05). The range of Young′s modulus was (2.46-7.11) kPa and (5.62-9.11) kPa in liver congestion group and liver necrosis group, respectively.

SWE can quantitatively evaluate the hardness of liver tissue, and has a high specificity in the differentiation of abnormal and normal donor livers. SWE combined with conventional ultrasound can evaluate the quality of donor liver noninvasively and quantitatively, which has high clinical application value.